ACLS FOR STROKE
Stroke is a medical emergency that occurs when blood flow to the brain is interrupted, either by a blockage (ischemic stroke) or by bleeding (hemorrhagic stroke). Rapid recognition and treatment are crucial to minimize brain damage and improve patient outcomes. ACLS providers play a vital role in the initial assessment and stabilization of stroke patients.
RECOGNIZING STROKE (FAST)
The acronym FAST is a helpful tool for recognizing the signs and symptoms of stroke:
- Face: Ask the person to smile. Does one side of the face droop?
- Arms: Ask the person to raise both arms. Does one arm drift downward?
- Speech: Ask the person to repeat a simple sentence. Is their speech slurred or strange?
- Time: If you observe any of these signs, time is of the essence. Call 911 or your local emergency number immediately.
INITIAL ASSESSMENT AND STABILIZATION
ACLS providers should focus on the following during the initial assessment and stabilization of a suspected stroke patient:
- Airway, Breathing, and Circulation (ABCs): Ensure a patent airway, adequate breathing, and stable circulation. Provide supplemental oxygen if needed.
- Rapid Neurological Assessment: Perform a rapid neurological assessment using tools such as the National Institutes of Health Stroke Scale (NIHSS).
- Establish Time of Onset: Determine the exact time when the stroke symptoms began. This is crucial for determining eligibility for thrombolytic therapy (clot-busting medication).
- Activate the Stroke Team: Immediately notify the hospital’s stroke team.
- Obtain IV Access: Establish IV access for administration of medications and fluids.
- Monitor Vital Signs: Continuously monitor vital signs, including blood pressure, heart rate, and oxygen saturation.
KEY CONSIDERATIONS IN ISCHEMIC STROKE
- Thrombolytic Therapy: If the patient is eligible and presents within the appropriate time window (typically within 3-4.5 hours of symptom onset, but can be extended in certain cases), thrombolytic therapy (e.g., alteplase) may be administered to dissolve the blood clot causing the stroke.
- Blood Pressure Management: Careful blood pressure management is essential. Extremely high blood pressure may need to be lowered cautiously, while very low blood pressure should be treated to maintain cerebral perfusion.
KEY CONSIDERATIONS IN HEMORRHAGIC STROKE
- Blood Pressure Control: Strict blood pressure control is crucial to prevent further bleeding.
- Reversal of Anticoagulation: If the patient is taking anticoagulants (blood thinners), reversal agents may be administered.
TRANSPORT TO A STROKE CENTER
Rapid transport to a designated stroke center is essential for definitive stroke care.
This lesson provided an overview of ACLS interventions for stroke. Rapid recognition and appropriate management are crucial for improving patient outcomes.