Are You At Risk For A Stroke
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Transcript of Are You At Risk For A Stroke
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Are You at Risk For a Stroke?
Brian Huettl, MDDepartment of Emergency Medicine
Saint Francis Hospital
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Agenda• Stroke
– Definition and statistics• Evidence-based medical literature
– Prevention• Risk factors
– Early identification, diagnosis, treatment– Organized care
• What can you do?
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Stroke: StatisticsFact: Stroke is our nation’s #3 killer and a leading cause of disability
• 780,000 Americans have a stroke each year– 600,000 are first time strokes
• One stroke occurs every 40 seconds on average
• Every 3-4 minutes, someone dies of stroke– Of those who survive, 90% have a functional
deficit• Stroke kills 2 million brain cells per minute• Stroke costs approximately $60 billion/year in the U.S.
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Stroke: StatisticsFact: Some people have a higher risk of stroke.
• About 60,000 more women than men suffer a stroke each year
• African-Americans have almost twice the risk of a first ever stroke compared to Caucasians
• People with high blood pressure (140/90+) have about twice the risk of stroke as people with blood pressure under 120/80
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Stoke: Definition• Ischemic stroke• Hemorrhagic stroke• Transient Ischemic Attack (TIA)
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Ischemic Stroke• Approximately 83% of
strokes are caused by ischemia– Large vessel (Atherosclerotic) = 30%
– Small vessel (Lacunar) = 25%– Embolic = 30%
• Results from blockage within the blood vessels that supply blood to the brain
*Reference: American Heart/Stroke Association 2008
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Hemorrhagic Stroke• Approximately 17% of
strokes are from hemorrhage– Intracerebral
hemorrhage – Subarachnoid
hemorrhage • Results from a weak
brain vessel that ruptures
*Reference: American Heart/Stroke Association 2008
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TIA• aka, “mini stroke”• Blood clot temporarily blocks the blood
vessel• Stroke prevention factors
– Medical treatment– Surgical evaluation
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Evidence-Based Medical Literature
• Prevention• Early detection• Early diagnosis and treatment• Organized care
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Prevention: Controllable Risk Factors
• High blood pressure
• Cigarette smoking
• Diabetes mellitus
• Carotid or other artery disease
• Atrial fibrillation• Other heart
disease• Obstructive
sleep apnea
• Sickle cell disease
• High cholesterol• Poor diet• Decreased
physical activity• Obesity• Alcohol/drug
abuse
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Prevention: Uncontrollable Risk Factors
• Age• Family history• Race• Gender• Prior stroke, TIA, heart attack
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Secondary Prevention• Blood pressure management• Aspirin• Plavix• Coumadin• Statin• Smoking cessation• Eliminating alcohol intake• Weight reduction/modified diet• Exercise
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Early Identification• Fact: Stroke is
highly treatable within the first three hours
• Time is brain!
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Stroke Signs/Symptoms• When a part of the brain begins to die,
there are signs and symptoms that this is happening– 2 million brain cells die each minute
• Remember as much as possible about a person’s responses– Actions or lack of actions– What time did the signs begin?
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Stroke signs/symptoms
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Stroke Signs/Symptoms
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Stroke signs/symptoms
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Is their BALANCE off?Things to look for or ask:• Can they stand and sit straight and tall?• Do they slump of lean to the right or left?• Can they walk in a straight line or do they
veer to the left or the right?• Do they drag a right or left leg or foot?• Do they let a right or left arm hang when
they walk?
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Is their SPEECH SLURRED or FACE DROOPY?
Things to look for or ask:• Does one side of the mouth droop when
they smile?• Do both eyes close when they blink?• Can they stick their tongue out straight?• Can they say “______________”?• Do they sound like they have something in
their mouth when they speak?• Do their words make sense?
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Is one side WEAK or NUMB?Things to look for or ask:• Ask the person to raise both their arms up
together in front of them. Does one arm begin to fall down?
• Ask the person to squeeze your fingers with each hand. Is one hand weaker than the other?
• Ask the person to try to hold something like a pen, cup, spoon or fork. Can they do it without any difficulty?
• Can the person feel you lightly touch them on both arms? Ask them if the feeling is the same on each.
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Is their VISION all or partly lost?
Things to look for or ask:• Ask the person whether they can see. Do
you look clear to them? Do you look blurred? Do they see more than one of you?
• Ask the person whether they normally wear glasses or contact lenses.
• Ask the person to describe any changes in vision.
• When they look straight ahead, can they see a little to both sides and up and down?
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Is their HEADACHE severe?Things to look for or ask:• Do they have any pain anywhere?• Do they have a headache? On a scale of 1-10,
10 being the worst, ask them to rate their headache.
• Do they normally have headaches? Is this headache any different from their usual headache?
• Does this feel like the worst headache of their life?
• Does light bother or hurt their eyes?• Does a sound or loud noise make the headache
worse?• Is their pain different when they stand, sit or lie
down?
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Immediate Actions to Take• Remember what is happening or write it
down if it does not slow down in getting emergency help
• Time is brain!• Options:
– Call 911– Get to an Emergency Department
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Stroke Treatment: Thrombolytics
Alteplase (tPA)=
Clot buster
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tPA Benefits• Independent life vs. dependent
– Excellent recovery = 31% vs. 20%– Death = 9% vs. 20%
• For every 100 patients treated with tPA:– 32 benefited– 3 were harmed
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Organized Care• Consistent, efficient use of proven medical
treatment in an organized manner• Care protocols• Outcome measures
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Primary Stroke Centers: Proven Outcomes
• Rapid evaluation and treatment– ie: thrombolytics
• Urgent referral for more advanced clot treatment
• Specialty units in the hospital with experienced staff
• Initial and ongoing reviews of care– Certifying agency such as Joint Commission
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Primary Stroke Centers: Proven Outcomes
• 19% decline in mortality• 25% decline in death/institutional care• 29% decline in death/dependency• Increase in expediency of MD evaluation,
CT, tPA administration
*Reference: Cochrane Database, 2000
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What Can You Do?Community and family outreach• Reduce risk• Recognize signs• Respond quickly
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Questions?Resources available:• Resurrection Health Care 1-877-RES-INFO (1-877-737-4636)
www.reshealth.org
• Your Resurrection Health Care Hospital’s Stroke Care Coordinator
• American Heart/Stroke Association 1-888-4-STROKE www.strokeassociation.org
• National Stroke Association 1-800-STROKES • www.stroke.org
• American Physical Therapy Association 1-800-999-APTA (2782)• www.apta.org
• American Occupational Therapy Association 301-652-2682• www.aota.org
• American Speech-Language-Hearing Association 301-296-5700• www.asha.org
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