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Are You At Risk For A Stroke

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Dr. Brian Huettl of Saint Francis Hospital in Evanston, Illinois presents the signs, symptoms and treatments for stroke, as well as tips on prevention.

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Are You At Risk For A Stroke

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

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