Rehabilitation - life after a stroke. First aid for stroke

Stroke is a life-threatening disease, in most cases leading to disability and even death. The likelihood of developing dangerous consequences depends on the time interval that has elapsed between the peak of the attack and the provision of medical care in the hospital. A stroke victim, people around him and doctors have no more than 4 hours to restore blood flow to the brain. Therefore, prompt first aid for a stroke is extremely important, during this period it is necessary to recognize an attack by characteristic symptoms, reduce the impact of the attack before the arrival of medical personnel by providing first aid, deliver the victim to the hospital and prescribe him treatment.

It is possible to recognize a stroke and the nature of its development mechanism by a complex of general neurological and specific symptoms in order to provide first aid in a timely manner. To general primary signs, arising spontaneously without any precursors, include:

numbness of the limbs - in most cases on one side of the body;
darkening and double vision;
impaired coordination and orientation;
brief bouts of amnesia;
speech disorder.

Manifestations ischemic stroke have their own characteristics:

paralysis of the body or limbs develops on one side, almost always the opposite side of the brain cell lesion;
the gait becomes unsteady and shaky, often the victim cannot stand on his own;
speech becomes difficult, articulation and perception of what is said is reduced;
occurs, accompanied by bouts of vomiting.

I will attack hemorrhagic stroke quite often preceded by a sharp increase blood pressure- hypertensive crisis. As a result, an artery ruptures and a hemorrhage occurs in the brain tissue. At the time of an attack, a person has:

sharp and unbearable pain, it feels like tearing the head;
rapid heart rate;
distortion of the face against the background of increased muscle tone;
paralysis;
high photosensitivity, dots and blurry circles before the eyes.

Signs that allow you to finally diagnose a stroke before the arrival of doctors include:

asymmetrical smile and the impossibility of raising one of the corners of the lips;
impaired articulation and inhibited speech;
asymmetrical movement of the limbs when trying to simultaneously lift them up.

If, with a sudden deterioration in well-being, a person has at least a few of the described symptoms, an intensive care unit should be called immediately. ambulance and take him to the hospital.

At the first signs of a stroke, despite the presence of consciousness in the victim and his assurance that everything is in order, the people nearby should promptly call an ambulance, while describing in detail to the dispatcher the symptoms of brain failure. Before the arrival of doctors, the patient must be provided with primary care to alleviate the condition:

Are you worried about something? Illness or life situation?

When special instructions dispatcher - to fulfill them implicitly.
Gently place the victim in a position in which the head is raised to 30 ° and slightly turned to one side. This is necessary so that in the event of sudden vomiting, food debris does not enter the respiratory organs, and in case of loss of consciousness, the tongue does not sunk.
Open a window or vent so that fresh air enters the room where the victim is located.
Reassure the patient if he is overexcited or begins to get nervous due to limited mobility. It should be explained in a calm tone that medical assistance will soon be provided to him to alleviate his condition.
Measure the pressure and, if possible, the level of sugar, record the results of the measurements in order to subsequently inform the doctors.
Remove or unfasten clothing items that squeeze the throat, chest, belt.
In the absence of consciousness, breathing and heartbeat, immediately perform chest compressions and artificial respiration.

There are also methods of primary stroke care that are not always recognized by specialists. traditional medicine, however, are quite effective in practice. The main one is the method of acupuncture. An unconscious victim is pierced with an alcohol-treated needle on the fingertips until 2 or -3 drops of blood appear.

Also, with a pronounced asymmetry of the face, the patient's earlobes are intensively rubbed, after which they are pierced with a needle until blood appears. This technique quite often brings the patient to consciousness and allows you to relieve tension in the structures of the brain.

to the actions that forbidden to perform if a stroke is suspected, include:

strong shaking of the victim, sudden movements, screams and hysteria of others;
feeding and drinking plenty of water;
bringing to life with ammonia and other acid-containing agents;
attempts to eliminate the symptoms of brain failure on their own with pharmaceutical means;

First aid for stroke

Before the arrival of the ambulance team, it is not recommended for the victim to independently give any medications, except in cases where the ambulance dispatcher can make a single appointment based on the symptoms described.

Medical assistance is provided by ambulance paramedics. Directly in the resuscitation vehicle, doctors perform operational actions aimed at maintaining the vital signs of the body. These include:

indirect heart massage;
artificial respiration;
tracheal intubation;
the introduction of blood-thinning drugs for symptoms of ischemic stroke;
the introduction of anticonvulsants in severe convulsive syndrome;
lowering blood pressure medications if its indicators are critically increased;

First aid for a stroke is those activities that can alleviate the patient's condition and, most importantly, prevent death and all those dangerous complications that accompany this functional disorder brain activity.

stroke is not independent disease, but pathology, which is a complication of such diseases as hypertension, atherosclerosis, arrhythmias, coronary artery disease, diabetes, vascular anomalies, etc. and occurs after stress, overeating, alcohol abuse, and sometimes against the background of general well-being.

Irreversible processes in the brain occur in the first hours, therefore, adequate first aid provided in time for a stroke will help save the patient's life and reduce all adverse consequences.

What is a stroke

At the sight of a patient, relatives panic - what to do with a stroke? Therefore, it is necessary to have an idea about this pathology. This is an island-like disorder of the functionality of the brain, which is caused by a violation of the activity various sites due to ischemia. According to the mechanism of damaging action, there are: ischemic, hemorrhagic stroke and subarachnoid hemorrhage.

Ischemic stroke occurs due to malnutrition of a part of the brain as a result of vascular disorders: spasm, stratification and blockage of the vessel. Hemorrhagic stroke is the formation in the brain due to a vascular rupture of a hematoma, which presses on intact tissues and causes their ischemia and impaired function. Subarachnoid hemorrhage in most cases occurs after injury and is localized between the membrane and brain neurons.

Signs and symptoms

IN Lately stroke is much younger: the age of patients is from 20 to 80 years. Men are more often ill. At initial signs stroke, first aid in the first minutes is 50% of the success of the cure. The onset of a stroke may be accompanied by severe pain in the occipital and temporal regions of the head and the impossibility of even a slight tilt, nausea, vomiting.

There are cases of loss of consciousness or symptoms of damage to a certain part of the brain - paresis, impaired speech, swallowing, vision, coordination of movement. In most cases, a stroke occurs immediately after waking up. Sometimes the patient complains of a feeling of numbness in one or more limbs, convulsions are possible.

Older people develop encephalopathy - inappropriate behavior, aggressiveness or refusal to communicate with loved ones.

If a stroke is suspected, if the person is adequate, it is necessary to ask the patient to smile, say a simple sentence, raise his hands and stick out his tongue. With a stroke, the smile is asymmetrical, the corner of the mouth is lowered; the patient's speech is confused, inarticulate; when raising hands, one limb does not obey well and lags behind when moving; the tongue is asymmetrical and falls to the side.

Knowing these symptoms of a stroke, it is urgent to provide first aid.

First aid

Immediate care for a stroke is the key to a full recovery. The 03 dispatcher needs to describe the symptoms in as much detail as possible in order for the neurological team to arrive.

It should be remembered that brain cells die not in 4 minutes, but 3-5 hours after an attack - this is the period during which first aid is needed for a stroke. This will help eliminate the cause of the disease and prevent formidable complications that lead to disability and death. The patient must be laid on the bed, head raised. First health care in a stroke is to alleviate general state human and control basic functions.

When vomiting, tilt your head to one side, free your mouth from the contents. It is necessary to evaluate the function of breathing and count the pulse. Blood pressure measurement is important, but should not be drastically reduced high blood pressure. Limit figures - 185-110 mm Hg. Art.

Enalapril or captopril can be given under the tongue. If normal breathing is impossible, you need to throw back the patient's head, open the mouth and push the jaw, and also try to give the patient artificial respiration.

Taking diuretics (2 tablets of furosemide) significantly improves the patient's condition and prevents the development of cerebral edema. And the use of glycine, cerebrolysin, nootropil will improve the nutrition of brain cells.

Before the arrival of the ambulance, the stabilized condition of the patient is important to prevent consequences. The sooner the patient gets to a specialized department, the better the prognosis for his life. Be sure to tell the doctor exactly what drugs you gave the patient and at what dosage.

You should not panic, but it is important to calm down and remember what to do with a stroke.

Some advise bloodletting as first aid for a stroke. The method consists in piercing the pads of the fingers and earlobes with a sterile needle so that some blood flows out. But this is an unprofessional approach, and this technique is even contraindicated in hemorrhagic stroke.

This disease is social problem because stroke ranks first in terms of disability. After an attack, 50% of patients die. Therefore, everyone should know its symptoms and be able to provide urgent needed help. The Internet is full of advice on emergency care for a stroke. The online game "First Aid for Stroke" has the most interesting and correct methods.

Video about first aid for a stroke:

Around 450,000 people worldwide suffer from a stroke every year. This number is comparable to the population of a large city. In Moscow, 80-120 people are diagnosed with stroke every day. The disease occurs only in acute form, is highly lethal, and in 50% of survivors it recurs within five years of subsequent life. 31% of stroke patients need special care, 20% cannot walk independently and only 8% can return to full life. The earlier a stroke is diagnosed and the first pre-medical and medical assistance is provided, the more chances the patient has to survive and recover from the disease. Therefore, as many people as possible should be informed about the signs of a stroke and first aid for stroke at home.

Signs of a stroke

Stroke can be hemorrhagic (bleeding into the brain) or ischemic (death of brain cells, also called cerebral infarction).

Signs of hemorrhagic stroke are:

Acute headache, confusion or fainting.
Sudden vomiting, salivation.
Decreased hearing and vision.
Paralysis of half of the body, distortion of facial expressions.

Signs of ischemic stroke include:

Dizziness.
Feeling of weakness and numbness in the limbs, which gradually increases.
Confusion of speech, mangling of words, impaired coordination of movements.
Decreased visual acuity.
Distortion of the face.
Seizures.

In both cases, a stroke develops within minutes. Signs of hemorrhagic stroke are more vivid. As a rule, the patient cannot answer questions. With an ischemic stroke, the patient first feels a slight malaise, and here it is necessary to conduct a few simple tests: ask to smile, raise your hands, read the line in small print. If the patient has one corner of the mouth left down, it is difficult for him to move his limbs, vision problems have begun, it is necessary to call an ambulance. Ischemic stroke is more common, accounting for about 85% of cases.

Currently, special information brochures are published with instructions for self-diagnosis acute violation cerebral circulation. It is useful for everyone to get acquainted with them. Remember that you can help not only your loved ones, but also random people in transport or on the street, such cases are not uncommon. The patient may not attach importance to his malaise, resist testing and calling an ambulance, which often leads to death in a few hours. The importance of prompt diagnosis should be calmly explained. Special attention in such cases is required for people with hypertension, as well as the elderly.

Time to rescue: first aid for a stroke before the ambulance arrives

With brain damage, irreversible changes begin within a few hours. There is a so-called therapeutic window - 4.5 hours. This is the period in which it is possible to prevent the development of serious consequences of a stroke associated with the necrosis of a significant part of the brain cells. If during this time it is possible to provide the patient with qualified medical care, he can relatively quickly return to normal life. However, it should be borne in mind that in practice, doctors have not 4.5 hours, but much less. Most of the time is spent on testing, making a decision, calling an ambulance and transporting to a hospital. Therefore, the sooner signs of a stroke are detected and primary measures are taken, the more likely it is to avoid death or profound disability. Extensive brain damage during a stroke can lead to loss of vision, hearing, paralysis. Often, post-stroke patients have to re-learn how to speak, walk, and perform basic household functions.

How to help a person with a stroke

When signs of acute cerebrovascular accident are detected emergency care must be called as early as possible!

The order of assistance before the arrival of the ambulance:

calm the victim so as not to aggravate the situation with excitement;
put the patient on the bed, raise his head 30 degrees; if consciousness is lost, turn your head to the side (vomiting is possible), stretch out your tongue;
loosen clothes - collar, belt; ensure air flow;
measure the pressure and, if it is elevated, give drugs to reduce;
lower the legs into the pelvis hot water or put a heating pad at your feet to help drain blood from your brain.

It is forbidden:

Give the patient a vasodilator until the ambulance arrives.
Drink or feed the patient.

A special case is when a stroke occurs in a car, and the victim is driving. Here, not only his life, but also the lives of passengers may be in danger. In this case, you need to stop, call an ambulance, open all windows.

Assistance in transporting a patient in an ambulance for a stroke

First of all, no attempt should be made to deliver the patient to the hospital by private or public transport. In case of a stroke, a specially equipped ambulance is needed, with qualified personnel, medicines and a siren. Transportation is carried out to a specialized neurological hospital or to the intensive care unit of the nearest general hospital, where doctors have already been warned in advance. As a rule, doctors remain in best case an hour and a half to help the patient. Those who were close to the patient during the attack should accompany him to the hospital in order to tell the doctors in detail and constructively about the details of what happened and the first aid provided.

By ambulance can be carried out the following measures:

Prevention of respiratory disorders (if necessary - tracheal intubation, artificial ventilation lungs).
Smooth decrease in blood pressure.
Maintenance of water-electrolyte metabolism with the help of droppers with saline.
Administration of anticonvulsants.
When transporting a stroke patient, they are guided by the principle of "delivering with the least loss to the body."

First aid in the hospital

Upon arrival at the hospital, first of all, it is necessary to conduct a qualitative diagnosis, which will confirm or refute the presence of a stroke and identify its type. Depending on the results, resuscitation measures are prescribed. The localization of the lesion is important: for example, an ischemic stroke of the cerebellum can also cause cerebral hemorrhage.

Diagnostics. Done urgently CT scan brain. Doppler ultrasound may also be required to assess the speed of blood movement through the vessels. Additional ECG, X-ray chest blood test for platelets and glucose, biochemical analysis blood.
resuscitation activities. Common to both types of stroke are the following measures: maintaining the patient's breathing, control of blood pressure and work of cardio-vascular system, control of swallowing function, maintenance of work Bladder and gastrointestinal tract, elimination of cerebral edema. Of the medicines for ischemic stroke, eufilin, trental, heparin are prescribed. With hemorrhagic - Gordox, Trasilol, Vikasol. Also, with this type of stroke, surgical removal of a hematoma can be indicated if it compresses the brain. However, such operations are not prescribed for elderly patients.

After a few days, depending on the condition of the patient, he is transferred from the intensive care unit to the intensive care unit, where he usually spends two to three weeks. However, the treatment of stroke does not end there, long-term rehabilitation (six months to a year) is required.

Secondary prevention of stroke is especially important during this period in order to prevent a second attack. Here you should already be patient and methodically follow the recommendations of specialists, haste during rehabilitation is inappropriate. Best Solution- put the patient in rehabilitation center where a whole team of professionals will work with him.

It is called a sharp violation of blood circulation in the tissues of the brain, which leads to their death and the loss of the ability of this area to perform its functions. Depending on how large the lesion is and where it is located, both the consequences and the severity of the symptoms will differ.

It lies in the fact that it is not immediately possible to recognize it, as well as in underestimating the seriousness of the situation by the patient. Many people do not go to the doctor or refuse to go to the hospital, while the key to successful rehabilitation is precisely the timely emergency care provided.

In some cases, the lesions are so severe that even with immediate medical intervention, it is not possible to save a person's life. But often the correct first aid for a stroke in the first minutes and hours after an attack allows you to subsequently return a person to a normal life. Knowing what to do with a stroke and how to provide first aid for a stroke before the ambulance arrives will help minimize dangerous consequences attack.

Varieties and the first signs of a stroke

In order to properly provide first aid for a stroke, you need to recognize the symptoms of an incipient attack in time. Stroke can be of two types: ischemic and hemorrhagic. In the first case, the cause is a blockage of the vessel, which causes a cessation of nutrition and the death of a certain area of tissue. It is in ischemic stroke right help in the first hours allows you to minimize the consequences.

When there is a rupture of the vessel, which leads to hemorrhage in the tissue. This is less common, but most dangerous view leading to death in more than 90% of cases. Often death occurs almost instantly, and to provide any first aid when this type stroke is not possible. In milder cases, disability occurs, the loss of the ability to perform vital functions, such as paralysis. Medical assistance is, among other things, surgical intervention therefore, in the event of a hemorrhagic stroke, it is important to get the person to the hospital as soon as possible.

You can recognize a stroke by the following signs:

When the headache is intense, there is weakness in the body, dizziness, fainting is possible. With a hemorrhagic stroke, the headache is sharp and pronounced, throbbing, the patient reacts painfully to bright light, there are difficulties with breathing and palpitations, paralysis of half of the body and vomiting are characteristic. Help for ischemic stroke is different from the hemorrhagic type, but only a doctor can clearly make a diagnosis.

A universal way to check a person for an attack is the following algorithm of actions:

If you ask a person to smile and stick out their tongue, then one of the halves of the mouth will remain motionless.
Ask for a simple phrase, such as your name. Speech will be slurred, the patient has difficulty in pronunciation.
If you tell the patient to raise two hands up, then most likely only one will rise.

Even if at least one of the symptoms described is manifested, it is urgent to call an ambulance. This is especially true for people who are at risk for this disease:

Pre-medical actions

Calling an ambulance should be the first step in suspecting a stroke. But the medical team cannot immediately appear near the patient, especially if he lives in remote areas, or, conversely, in a metropolis, and the attack happened at rush hour. Therefore, you need to know what to do and provide first aid yourself.

First aid for an ischemic stroke is the following:

Lay the patient in such a way that the body is on a flat surface, and the head is slightly elevated.
Gently rub hands and feet.
Observe the state of breathing.
The head should be turned to the side.

Before the ambulance arrives, you should not try to help with any pills.

For the hemorrhagic type, first aid for a stroke at home is to follow similar recommendations:

Open a window or door to allow entry fresh air into the room.
Give the body a position similar to the recommendations for ischemic stroke.
Remove jaw prostheses, if any.
Cover the patient with a blanket.
Make sure that the patient does not choke on vomit, remove them in a timely manner.
You can apply a cold towel to the head on the side opposite to the one where the defeat is expected. It must be remembered that if paralysis occurred on the left side of the body, then the right hemisphere of the brain suffered, and vice versa.

The most important thing is to immediately call an ambulance and not leave a person unattended. Beware of giving any medication. Monitor your blood pressure, breathing and heart rate. It will be necessary to do resuscitation during a stroke before the ambulance arrives if the patient is not breathing and the heart has stopped beating.

It is important to ensure free breathing by unbuttoning or removing tight clothing. by the most safe position is the side lying position. It prevents suffocation from saliva or vomit entering the respiratory tract. This probability occurs if the patient has impaired swallowing function.

Cautions

Since a stroke is a life-threatening disease, it is forbidden to self-treat it at home. The only correct action is to call a doctor.

Only a doctor as a result of the examination will be able to accurately determine the type of stroke. Therefore, it is strictly forbidden to give medicines before his arrival. For each type of attack, drugs are prescribed that are incompatible with the other. Therefore, illiterate treatment will only accelerate the onset of the worst prognosis.

The method of bloodletting, often recommended and popular in the era of undeveloped medicine, should also not be used as first aid for a stroke patient. Because if the vessel breaks, it can even be dangerous.

Also, you can not refuse hospitalization. Before the arrival of the brigade, it is necessary to prepare everything necessary for the hospital. This is a minimum of personal belongings and medical documents of the patient.

Proper first aid for a stroke increases the patient's chances of surviving and recovering. Therefore, in case of any suspicion, it is necessary to contact the doctors, and before their arrival, only maintain a normal moral and physical state person.

A stroke is a violation of cerebral circulation. The arteries supplying blood to the brain may become blocked, and then an ischemic stroke occurs, or an artery may rupture and this is a hemorrhagic stroke. Thus, as a result of this vascular catastrophe, part of the brain is left without a normal blood supply, experiences oxygen starvation. As a result of hypoxia - a lack of oxygen in the tissues, nerve cells die. This leads to a variety neurological symptoms, it can be complete or partial loss speech, memory lapses, paralysis of body parts (hemiparesis).

Among all strokes, the ischemic variant occurs in 80% of cases. Blockage of the arteries supplying the brain with oxygenated blood is most often caused by cholesterol deposits. Ischemic strokes most often occur against the background of low blood pressure and occur mainly in the morning. If the artery is not very large diameter, then the clinic of such a stroke develops gradually, begins with weakness, dizziness, numbness of the face, arms and (or) legs on the one hand, vision and speech disorders may appear, the corners of the mouth become asymmetrical, headache may appear, loss of balance. In case of blockage of a large diameter artery, differential diagnosis between ischemic and hemorrhagic stroke at the prehospital stage is extremely difficult.

Bleeding into the brain (hemorrhagic stroke) occurs when the blood vessel and filling the surrounding tissues with blood. This disrupts the normal blood flow to the brain, the outflow of blood compresses the brain tissue, leading to further damage. More often hemorrhagic strokes occur as a result of high blood pressure.

With a decrease in the lumen of the vessels supplying the brain with blood and, accordingly, a deterioration in its nutrition, it is necessary to prescribe drugs that reduce blood clotting (blood thinning) - this may be aspirin, which is used enough long time¼ tablet a day, or newer drugs - warfarin, at a dose prescribed by the attending doctor. The drug clopidogrel or zylt is now being used, which is also recommended by neurologists as a disaggregant, including at the prehospital stage.

What to do

Emergency care for severe course does not require a stroke at the prehospital stage exact definition its nature (hemorrhage or ischemia). The basic principles of such emergency assistance are to create conditions for the normalization of the vital functions of the body - this is breathing and blood circulation, the fight against cerebral edema. Respiratory disorders during loss of consciousness may be due to impaired patency respiratory tract, which means it is necessary to exclude the retraction of the tongue, the ingress of vomit into the trachea and bronchial tree, and for this the patient's head should be turned to one side. According to modern recommendations of neurologists, blood pressure correction is carried out only if it significantly exceeds normal performance, since low blood pressure in patients with stroke usually leads to a worsening of his condition and further prognosis.

The patient needs to provide oxygen supply, drugs with antihypoxic action are prescribed. To date, preference is given to the drug - mexidol, which must be administered intravenously, at a dose of 5 milliliters, diluted in saline. Of the drugs that improve cerebral circulation, neurologists today recommend the use of a magnesium sulfate solution at the prehospital stage. From the use of aminophylline in strokes, they have now moved away and are no longer recommended. With the threat of cerebral edema, oxygen therapy continues, diuretics (lasix) are prescribed. In case of seizures - anticonvulsant therapy (Relanium). The patient should be hospitalized in the vascular center, in the primary vascular department, or in the nearest medical institution with an intensive care unit, since quite often such patients require intensive care, including resuscitation.

Prevention measures are to protect the vessels, and this is, first of all, quitting smoking, since nothing destroys the vascular wall as much as the components tobacco smoke(and there are more than three hundred components!), control and treatment of arterial hypertension, diet, regular physical exercise. It is worth recalling that 80% of our health, according to WHO, depends on our lifestyle.