Emergency care for hemorrhagic stroke. Emergency care for a stroke: characteristic symptoms of brain damage and rules for providing first aid Stroke assistance

Content

Damage to brain tissue that develops as a result of vascular damage and hemorrhage is called a hemorrhagic infarction or stroke. The pathology usually occurs suddenly, during the day or in the morning, with a sharp increase in blood pressure (hypertensive crisis), physical activity, severe stress or emotional shock. The consequences of a hemorrhagic stroke are often unfavorable.

What is hemorrhagic stroke

The clinical form of acute cerebrovascular accident (ACVA), resulting from spontaneous damage to cerebral vessels, is called hemorrhagic stroke. Such damage accounts for approximately 10–15% of all cases of stroke. The pathology is typical for middle-aged and young people. The following signs are characteristic of hemorrhagic lesions:

• Suddenness. More than half of all cases occur without any previous signs of damage.
• High mortality rate. Fatal outcome in 60–70% of patients; they die within the first 3–5 days after the lesion.
• Profound disability. According to statistics, 70–80% of people who have suffered a cerebral hemorrhage lose the ability to self-care.

Causes of cerebral hemorrhage

Hemorrhagic stroke of the brain usually develops due to a decrease in the elasticity and strength of cerebral vessels. In addition, the following factors can provoke hemorrhage:

• arterial hypertension;
• aneurysms;
• vasculitis;
• hemorrhagic diathesis;
• amyloid angiopathy;
• brain tumors;
• encephalitis;
• small idiopathic subarachnoid hemorrhages;
• hemophilia;
• obesity;
• smoking;
• addiction.

Kinds

In clinical practice, the location of the hemorrhage is of great importance, because It determines the scope of necessary treatment and rehabilitation. Depending on the location, the following types of stroke are distinguished:

The trigger for hemorrhagic brain damage is a pathological change in the permeability and integrity of cerebral vessels of different sizes. As a result, a hematoma is formed, the functioning of neurons is disrupted, and tissues begin to quickly die. In the pathogenesis of hemorrhagic stroke there are several stages:

1. The most acute. It occurs immediately after hemorrhage and lasts 24 hours. Characterized by the rapid development of coma, respiratory and heart failure. When providing medical care during this period, the risk of death and the development of severe complications is significantly reduced.
2. Spicy. It begins a day after the stroke and lasts about three weeks. During this period, symptoms increase slowly, and compensatory mechanisms are gradually activated.
3. I'll sharpen it up. It occurs 22-23 days after the lesion and lasts up to three months. Symptoms gradually fade away, tissue regeneration and restoration of cognitive and physical functions gradually begin.
4. Early recovery. Active processes of brain tissue restoration continue. Collateral circulation develops powerfully. The stage lasts from the third month from the onset of the disease to six months.
5. Late recovery. Glial scars or cystic tissue defects form at the site of the lesion. It begins in the seventh month after the defeat and lasts up to a year.
6. Stage of long-term consequences. It begins a year after the stroke, continues until all symptoms disappear completely, and sometimes persists for life.

Symptoms

Clinical symptoms of the disease, their severity and duration depend on the location of the lesion and its volume. The main signs of cerebral hemorrhage are:

• severe headaches;
• vomit;
• impaired coordination of movements (walking, standing, sitting);
• facial redness;
• disturbance of consciousness (stupor, stupor, coma);
• paresis and paralysis - impaired movement of the limbs on one half of the body, since they are constantly in a half-bent position and it is impossible to straighten them;
• speech disorder;
• convulsive syndrome;
• decreased muscle tone;
• mental disorders and irritability;
• visual impairment up to complete blindness;
• facial distortion;
• weakened breathing;
• hemiplegia, hemiparesis, hemihypesthesia;
• numbness of the skin of the limbs, face;
• vegetative state (lack of response to external stimuli and signs of brain activity in the presence of pulse and breathing).

Consequences of cerebral hemorrhage

After suffering hemorrhagic brain damage, the majority of patients have a significantly reduced quality of life. People lose the ability to self-care, work, and move. In addition, the following consequences of a stroke are distinguished:

• memory and attention deteriorate;
• visual acuity decreases, sometimes to complete blindness;
• lack of sensitivity in the limbs and face;
• hearing loss;
• speech and writing disorders;
• mental disorders.

Diagnostics

To determine the presence of a stroke and its exact localization, modern instrumental diagnostic methods are used. These include:

1. Lumbar puncture. During the study, the spinal canal is punctured and cerebrospinal fluid is taken for examination. A stroke is indicated by the pink color of the cerebrospinal fluid and the presence of a large number of red blood cells in it.
2. Computer (CT), magnetic resonance imaging (MRI). Thanks to such studies, it is possible to quickly and accurately determine the presence of pathology in the brain, its location and size.
3. Angiography of cerebral vessels. In this study, a contrast agent is injected into the cerebral arteries and X-rays are taken. Angiography clearly shows the location of the hemorrhage and its cause.

First aid

The main goal of first aid for a stroke is to maintain breathing, heartbeat and urgent hospitalization. When providing first aid for a stroke, you must do the following:

• If there is no pulse in the peripheral arteries, heartbeat and breathing, chest compressions and artificial respiration should be performed.
• If there are convulsions, it is necessary to lay the victim on his side and place something soft under his head.
• Measure and adjust blood pressure.
• Apply an ice pack to your head: this will help constrict blood vessels and stop bleeding.

Treatment of hemorrhagic stroke

Stroke therapy should be carried out only in specialized clinics. For the first 5–7 days after the injury, patients are placed in the intensive care unit, where the patient’s condition is monitored around the clock by qualified medical staff. If the course is favorable, the victim is transferred to the neurological department. Treatment of stroke involves drug therapy and, if necessary, surgery.

Non-surgical treatment

Complex conservative therapy is carried out for minor hemorrhages, and also as an addition to surgery. Non-surgical treatment includes:

• Adjustment of blood pressure. To eliminate hypertension, solutions of Enap, Benzohexonium, and Dibazol are administered intramuscularly or intravenously. If the patient’s consciousness during a hemorrhagic stroke is preserved, then Clonidine, Metoprolol, Farmadipine are used. For low blood pressure, Dopamine, Mezaton, and Prednisolone are used.
• In case of respiratory failure, the patient is intubated and connected to a ventilator.
• Elimination of cerebral edema using the following medications: Furosemide, Manitol, Dexamethasone or L-lysine.
• Improving the supply of oxygen and nutrients to brain cells using pharmacological agents such as Ceraxon, Thiocetam, Cortexin, Actovegin, Cavinton, Reosorbilact, Cytoflavin.
• To stop bleeding, Dicinone, Etamzilate, Vikasol, Aminocaproic acid are prescribed.

Surgical intervention

Surgical treatment is carried out within the first three to four days after hemorrhage. Indications for surgery for hemorrhagic stroke are:

• parenchymal hemorrhage in the brain with the formation of large hematomas;
• rupture of a large vessel;
• extensive hemorrhage in the brain due to a ruptured aneurysm.

Surgical removal of blood is aimed at reducing intracranial pressure, tissue decompression and preventing brainstem herniation. For hemorrhagic stroke, the following types of operations are used:

1. Trephination. During this surgical procedure, the doctor removes a fragment of the skull bone above the affected area. The accumulated blood is removed through the surgical wound. The advantage of trephination is that it allows you to quickly reduce intracranial pressure and cerebral edema. The operation is usually performed for superficial hematomas.
2. Puncture. During the operation, a puncture of the skull is performed under the control of computed tomography. The needle is carefully brought to the area of ​​hemorrhage and the blood is sucked out. Puncture is indicated for hemorrhagic lesions of the deep parts of the brain.
3. Draining. To eliminate the hematoma, special tubular drainages are installed to drain the cerebrospinal fluid from the ventricles. Manipulation helps reduce intracranial pressure.

Recovery after hemorrhagic stroke

Rehabilitation after a hemorrhagic lesion is a long and labor-intensive process. All measures are aimed at restoring the patient’s lost cognitive or physical functions. Rehabilitation includes:

• training on special simulators;
• prevention of bedsores;
• enriched nutrition;
• therapeutic massage;
• physical education and gymnastics.

Speech and memory restoration is carried out with the help of speech therapists and psychologists. The duration of rehabilitation after a stroke depends on the location, volume of the lesion, treatment provided, the presence of concomitant pathologies, and the age of the patient. Recovery time ranges from several weeks to several years. According to statistics, only 15–20% of patients return to a full life.

Recovery prognosis

With hemorrhagic lesions, the prognosis is unfavorable. The overall mortality rate is about 70%, of which 90% die within the first few days. The main causes of death are acute cerebral edema and repeated hemorrhage. Most surviving patients remain disabled for life. If the victim was hospitalized in the first 3-4 hours after a stroke, then the chances of survival and full recovery are maximum.

Prevention

Typically, cerebral hemorrhages are associated with high blood pressure (hypertension). Timely treatment of hypertension significantly reduces the risk of stroke. Prevention of hemorrhagic brain damage includes:

• giving up bad habits (smoking, drinking alcohol);
• adherence to sleep and rest patterns;
• elimination of stress, nervous tension;
• moderate physical activity;
• timely treatment of chronic pathologies;
• control of blood pressure, cholesterol and blood sugar.

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A sudden disruption of the blood circulation in the brain, as a result of which vital areas of the nervous system do not receive blood and neurons die, causes a stroke. The disease manifests itself in a number of life-threatening symptoms. Every year, the disease is diagnosed in every 5 residents of Russia, with death occurring in a third of all cases.

The sooner first aid is provided during a stroke, the greater the chance that the person will survive. In this case, the patient must be transported to a medical facility within three hours from the onset of the attack.

Classification

First aid for a stroke at home is an important step to save a person’s life.

However, you should know that the consequences of an attack can be prevented and the functions of depressed circulation can be completely restored only in medical institutions. Therefore, if you suspect a stroke, you first need to call an ambulance, and then begin providing emergency care.

To help the patient, it is important to know the types of diseases and their symptoms.

Circulatory disorders during a stroke can be of 2 types:

1. The ischemic type is called a brain infarction state. It develops due to the fact that the arteries that supply the brain with necessary substances are blocked by a blood clot. In this case, a blood clot can develop in the heart, leg arteries or any other vessels. As a rule, the main causes of ischemic disease are vascular atherosclerosis and. Most often diagnosed in people over 60 years of age.
2. A hemorrhagic type of circulatory disorder appears due to a rupture of a cerebral artery. Hemorrhagic stroke is a consequence of hypertension, when weakened cerebral vessels cannot withstand and rupture. For this reason, hypertensive patients need to strictly adhere to the treatment prescribed by the doctor. And in case of increased blood pressure or arrhythmia at home, strictly adhere to the algorithm to eliminate alarming symptoms. ). This type of stroke mainly affects people between 40 and 60 years of age.

Symptoms

It is difficult to diagnose one or another type of cerebral circulatory disorder at the time of providing emergency care for a stroke, but for doctors, distinguishing between types is very important, since the type of therapy depends on them.

In order to understand that a person is having a stroke, you can use a special technique that will help identify important symptoms of the disease.

• U – smile. The patient’s facial expressions change: he will be able to smile with only one half of his face;
• D – movement. After the patient raises both limbs, it will be clear that one of them is significantly lower than the other;
• A – articulation. A person affected by a stroke cannot speak clearly;
• R – solution. If at least one of the symptoms appears, emergency assistance for a stroke should be provided and doctors should be called.

Note!

“Male” stroke has several differences in its manifestations from “female” stroke.

The exact sequence and time of manifestation of symptoms cannot be predicted, since each body reacts to an attack differently. In addition, the signs may vary depending on different types of cerebral circulatory dysfunction.

With an ischemic stroke, the symptoms are more pronounced, and the attack itself is severe: a person can. In addition, with ischemia, the first signs begin to appear several days before the attack itself, while the hemorrhagic type occurs suddenly.

First aid

If you do not have experience in determining the type of attack, first aid for a stroke is carried out by following these recommendations.

If the person has not lost consciousness, the algorithm of action before the ambulance arrives is as follows:

• Calm the victim;
• Lay him comfortably, giving a higher position to the head and shoulder area;
• Provide a free flow of fresh air into the room;
• Remove or unfasten pressing items of clothing;
• Promote complete rest for the patient.

Note!

First aid for a stroke does not allow the use of medications until the patient is examined by doctors!

What not to do when a stroke occurs:

• Move the victim yourself or ask him to move;
• Use ammonia;
• Giving a person food or drink;
• Use drugs containing acids to bring the patient to consciousness.

Note!

The patient’s life depends on how quickly a medical team is called and first aid is provided.

Important Details

If you can distinguish the symptoms of an ischemic type of stroke from a hemorrhagic one, then help is differentiated:

Note!

If a person has hypertension, it is necessary to measure his blood pressure before being examined by doctors. Report the results of the study to doctors. Before they arrive, immerse the victim’s feet in a bath of hot water.

What to do if the patient is unconscious?

Turn his head to the side to prevent his tongue from sticking or vomit from getting into the pharynx, warm his legs and arms, and provide a flow of fresh air.

If a patient has a stroke, accompanied by an extremely serious condition that has symptoms of clinical death (no breathing or heartbeat, the pupils of the eyes are dilated), emergency assistance must be provided:

• Tilt the patient's head back to the side;
• If necessary, free the oral cavity from mucus or masses and foreign objects;
• Wrap your fingers around the edges of the lower jaw and push it forward;
• Execute ;
• Massage the heart muscle.

Statistics show that first aid, competently provided, and the patient within the first three hours in a medical facility helps save lives in 60% of cases. 90% of patients fully recover their health and lead a full life. In 70% of patients, irreversible processes in the blood circulation of the brain will not occur.

Medical assistance

First aid for a stroke is provided by a team of doctors who arrive on call.

After a diagnostic examination, doctors carry out a number of measures aimed at restoring or maintaining impaired respiratory or cardiac function.

Honey. help consists of the use of medications, which are used depending on the symptoms and type of stroke. What to do if a patient has a stroke after hospitalization is decided by the doctors of the medical institution.

Prevention and recovery

Many people are not prepared for the manifestation of a stroke: people ignore doctors’ prescriptions, they do not systematically treat chronic diseases of the heart and blood vessels.

In addition, regular stressful situations, bad habits and poor nutrition increase the risk of the disease several times.

Therefore, in order to prevent the occurrence of this extremely dangerous condition for life and health, you must adhere to the following rules:

• Eat right;
• Give up bad habits;
• Follow all recommendations of your doctor;
• Monitor your blood pressure;
• Watch your weight;
• Properly alternate periods of physical activity and rest;
• Avoid stressful situations and long-term depression;
• Spend more time outdoors.

1. What is a stroke?
A stroke is a transient disruption of brain function due to disturbances in its blood supply. Disturbances in the blood supply to the brain during a stroke may be associated with the development of ischemia (anemia, lack of blood supply) due to blockage of a vessel or narrowing of the lumen of the vessel by a thrombus or atherosclerotic plaque, or due to a violation of the integrity of the vessel or the permeability of its wall and subsequent hemorrhage. As a result, the affected area of ​​the brain cannot function normally, which can lead to problems with motor and sensory functions on one side of the body.

Stroke is a serious illness that requires emergency medical attention and can lead to irreversible impairment and even death. The sooner the provision of qualified medical care for a stroke begins, the higher the chances of saving life and restoring lost functions. After an ischemic stroke, the degree of irreversible damage to brain cells (neurons) steadily increases until the affected areas of the brain are left without sufficient blood supply. In areas of the brain completely deprived of blood flow, neurons begin to die in less than 10 minutes. In areas where it is preserved<30% нормального кровотока, нейроны начинают умирать в течение одного часа. В областях с 30% -40% от нормального кровотока некоторые нейроны некоторые нейроны теоретически могут восстановиться при начале терапии через несколько (3-4-6) часов.

Therefore, it is optimal if medical care begins to be provided no later than 3 hours from the onset of the stroke. After 3 hours from the onset of the disease, brain cells in the ischemic zone begin to undergo irreversible changes. The maximum time ("therapeutic window") before starting thrombolytic therapy for ischemic stroke is 4.5 hours. In the period up to 6 hours after the onset of stroke, among the brain cells that died from ischemia, individual cells still remain, which are theoretically capable of being restored when blood supply is restored.

2. How to recognize a stroke?

Signs of a stroke may include one or more of the following:
■ weakness, paralysis (inability to move), or numbness of the face or limbs on one side of the body;
■ sharp deterioration of vision, blurred images, especially in one eye;
■ unexpected speech difficulties, slurred speech, sinking tongue, tongue deviation to one side;
■ unexpected difficulties in understanding speech;
■ sudden difficulty swallowing;
■ unexplained falls, dizziness or loss of balance. Attention: if a person has not drank alcohol, but behaves “like a drunk,” this symptom may indicate the development of a stroke. The presence of alcohol intoxication also does not exclude the development of a stroke. Be more attentive to people who look “drunk” - maybe you can save someone’s life!
■ sudden severe (the worst of your life) headache or a new unusual type of headache without a specific cause;
■ drowsiness, confusion or loss of consciousness.

A person without medical training can use a simple pre-hospital test for assessing the likelihood of stroke using the Cincinnati scale:

The sudden onset of any of these three symptoms indicates the possibility of a stroke. You need to urgently call an ambulance! It is better to overestimate the severity and danger of the patient’s condition than to underestimate!

When assessing the patient's condition, keep the following in mind:
- A stroke can change a person's level of consciousness.
- In many cases, during a stroke, “nothing hurts”!
- A stroke victim may actively deny his painful condition!
- A stroke victim may inadequately assess his condition and symptoms: focus on your subjective opinion, and not on the patient’s answer to the question “How does he feel and what worries him?”

IMPORTANT:
There is a condition called transient ischemic attack, where the blood supply to the brain is temporarily interrupted, causing a “mini” stroke. Even if the observed symptoms of a stroke were mild and went away after a certain period of time, the tactics of action should be exactly the same as for a “big” stroke: place the patient in a position that is safe for vomiting, ensure his immobility and immediately call an ambulance. A “mini” stroke can be a precursor to the development of a “big” stroke.

First aid for stroke.

The most important first aid for a stroke is to immediately call an ambulance!

"Russian" features of calling and interacting with the ambulance team:

If a stroke happened in a public place or on the street, and even in a crowd of people, then there will be no nuances in communicating with the ambulance. If the patient is at home, then some sovereign Russian features of the work of the ambulance may appear, which you need to know in advance and be prepared for.

1. If you are very likely to be sure of the diagnosis, call the ambulance that the patient is having a stroke and requires the arrival of a neurological team. To the question "How do you know about the diagnosis?", in a confident voice, inform that the diagnosis was made by a neighbor doctor or a relative doctor and demanded that you immediately call a neurological ambulance team. According to statistics, an ambulance dispatcher is able to correctly determine the diagnosis of “stroke”, taking into account the caller’s confusing story, only in 1/3 of cases. The arrival of a regular ambulance rather than a neurological one can lead to a loss of time before the start of medical care in a hospital. During negotiations with the ambulance, someone must be with the patient at all times!

2. Send someone to your neighbors for help: you will need 2-4 strong men to carefully carry the patient on a stretcher from the house to the ambulance. If you have not yet encountered Russian ambulance, then you should know that not in all, but in many cases doctors, paramedics, nurses, drivers ambulance workers (at least in St. Petersburg) refuse to carry patients on stretchers into the ambulance, arguing "that this is not their responsibility" or "they're not strong enough", or they demand money for carrying patients. Any delay plays against the patient: prepare your porters in advance. Don't get into conflict with ransomware- you may lose valuable time providing medical care. Agree to their terms: remember that life and health are much more important than money. It will be possible to deal with the extortionists after the patient’s condition is stabilized in the hospital. To do this, ask one of your family members or neighbors to be present at the “bargaining” and discreetly record the fact of extortion of money on a mobile phone (video, voice recorder) and later contact the police with these materials: outright lawlessness taking advantage of the helpless situation of patients must be fought.

The responsibilities of doctors, paramedics and ambulance drivers to transfer patients to the ambulance are recorded in the appendices to Order No. 100 of the Ministry of Health of the Russian Federation dated March 26, 1999
Appendix No. 9 Regulations on the doctor of the mobile emergency medical team: The doctor is obliged (clause 2.3) Ensure gentle transport with simultaneous intensive therapy and hospitalization of the patient (victim).
Appendix No. 10 Regulations on the paramedic of the mobile emergency medical team: The paramedic is obliged (clause 2.7) Ensure that the patient is carried on a stretcher, if necessary, take part in it (in the working conditions of the team, carrying a patient on a stretcher is regarded as a type of medical care in a complex of medical measures). When transporting a patient, be next to him, providing the necessary medical care.
Appendix No. 12 Regulations on the driver of the ambulance team: Responsibilities of the driver: (clause 2.5) Provides, together with the paramedic (paramedics), carrying, loading and unloading patients and victims during their transportation, assists the doctor and paramedic in immobilizing the limbs of victims and applying tourniquets and bandages, transfers and connects medical equipment. Provides assistance to medical personnel accompanying mentally ill patients.

For those who don’t believe that the ambulance doctors in St. Petersburg “don’t know how” and “don’t want” to carry patients on stretchers, I suggest watching the latest video from CCTV cameras showing how a patient with a criminal closed craniocerebral injury (according to the press, the victim Denis was beaten in the entrance) “medics” carry him to the “ambulance”:

3. Some emergency physicians may argue that it is dangerous to take a stroke patient to the hospital because he or she is “about to die,” and that “it is better to write a refusal to be hospitalized” and leave the patient to die at home. Unscrupulous emergency doctors use this technique to protect themselves from the death of a patient in an ambulance and subsequent organizational conclusions. The mortality rate for strokes is quite high and amounts to up to 35% at the hospital stage. Insist on hospitalization - you must give the patient a chance at life and recovery. Without immediate provision of qualified medical care, the patient will have much less chance of surviving or avoiding severe disability. If the ambulance doctor refuses to hospitalize the patient, dial the ambulance phone number and report the situation. It is possible that your requests will not be responded to. You can also threaten to call (or telephone) the police and report the doctor's inaction and leaving the patient in danger. Another technique used by doctors who have forgotten the Russian Doctor’s Promise (the Hippocratic Oath) is an “unclear diagnosis.” Such doctors claim that they cannot establish a diagnosis. No diagnosis - no hospitalization. If you encounter such emergency doctors, call a paid ambulance: time plays against you and the patient’s life. Remember that a paid ambulance will cost much less than the funeral of a patient left without qualified medical care. In a hospital, doctors can no longer refuse to provide care.

4. Patients with ischemic stroke are hospitalized in a neurological hospital (90% of stroke cases). Patients with hemorrhagic stroke are hospitalized in a neurosurgical hospital (10% of stroke cases). The type of stroke can only be determined by an emergency physician. As you know, in Russia not all hospitals are “equally good.” An ambulance may refuse to take a patient to a “good” hospital, and offer only a “bad” hospital for hospitalization, which is known for its disregard for patients. Prepare money in advance to pay the ambulance staff to transport a stroke patient to a “good” hospital. If you have friends in the hospital: call them in advance and warn them that you are taking them to a patient with a stroke and ask them to conduct an initial examination, instrumental diagnostics and begin providing medical care immediately. Usually, emergency doctors require you to tell them the full name of the hospital doctor with whom there is an agreement for hospitalization. Prepare this data in advance so as not to waste time.

5. Upon arrival at the hospital emergency department, contact your friends with whom you have previously telephoned, or, if you do not have them, the responsible doctor and explain that the patient has a stroke, and every minute is needed before medical care begins (remember the 3-hour rule from the onset of stroke). Tell them that the life and health of the sick person are dear to you and you will pay for the immediate start of diagnosis and medical care. Otherwise, in the evening, in hospitals in large cities, such as St. Petersburg, the waiting time in the emergency room before medical care begins can be 3-5 hours, which will lead to irreversible impairment of the patient’s brain function during a stroke, despite the fact that that care for stroke should begin as a priority, just as, for example, for myocardial infarction.

If you are in a region where there is no ambulance or an ambulance arrives after a few hours (or does not always arrive - “no gasoline”, “no bridge”, “no roads”), then it is necessary to transport the patient in a lying position on his side (to prevent inhalation of vomit), ensuring airway patency to the nearest medical facility where assistance can be provided. It is better to call there in advance and warn them that you are transporting a patient with a stroke.

What to do before the ambulance arrives?

The main tasks of loved ones and relatives before the ambulance arrives at a stroke patient:
■ Maintaining airway, breathing and circulation.
■ Prevention of complications.
■ Reducing the severity of stroke consequences.
■ Preparation of documents (passport, medical insurance) and important information about the patient (chronic diseases, drug intolerance).

1. Reassure the patient, let him know that you are looking after him, and that an ambulance will arrive soon. If a stroke patient is not in contact with you due to confusion, this does not mean that he does not hear or understand you. The lower the patient's stress/anxiety level, the greater the chance of a better outcome.
2. Do not give the patient anything to drink or eat. Do not give the patient any medicine.
3. Place the patient on a horizontal surface. The less the patient moves, the less chance there is of increased bleeding (if any), blood clot rupture, or vasospasm. If the patient is conscious and there is no vomiting, then he can be laid on his back. You should not raise your head and shoulders: a horizontal position of the head ensures better blood supply to the brain. Remove dentures and food debris from your mouth. You can raise your legs a little - this will improve blood flow to the head. Do not allow the patient to move.

Vomit:

If the patient is not conscious or is feeling sick (vomiting): Immediately turn the patient onto his side, immediately keeping his head in the lateral position to remove vomit. Inhalation of vomit can lead to suffocation or subsequent development of severe pneumonia. It is necessary to monitor the position of the tongue so that its retraction does not block the airways.

Providing a safe position for the patient on his side:

Kneel next to the person. Turn him on his side to face you. Extend his lower arm forward at a right angle. Bend his top leg at the knee, keeping the other leg straight. The bent leg should rest with the knee on the surface. Tilt your head and neck slightly back and down so that the contents of your mouth (if any) can flow down freely. Pull your jaw down and check the airway with your finger. Remove any remaining food or vomit. Hold his jaw so that his mouth is open at all times. Check for free breathing: is there movement of the chest? Do you feel, when you lean your neck towards the patient’s face, his exhalation? Can you hear his breathing? If there is no breathing, it is necessary to urgently begin cardiopulmonary resuscitation (artificial respiration and chest compressions).

Provide a dish or towel for vomit. When vomiting, turn and hold your head down to drain the vomit and prevent inhalation. Use your finger to clear your mouth of any remaining vomit.

Oxygen access:

Unfasten the collar, belt and all other items of clothing that tighten the body and impair blood circulation. Remove the patient's shoes. Ask to open a window for fresh air. Constantly hold the lower jaw so that the patient's mouth is constantly slightly open - this will improve the flow of oxygen. If you have a medical aerosol cylinder with oxygen and a mask (sold in pharmacies) - use it.

Controlling blood pressure:

In most cases, blood pressure increases during the acute period of a stroke. On the one hand, increasing blood pressure is a compensatory means to improve blood supply to the brain. On the other hand, high blood pressure increases the risk of recurrent stroke and worsening the patient's condition. If you can monitor the patient's blood pressure using a tonometer, it is recommended to maintain the following blood pressure values ​​in a patient with a stroke in the acute period:
in patients with hypertension: 180/100-105 mm Hg
in patients without hypertension: 160-180/90-100 mm Hg
Reducing blood pressure with medications without a doctor is strictly prohibited!

Simple manipulations with ice (snow) and heating pads will help slightly reduce blood pressure: Cold (ice) compresses should be applied to the area sinocarotid node(under the lower jaw on the side of the trachea). Impact on the sino-carotid node leads to a decrease in blood pressure and dilation of blood vessels. If there is nowhere to get ice or snow, use a damp towel to cool the reflexogenic zone. A few finger presses on the eyeballs will also help reduce the pressure. At the same time, apply a hot heating pad to your feet or rub your feet with mustard. You should not cover the patient with a blanket: cooling the body leads to centralization of blood circulation, which means improved blood supply to the heart, lungs and brain, which is necessary during a stroke.

You cannot apply ice (cold) to the head or back of the head - this can worsen the blood supply to the brain!

4. Reflexotherapy and micro-bloodletting for acute stroke*

	For stroke the point is actively massaged with force for 3-5 minutes (rubbed, pressed, punctured with a nail), or burned with a cigarette (from a distance of several cm) GI3 san-jian and period V62 shen-may(massage only). In case of loss of consciousness, coma The point is actively massaged with force for 3-5 minutes (rubbed, pressed, punctured with a nail) GI4 he-gu: first on the healthy side of the body, then on the side affected by the stroke.
	Then proceed to influence (strong massage for 3-5 minutes) on the points sequentially VG20 bai-hui(located along the midline of the head at the intersection with the line from the top of the ears) and pressing the point with a fingernail VG26 ren-chong, which is located in the upper 1/3 of the nasolabial fold under the nasal septum.
	Further emergency puncture is performed with a sterile needle from a regular syringe of special extra-meridian points PC86 shih xuan, which are located in the middle of the tip of each finger, 3 mm from the free edge of the nail, with squeezing a drop of blood from each finger, can reduce the severity of the consequences of an acute stroke. Start with puncture of the IV and V fingers. With increased blood pressure points are additionally punctured PC86 II and III fingers of each hand. If it is difficult to remember all the acupuncture points during the procedure, then at least remember about pricking all your fingers and earlobes with a syringe needle.

An infarction of the brain substance that occurs as a result of sudden circulatory failure is called a stroke. This is a fatal pathological condition for humans. First aid (first aid) for a stroke helps a person save a life, as well as avoid its severe consequences.

It is especially important to know what to do in case of a stroke for each person to provide first aid - sometimes the count can literally be “minutes”.

Causes of stroke

During a stroke, blood flow to certain areas of the brain decreases or stops. It is customary to distinguish two variants of the disease - ischemic, when full blood flow is prevented by a plaque, and hemorrhagic - when the vessel wall is ruptured.

Causes of plaque:

• The formation of an atherosclerotic or thrombotic obstruction—thrombosis.
• The entry of a foreign particle into the choroid duct is an embolism.

Causes of vascular wall rupture:

• Arterial hypertension.
• Aneurysms are congenital thinning of a section of the vascular wall.

Provoking factors:

• Tobacco smoking.
• Abuse of excessively fatty foods.
• Obesity.
• Alcoholism.

Signs of an acute condition

Every person needs to know how to recognize a stroke. It could one day save another person's life. The main symptoms of the pathology include:

1. A sudden, painful, severe headache, accompanied by severe nausea and repeated vomiting, flashing of foreign spots before the eyes are the first symptoms of increased intracranial pressure.
2. Significant fluctuations in individual blood pressure parameters.
3. Possible loss of coordination of movements, up to loss of consciousness.
4. Significant impairment of facial expressions and speech – “verbal porridge”.
5. The appearance of double vision, a decrease in visual acuity, usually in one eye.
6. A person suddenly stops recognizing familiar objects, surrounding people, does not remember dates and what day of the week it is on the street.
7. Unilateral paresis and paralysis of the limbs, half of the face.
8. Tremor of the tongue, its pathological deviation to the side.

Any of the listed signs, or their combination, should be alarming - only a specialist will be able to determine the root cause of the condition and prescribe adequate treatment tactics.

Signs of stroke in women, often ignored, and in the meantime they already need first aid:

• Increased frequency of headaches.
• Accompanying habitual headaches with numbness of the face and limbs.
• Increased forgetfulness, which was not typical for women before.
• Impaired coordination of movements.

Signs of stroke in men that you should pay close attention to so that first aid is provided in time:

• Misunderstanding of speech addressed to him.
• Sudden onset of sweating and weakness.
• Numbness in the limbs.
• A sharp decrease in hearing or vision on one or both sides.
• Bradycardia.
• Disorientation in time, personality, space.

Many people do not understand how to identify a stroke in a person. To this end, you can carefully ask him to repeat a few simple steps:

1. Introduce yourself to the person and ask him to respond with his details - last name, first name, address, phone number.
2. Smile and watch how the person smiles back - if certain muscle groups no longer participate in the smile, a stroke is quite possible.
3. Asking a person to raise his hand up and hold it there for a while on his own - if the muscles are weak, this simple action is impossible.
4. When you open your mouth, your tongue may reflexively move to the side - one of the signs of a stroke.

First aid

As early medical care as possible for a stroke helps to avoid the development of irreversible processes in the human brain, and also saves lives. It is a well-known fact that the therapeutic window, when it is possible to stop the pathological process as much as possible, lasts only three hours.

If emergency care for a stroke was provided correctly and in this limited period of time, there is a high probability of a favorable outcome of the disease and optimal restoration of all body functions.

First aid for a stroke is an emergency call to the resuscitation medical team. If the request was transmitted on time, the person’s life will be saved. While emergency personnel are rushing to the call site, it is recommended to perform a number of important actions:

• Reassure the patient as much as possible - fear and anxiety only aggravate his condition.
• Loosen the compressive elements of clothing - the waistband of trousers, the collar of a shirt or blouse.
• The person's head should be higher than the body.
• Ensure as much air flow as possible (if the action takes place indoors).
• If a person knows about the presence of hypertension, and has a tonometer at hand, be sure to check the numbers; if they are significantly exceeded, antihypertensive drugs will be required (hypertensive patients should always have them with them).
• First aid for a stroke at home will consist of distracting procedures - foot baths with boiling water, applying mustard plasters to the calf muscles, etc.
• In case of loss of consciousness, the person should be carefully placed on his side in order to prevent aspiration of possible vomit. If the gastric contents come out, the oral cavity needs to be cleaned. Trace the location of the tongue - it should not go deep inside, otherwise the person may suffocate.
• It is strictly forbidden to give a person vasodilators, give him water or feed him before the arrival of emergency medical personnel. You can only wipe your face with a damp cloth and lightly massage your scalp.

First aid for suspected hemorrhagic stroke

1. Place the patient on a hard surface - table, floor, etc., so that the shoulders and head are in an elevated position. It is not recommended to move the victim over a significant distance.
2. Unfasten tight clothing.
3. Remove dentures, if present.
4. Provide a massive influx of air masses.
5. Tilt the person's head to the side. After vomiting, clean the mouth with a piece of gauze or a clean handkerchief.
6. A container with ice liquid should be applied to the head - to the numb limbs on the opposite side.
7. Maintain optimal blood circulation in all extremities - cover with a warm blanket, apply a heating pad or mustard plasters.
8. Prevent aspiration by monitoring salivation and removing everything from the oral cavity.
9. In case of paresis, lightly rub the limbs with an oil-alcohol solution.

First aid for suspected ischemic stroke

1. Place the person on a hard surface, in a lateral position.
2. Ensure maximum peace, do not move anywhere.
3. Keep the victim in a clear consciousness using cotton wool and ammonia.
4. Monitor breathing function - the tongue should not sink.
5. Do not allow the victim to take any medications, food or liquids.
6. Wipe the head and neck area with a damp cloth every thirty minutes.
7. Rub the torso and limbs with a soft cloth or with your hands.
8. If individual pressure levels are high and in the absence of antihypertensive drugs, immerse the person’s legs in hot liquid (at home).

First aid for stroke and bloodletting

When providing first aid to a person with a suspected stroke, one of the most controversial issues to date is bloodletting. It consists of piercing the fingertips with a needle disinfected over a flame until the first drops of blood appear. If there is asymmetry of facial features, you can intensively rub the ears, and then pierce each earlobe until a drop of blood appears.

It is not recommended to perform it without the advice of a specialist. Using this measure, you can get a double effect - a person’s condition will stabilize, or it will significantly worsen. In the opinion of medical specialists, this method does not have sufficient grounds.

Prevention

Preventive measures designed to prevent the development of this severe pathology include:

• Pay attention to individual blood pressure parameters.
• Regular medical examinations and not only in old age, but in the most able-bodied - stroke significantly - “rejuvenated”.
• Complete, fortified nutrition.
• Regular walks in the fresh air.
• Sufficient physical activity, visiting swimming pools and fitness centers.
• Attention to the slightest deviations in well-being is not typical: forgetfulness, imbalance of movements, numbness in the limbs.
• Compliance with the instructions issued by the attending family doctor.

Deviations noticed in time require consultation with a specialist, and then a stroke can be avoided.