Cerebrovascular accident or stroke (Table 13) is a syndrome associated with the interruption of blood supply to a portion of the brain causing neurologic deficit. Most commonly, a stroke is secondary to an evolving blood clot associated with atherosclerosis that progressively blocks a cerebral artery. Alternatively, it may be due to an embolus that lodged in a cerebral artery obstructing blood flow or result from subarachnoid or intracerebral hemorrhage into brain tissue. Stroke-like symptoms lasting less than 1 hour are termed transient ischemia attacks (TIA).
Table 13. Cerebrovascular Accident.
Prevention:
Identify at-risk patient
Reduce anxiety
Ensure profound local anesthesia
Use local anesthetic agents containing a vasoconstrictor congruent with the patient’s functional capacity
Place patient in an upright or semi-reclining position
Ask patient to smile
Normal: both sides of face move equally
Abnormal: one side of face does not move at all
Ask patient to raise both arms
Normal: both arms move equally or not at all
Abnormal: one arm drifts compared to the other
Ask the patient to repeat “you can’t teach an old dog new tricks”
Normal: patient uses correct words with no slurring
Abnormal: slurred or inappropriate words or mute
If any one of the 3 signs of stroke assessment is abnormal
Notify EMS
Administer oxygen
2 to 4 L/minute by nasal cannula
Monitor vital signs
If at any time the patient becomes unresponsive, no normal breathing, and no palpable pulse consider the diagnosis of respiratory and/or cardiac arrest
Immediate CPR and defibrillation congruent with current recommendations
Nota bene:
Signs of recovery: patient regains consciousness, respiration returns to normal
Signs of deterioration: unconsciousness persists, respiratory depression progressing to respiratory arrest
