Positioning Stroke Patients: Emt's Guide To Patient Comfort And Care

Strokes are a common emergency that EMS professionals respond to, and they can have severe and long-lasting effects on the patient. The positioning of a stroke patient is crucial for their immediate health and can impact their recovery. EMTs and paramedics are often the first healthcare providers to assess and treat stroke patients, so knowing how to position them is an essential skill.

Check for breathing and a pulse

When treating a stroke patient, EMTs follow the ABCDE approach: Airway, Breathing, Circulation, Disability, and Exposure. Checking for breathing and a pulse falls under the "Breathing" step.

To check for breathing and a pulse, watch the chest for movements for 5 to 10 seconds. Simultaneously, check the person's carotid pulse for a minimum of 5 seconds, but no more than 10 seconds. If the person is breathing and has a pulse, monitor them until emergency responders arrive.

If the person has a pulse but is breathing abnormally, maintain their airway and begin rescue breathing. Give one breath every 5 to 6 seconds, not exceeding 10 to 12 breaths per minute. If you are helping a baby or child (aged 1 to puberty), give one rescue breath every 2 to 3 seconds, or about 20 to 30 breaths per minute.

If the person is not breathing and does not have a pulse, start cardiopulmonary resuscitation (CPR). If you are alone, retrieve an AED (automated external defibrillator) and other emergency equipment, or send someone to get them if others are available. If you are trained in CPR, begin administering chest compressions at a rate of 100 to 120 compressions per minute, with a depth of 2 inches. Use a compression-to-ventilation ratio of 30 compressions to 2 breaths.

If the person is breathing but unconscious, roll them onto their side. If you suspect a head, neck, or back injury, do not move the person. If the person is conscious, try to reassure and comfort them. Loosen any constricting clothing or jewelry. If the person is having difficulty swallowing, try to turn them onto their side. Do not give them anything to eat or drink.

Roll the patient onto their side if they are breathing but unconscious

If a person is breathing but unconscious, they should be placed in the recovery position. This position keeps their airway clear and open and ensures that any vomit or fluid won't cause them to choke.

To roll a patient onto their side:

• Kneel on the floor next to the patient, who should be lying on their back.
• Extend the arm nearest you at a right angle to their body, with their palm facing up.
• Take their other arm and fold it so that the back of their hand rests on the cheek closest to you. Hold it in place.
• Use your free hand to bend the patient's knee farthest from you at a right angle.
• Carefully roll the patient onto their side by pulling on the bent knee and bringing it towards you.
• Their bent arm should now be supporting their head, and their extended arm will stop them from rolling too far.
• Make sure their bent leg is at a right angle.
• Open their airway by gently tilting their head back and lifting their chin. Check that nothing is blocking their airway.

If you suspect that the patient has a spinal injury, do not attempt to move them until emergency services arrive.

Loosen constricting clothing or jewellery

As an EMT, it is important to loosen any constricting clothing or jewellery on a stroke patient. This is because the patient's skin may experience allergies or itchiness if the fabric is rough or unsuitable. Soft and loose-fitting clothing is not only easier to put on but can also be removed more easily. For example, soft cotton knit hospital gowns with open back functionality can help EMTs dress a stroke patient easily and safely.

Additionally, tight clothing can restrict blood flow, which is especially dangerous for stroke patients as poor blood flow to the brain is the cause of their condition. Constricting clothing can also cause discomfort and pain, which can increase the patient's stress levels and make it more difficult for EMTs to treat them effectively.

When loosening clothing, it is important to be gentle and careful, especially if the patient has any injuries or fractures. If the patient is wearing jewellery, such as a necklace or bracelet, it may be necessary to remove it to prevent further complications.

EMTs should also be aware that some stroke patients may exhibit behaviours such as attempting to remove their clothing unnecessarily. This can be due to diminished intellectual function or difficulties with activities of daily living. In such cases, it is important for EMTs to handle the situation calmly and patiently, ensuring that the patient is safe and comfortable.

Check for signs of stroke: face drooping, arm weakness, speech difficulties

A stroke is a medical emergency that requires immediate attention and action. It is important to be able to recognise the signs and symptoms of a stroke to ensure the best chances of recovery for the patient. A stroke occurs when there is a disruption in blood flow to the brain, resulting in cell death and impaired brain function. The F.A.S.T. acronym is a helpful tool to identify the signs of a stroke:

Face Drooping:

Look for any asymmetry or drooping on one or both sides of the face. This can be identified by asking the person to smile. A stroke can cause the corners of the mouth to droop, resulting in a crooked smile or difficulty preventing saliva from leaking from the mouth. The eyelids may also appear pulled down, and the person may have difficulty smiling voluntarily.

Arm Weakness:

Check for any weakness or numbness in one arm. Ask the person to raise both arms and hold them for a count of ten. If one arm is weaker and begins to drop, this could indicate a stroke. The person may also be unable to fully raise their arm, hold or squeeze something, or experience a reduction in strength when carrying or lifting objects.

Speech Difficulties:

Listen for any changes in speech, such as slurred or garbled speech, or difficulty understanding and producing words. Ask the person to repeat a simple sentence like "The sky is blue". They may also have difficulty repeating basic sentences or understanding what others are saying.

If you notice any of these signs, it is crucial to act quickly. Call 911 immediately, as time is of the essence in stroke treatment. While waiting for emergency services to arrive, ensure the person is safe, lying down, and comfortable. Loosen any tight clothing, and do not give them anything to eat or drink.

Call 911 immediately if the patient is showing any stroke symptoms

If a patient is showing any signs of a stroke, it is imperative to call 911 immediately. Stroke is a medical emergency that requires prompt attention and treatment. The faster the response, the better the chances of recovery for the patient.

The signs and symptoms of a stroke can vary but typically include sudden weakness or numbness, particularly on one side of the body. This may present as a drooping face or an uneven smile when asked to smile. The patient may also experience arm weakness, with one arm drifting downward when asked to raise both arms. Speech may become slurred or hard to understand, and the person may have difficulty speaking or understanding others.

Other symptoms include a sudden severe headache with no known cause, sudden confusion or disorientation, trouble seeing in one or both eyes, and sudden dizziness or loss of balance and coordination.

If you suspect someone is having a stroke, do not hesitate to call 911. While waiting for emergency services to arrive, assist the patient by having them lie down. Open their airway by lifting their chin, and check for breathing and pulse. If necessary, perform cardiopulmonary resuscitation (CPR). If the person is breathing but unconscious, roll them onto their side, unless a head, neck, or back injury is suspected.

Time is critical when it comes to stroke treatment, so calling 911 immediately can improve the patient's chances of a positive outcome.

Frequently asked questions