Stroke Patients: The Risks Of Being Carried

Ischemic stroke, the most common type of stroke, occurs when blood supply to the brain is blocked, often by a blood clot or atherosclerosis. This can lead to severe and long-term brain damage and even death. Therefore, it is crucial to recognise the signs of a stroke and seek immediate medical attention.

The signs of a stroke include:

- Sudden numbness or weakness of the face, arm or leg, especially on one side of the body

- Sudden trouble speaking

- Sudden trouble seeing in one or both eyes

- Sudden trouble walking

- Sudden dizziness, loss of balance or coordination

- Sudden, severe headache with no known cause

If you or someone near you is experiencing these symptoms, call 911 immediately.

The urgent treatment for an ischemic stroke is clot removal

The urgent treatment for ischemic stroke is clot removal. Doctors can accomplish this with medication and mechanical treatments.

Medications used to treat ischemic stroke include:

• Alteplase IV r-tPA (tissue plasminogen activator)
• Tenecteplase

Mechanical treatments used to treat ischemic stroke include:

• Mechanical thrombectomy
• Intra-arterial (IA) and mechanical thrombolysis

The main cause of an ischemic stroke is atherosclerosis

Atherosclerosis, often referred to as the hardening of the arteries, is the main cause of ischemic stroke. It is a slow and complex disease that usually starts in childhood and progresses with age. Atherosclerosis affects large and medium-sized arteries, and it starts when the inner lining of an artery, known as the endothelium, is damaged. This damage may be caused by physical stress, such as high blood pressure, high blood cholesterol, high blood sugar, or inflammation driven by the immune system.

When the inner lining of an artery is damaged, fats, cholesterol, platelets, cellular debris, and calcium accumulate in the artery walls, leading to the formation of plaque. This plaque thickens the artery wall, narrowing the vessel and decreasing blood flow. As a result, the oxygen supply to the part of the body served by the artery is reduced.

Atherosclerosis can lead to two types of ischemic stroke: atherothrombotic stroke and embolic stroke. Atherothrombotic stroke is the most common type, occurring when a plaque in a blood vessel breaks, causing blood clots to form and block blood flow. On the other hand, an embolic stroke happens when a blood clot or other particle breaks away from the rupture site and travels through the bloodstream until it lodges in an artery in the brain, blocking blood flow.

Males and individuals with a family history of premature cardiovascular disease have an increased risk of atherosclerosis. Other risk factors include high blood pressure, high blood cholesterol, cigarette smoking, unhealthy eating habits, and older age.

Ischemic stroke occurs when the arteries that supply blood to the brain become narrowed or blocked, resulting in insufficient blood and oxygen flow to the brain. It is the most common type of stroke, accounting for about 87% of all strokes. The urgent treatment for ischemic stroke is clot removal, which can be achieved through medication, such as tissue plasminogen activator (tPA), and mechanical treatments, such as mechanical thrombectomy.

In-hospital strokes have a mortality rate 2-3x greater than community-onset strokes

In-hospital strokes have a mortality rate that is two to three times greater than community-onset strokes. In-hospital strokes are defined as acute infarction of central nervous system tissue that occurs during hospitalisation in a patient originally admitted for another diagnosis or procedure. The median National Institute for Health Stroke Severity (NIHSS) score for in-hospital strokes is 9, which is more than twice the median severity for strokes from the community (median NIHSS score of 4).

In-hospital strokes are associated with longer hospital stays, greater disability on the modified Rankin score, and a lower likelihood of returning home directly from the hospital. In-hospital strokes are also associated with a mortality rate of 14% to 19%, which is substantially higher than the rate for community-onset strokes.

The higher mortality rate of in-hospital strokes may be due to the combination of the original cause of hospitalisation and the subsequent complication of an in-hospital stroke. Additionally, there are often higher rates of medical contraindications to intravenous thrombolysis in patients with in-hospital strokes, which can delay treatment and contribute to worse outcomes.

To improve the quality of care and reduce the mortality rate for in-hospital strokes, it is important to address the delays in hospital-based evaluation and treatment. Implementing quality improvement initiatives, such as creating acute inpatient stroke response systems and developing stroke-specific protocols, can help reduce response times and improve patient outcomes.

Nurses are critical in supporting and providing educational opportunities to prehospital providers

Nurses play a critical role in supporting and providing educational opportunities to prehospital providers. They can offer valuable insights into patient safety culture and help develop policies that encourage students to express concerns and celebrate successes. Nurses can also aid in enhancing psychological safety within teams, fostering an environment where everyone feels comfortable speaking up. This includes supporting students in processing and reflecting on patient safety events to prevent them from affecting their future careers and professionalism.

Additionally, nurses can provide clinical training and facilitate the application of theoretical knowledge to practice. They can guide prehospital providers in developing critical incident management skills and help them understand the complexities of the prehospital environment, which differs significantly from other healthcare settings. Nurses can also offer expertise in areas such as anatomy, physiology, pharmacology, and cardiology, enhancing the knowledge and skills of prehospital providers.

Furthermore, nurses are well-positioned to provide mentorship and ongoing support to prehospital providers. They can offer guidance on ethical considerations, patient interactions, and collaboration with other healthcare professionals. By sharing their experiences and best practices, nurses can empower prehospital providers to make informed decisions and provide the best possible care to patients.

Nurses also play a vital role in advocating for policy changes and resource allocation to optimize prehospital care. They can collaborate with healthcare organizations and managers to develop and implement evidence-based practices that improve patient outcomes. By actively engaging in research and contributing to the development of clinical guidelines, nurses can help shape the future of prehospital emergency care.

Overall, nurses are integral to the education and professional development of prehospital providers. Through their clinical expertise, mentorship, and advocacy, nurses help ensure that prehospital providers are well-equipped to handle emergencies and provide high-quality care to patients.

Secondary stroke prevention requires collaboration from all members of the healthcare team

Personal development, social well-being, interprofessional education, communication, and role understanding significantly contribute to stroke team functioning. Team-level constructs affecting interprofessional stroke team functioning include communication and role understanding.

Interventions to improve team members' social well-being, communication, and role understanding will improve teams' performance. Healthcare organizations should pay attention to developing professionals' interpersonal skills and interprofessional education to further advance interprofessional team functioning.

The urgent treatment for ischemic stroke is clot removal through medication and mechanical treatments. Doctors can use medication such as Alteplase IV r-tPA, which is approved by the Food and Drug Administration, or mechanical thrombectomy to remove a clot in eligible patients with a large vessel occlusion.

Individualized hospital care for stroke focuses on monitoring and observing to detect and prevent complications, finding the cause of the stroke, identifying and initiating treatment to prevent further strokes, starting the recovery process, and providing instruction and guidance for next steps, including a follow-up plan to prevent another stroke.

Collaboration between health professionals is required across the entire stroke pathway. Stroke remains a complex and challenging condition, but there have been sustained improvements in early recognition, hyperacute care, and inpatient stroke unit and early supported discharge services.

Frequently asked questions