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Literature review on Stroke
Essay on types of stroke and common warning signs and symptoms
Literature review on Stroke
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Epidemiology /Incidence of the Patient’s Clinical Presentation and relevance to paramedic practice Cerebral vascular accidents are becoming a predominant health issue within society, effecting approximately 51,000 Australians each year (1,2), and has been identified as the second most common cause of death within communities. The Australian Government currently spends in excess of $5 billion annually on treatments for cerebral vascular accidents with costs continuing to increase dramatically (2,3). Strokes are a major cause of mortality and one of the most common causes of permanent disability, statistics show that there is over 440,000 people living with the debilitating effects following strokes in Australia alone (2,3). Two classifications …show more content…
of cerebral vascular accidents exist, these are ischemic and hemorrhagic (1). With the lifestyle of many individuals worldwide looking towards fast and convenient living, the incidence of cerebral vascular accidents is increasing rapidly. In addition to lifestyle choices, many predisposing factors such as genetics, ethnicity, high blood pressure, bleeding disorders and others exacerbate the condition (4, 5). Paramedics are becoming an essential tool in treating stroke cases, having the ability to rule out certain problems which may mimic stroke symptoms, being able to provide reassurance for the patient by providing care and medication (eg. anti-emetics) and also increase the positive outcome of patients after being admitted to hospital resulting from the fast reaction, treatment and transport to appropriate stroke centres (6). Patient’s Clinical Presentation The 70 year old female patient has presented with multiple signs and symptoms indicating towards a cerebral vascular accident. Whether ischemic or hemoharrgic is unknown until the patient is admitted into the hospital setting and professional assessments are completed. Many of the clinical presentations of the patient are similar for both types of strokes, depending upon the area of the brain which is affected. The sudden onset of headache is a common symptom for many stroke patients, the cause can vary but it is suggested to involve the blood vessels within the brain or the irritation of the membrane (4). The patient also presented with slurred speech and a loss of function on one side of the body, which relates to hemiparesis: when one side of the body becomes weakened due to the occlusion of certain arteries (7). The side which is experiencing the loss of function relates to particular arteries within the brain (7). High blood pressure is a common risk factor for the occurrence of strokes. The high blood pressure of 190/100 and also the high resting pulse rate of 120, may indicate to the paramedics that hypertension may have been a contributing factor to the stroke initially or may have been caused by the stroke itself (8). No family history has been provided from the patient in relation to any factors which may cause the onset of presented symptoms, or any predisposing factors which may indicate why the symptoms are present. In this case, further questioning will be undertaken in consideration to medical history and medications. Aetiology and Pathophysiology of Case Presentation Ischemic strokes are the more common classification of stroke, with more than 80% of patients experiencing one (5, 9). The patients symptoms resemble those of a stroke as evidenced by the sudden onset of headache and hemiparesis. Ischemic strokes occur when there is loss of oxygen and nutrients to a certain area of the brain. Oxygen and nutrients, such as glucose, help the brain maintain homeostasis and maintain function at maximum efficiency (10). This loss is caused when cerebral vessels either become more narrow or the pressure within them is decreased, which results in tissue damage downstream from the injury (11). Thrombosis, embolisms, athersclerosis and even focal hypo-perfusion also have the ability to effect the cerebral blood flow (9, 12). Atherosclerosis causes the progressive hardening of arteries due to lifestyle factors and predisposition to genetic factors. Fat, cholesterol, waste products and other materials build up and form a plaque blockage within the artery (13). If the plaque builds up in an artery which allows blood flow to the brain, this results in diminished oxygen and nutrient supply, leading to a stroke (12). With delayed action and treatment, the lack of oxygen and nutrients pushes neurons to work anaerobically instead of aerobically, which results in tissue damage and necrosis. Pre-hospital Management Paramedics play a vital role in the pre-hospital management of strokes. As stated above, paramedics have the ability to decrease patient mortality and morbidity. According to the clinical practice guidelines, there are multiple interventions paramedics are able to undertake whilst transporting the patient.
In cerebral vascular attacks, maintaining airway, breathing and circulation is the main focus (6). It essential to keep the airway open and clear of any objects. With the patient presenting hemiparesis, it is possible the patient may have blockage in the airway through the loss of ability to maintain the airway themselves, such as loss of muscle tone to tongue and loss of control to muscles in the airway (1,6). The patient presents with a Sp02 level of 99% which is normal, oxygenation and ventilation is not immediately required but respiratory rate, rhythm and Sp02 must continue to be monitored (1, 6). Curtis and Ramsden suggest that providing a patient with high Sp02 levels with supplememtary oxygen may cause hyperoxia, and therefore increase the cerebral injury severity (14), causing more harm to the patient (15). It is recommended that the patient is placed on a 45 degree angle in order to increase cerebral perfusion and decrease cerebral oedema, or build up of fluid (6). Antiemetics can be administered if the patient feels nauseous or is vomiting, or prophylactically to protect airway if patient shows an altered level of consciousness. Circulation needs to be monitored as the patient has presented with a high pulse rate and also a raised blood pressure
(6). Before diagnosing the patient with a stroke, the paramedics need to ensure that the symptoms are not indicating any other medical emergencies, such as hypoglycaemia, brain tumours, migraines, electrolyte imbalances, previous disorders, seizures, bells palsy, drug overdose or possible other states, which may require a different treatment or worsen with the recommended stroke treatment (16). The most important input paramedics can have to a patient presenting with the symptoms of stroke is fast transport to the appropriate facility in order to access hospital treatment such as thrombosis (17). Giving warning to hospitals of the incoming patient can reduce delay in waiting time once at hospital, decrease the chance of mortality and also increase quality of life after hospitalisation (18). Deciding which hospital the patient will be transported to is necessary for the best treatment. If possible, the patient indicating stroke symptoms should be taken to hospitals with specialised stroke centres for further medical diagnosis and intervention (6, 19). If the stroke symptoms have an onset of less than 3.5 hours, lysis is able to be provided within the hospital setting (6). ICP’s can be called to provide assistance if the airway becomes compromised.
In the research paper of Paramedics and Evidence based practice there was a large online survey, which was based on, five question related to Evidence Based Practice (EBP) and pre-hospital. Descriptive statistics are used to answer the question provided in the survey, where large number of paramedic have positive attitude towards evidence-based practices. The survey were consists of different question asked about paramedic with there year of experience there education level and clinical level where different demography of student and paramedic were involved. There were 892-response given to the survey through out one months of study period. Here 90% believed pre hospital care improve patient care and 92% report being likely to change clinical practices as a result of pre hospital evidences. With the research of Evidence Based Practice they find out that paramedic were distinct group of health provider in the society. The research also tells us that paramedics who have positive expectation on EBP were more likely to responds towards the survey which involves tertiary education and shorter length services. Some limitation of these survey includes only certain groups of paramedics were involved also the instrument used were not validity or reliability and single paramedic have respond more than one in the survey.
Health Care workers are constantly faced with legal and ethical issues every day during the course of their work. It is important that the health care workers have a clear understanding of these legal and ethical issues that they will face (1). In the case study analysed key legal and ethical issues arise during the initial decision-making of the incident, when the second ambulance crew arrived, throughout the treatment and during the transfer of patient to the hospital. The ethical issues in this case can be described as what the paramedic believes is the right thing to do for the patient and the legal issues control what the law describes that the paramedic should do in this situation (2, 3). It is therefore important that paramedics also
The cost of Medical equipment plays a significant role in the delivery of health care. The clinical engineering at Victoria Hospital is an important branch of the hospital team management that are working to strategies ways to improve quality of service and lower cost repairs of equipments. The team members from Biomedical and maintenance engineering’s roles are to ensure utilization of quality equipments such as endoscope and minimize length of repair time. All these issues are a major influence in the hospital’s project cost. For example, Victory hospital, which is located in Canada, is in the process of evaluating different options to decrease cost of its endoscope repair. This equipment is use in the endoscopy department for gastroenterological and surgical procedures. In 1993, 2,500 cases where approximately performed and extensive maintenance of the equipment where needed before and after each of those cases. Despite the appropriate care of the scope, repair requirement where still needed. The total cost of repair that year was $60,000 and the repair services where done by an original equipment manufacturers in Ontario.
Being a part of the paraprofessional team requires that I be knowledgeable on how to handle all kinds of difficult scenarios. Case study number one presents a possible situation that a Resident Advisor may have to deal with. There are many steps and processes involved in solving some problems that paraprofessionals will encounter. Case study number one presents an issue between the members of a community government. It is important to recognize though, that there is much more hidden beneath the few problems that seem to have surfaced. These issues may appear as much less on the surface, but beneath each problem, lies much deeper roots. These roots are what must be dealt with in order to do a thorough job of taking care of the issues at hand.
Cerebrovascular Accident a) Overview - definition and the effects of the stroke on the body A stroke is a serious, life-threatening medical condition that occurs when the blood supply to part of the brain is cut off. (http://www.nhs.uk/conditions/Stroke/Pages/Introduction.aspx) This condition is a common cause of death and disability, especially in older people. Some predisposing factors include: • hypertension • atheroma • cigarette smoking • diabetes mellitus It occurs when blood flow to the brain suddenly interrupted, causing hypoxia. The effects include paralysis of a limb or one side of the body and disturbances of speech and vision.
The human body is an amazing machine, we have cells, tissues, organs and organ system that come together to create the human race. Each system plays a key role in our bodies mechanism. Without each systems our bodies would not function properly, but what happens when one of these system fails? The Cardiovascular system components are blood, blood vessels and the heart. The hearts function is to pump blood to all the major organs and tissues (Circulatory). It’s also important to be aware of the derivation that our bodies may encounter, for example a stroke. In this passage I discuss different types of strokes, what are the signs and symptoms and after care for this disorder of the cardiovascular system.
Stroke occurs when the blood supply to the brain is blocked or condensed. Blood works to transport oxygen and other beneficial substances to the body’s cells and organs, as well as the brain. There are two main types of strokes that are known as Ischemic strokes and Hemorrhagic strokes. When the blood vessels that provides for the brain becomes congested, is it referred to as ischemic stroke, the most common stroke within adults. Blood clots, a cluster of blood that sticks together, are the cause of Ischemic strokes. Ischemic strokes also takes place when arteries become backed up with plague, leaving less blood to flow. Plague is cholesterol, calcium and fibrous and connective tissue that sticks to the walls of blood vessels. Ischemic strokes eternally damage the brain and cause a person's body to no longer function habitually.Some risk factors that may increase stroke are high cholesterol, diabetes, high blood pressure, and obesity. Some stroke factors are also due to old age or having a family that has a history of strokes. Men are more likely to have a stroke but the most st...
It goes without saying that everyone’s health is important and should be taken care carefully. Everyone has heard of strokes before but many people do not really know its meaning, types, and the number of individuals of that dies due to this issue. According to Centers for Disease Control and Prevention (2015), strokes kills an average of 130,000 people a year and it is one of the most common deaths that happen in the United States. An average of 800,000 of people die from cardiovascular disease and strokes and it is also a reason of long-term disability (Centers of Disease Control and Prevention, 2015). Strokes, which can also be called cerebrovascular accident or CVA happen when the blood supply to the brain is interrupted or the blood vessel going towards the brain burst. Then part of the brain dies or become seriously injured because the brain cells do not receive oxygen and they eventually die. People’s lifestyle may also impact seriously on their health and increase the possibility of having a stroke. Some of the risk that can severely increase the cause of stroke would be high blood pressure, heart disease, diabetes, cigarette smoking, as well as strokes that
Emergency room nursing is a very rewarding job. Unlike other specialty nursing units in the emergency room the nurse never aware of what might walk in the door next. This can be scary and for the adrenaline junkie exciting. With the fact the nurse never know what might walk in the emergency room nurse needs to have a large knowledge base. This includes that of infection control.
A Paramedic (EMT-P) works directly with the public providing personal assistance, medical attention, and emotional support. They respond to medical emergencies providing on-scene treatment, crisis intervention, life-saving stabilization, and transport of ill or injured patients to a treatment center.
Strokes are not only the leading cause of mentally disabling adults, but they are also the third most common reason for deaths worldwide (Jarvis, 2012). In general, a stroke, also called a “cerebrovascular accident,” occurs when blood flow of the vascular system is blocked from reaching parts of the brain (Jarvis, 2012). There are two types of stroke, an ischemic stroke or a hemorrhagic stroke, and they differ in the way they affect the vascular system. An ischemic stroke is the most common type of stroke, accounting for 80 percent of all strokes, and it is due to a thrombus or embolus blocking blood vessels supplying the brain (Durukan & Tatlisumak, 2007). A hemorrhagic stroke is less common, but is caused by the rupturing of a blood vessel in the brain and causes bleeding (Jarvis, 2012).
The World Health Organisation (2013) explains that an Ischaemic stroke occurs as a result of a blood vessel becoming blocked by a clot, reducing the supply of oxygen to the brain and, therefore, damaging tissue. The rationale for selecting Mary for this discussion is; the author wishes to expand her evidenced based knowledge of stroke since it is the principal cause of disability and the third leading cause of mortality within the Scottish population (Scottish Intercollegiate Guidelines Network (SIGN), 2008) and, therefore, a national priority. In response to this priority, the Scottish Government (2009) produced their ‘Better Heart Disease and Stroke Care Action Plan’. Additionally, they have introduced a HEAT target to ensure 90% of stroke patients get transferred to a specialised stroke unit on the day of admission to hospital (Scottish Government, 2012).
Stroke is a serious medical condition that affects people of all ages specifically older adults. People suffer from a stroke when there is decreased blood flow to the brain. Blood supply decreases due to a blockage or a rupture of a blood vessel which then leads to brain tissues dying. The two types of stroke are ischemic stroke and hemorrhagic stroke. An ischemic stroke is caused by a blood clot blocking the artery that brings oxygenated blood to the brain. On the other hand, a hemorrhagic stroke is when an artery in the brain leaks or ruptures (“About Stroke,” 2013). According to the Centers for Disease Control and Prevention (CDC), “Stroke is the fourth leading cause of death in the United States and is a major cause of adult disability” (“About Stroke,” 2013). Stroke causes a number of disabilities and also leads to decreased mobility in over half of the victims that are 65 and older. The CDC lists several risk factors of stroke such as heredity, age, gender and ethnicity as well as medical conditions such as high blood pressure, high cholesterol, diabetes and excessive weight gain that in...
Stroke is a commonly known disease that is often fatal. This cellular disease occurs when blood flow to the brain is interrupted by either a blood clot halting the progress of blood cells in an artery, called an Ischemic stroke, or a blood vessel in the brain bursting or leaking causing internal bleeding in the brain, called a hemorrhagic stroke. When this happens, brain cells are deprived of oxygen and nutrients because the blood cells carrying these essential things are stopped, causing them to die. When the cells in the brain die, sensation or movement in a limb might be cut off and may limit an organism’s abilities. A person with stroke is affected depending on where in the brain the stroke occurs. In other words, symptoms of a stroke
Paramedics bear a tremendous amount of responsibility. They are heavily relied upon during emergency situations, and are often the only medical professionals at the scenes. A combination of qualities that are essential for paramedics include: a compassionate nature, a healthy physical condition, and a strong mental capacity.