Knowing how to act FAST when you suspect a STRoke can be the difference between recovery and disability! Do it right, do it FAST, and you could save a life. Take too long and, well…. Stroke can affect someone for the rest of their lives, assuming they survive. Read on and find out why it’s good to have your patients smile at you.
What is a stroke or CVA?
Something prevents blood flow to the brain. This causes lack of oxygen to brain tissues and so causes brain damage and very quickly death of the area of brain affected. CVA is simply a medical term for types of stroke, distinguishing stroke from other types of head injury. As different areas of the brain control different activities, the signs and symptoms you see will vary depending on which part of the brain is affected and how much. There are typically two types of stroke:
- Haemorrhagic: A burst blood vessel in the brain which bleeds into the brain, or which puts pressure on the brain.
- Occlusive: A blockage in a blood vessel supplying the brain. Blood no longer gets to brain tissue and so damage is caused (see the picture!).
Signs & symptoms
Remember these depend on which part of the brain has been affected. Some common signs and symptoms of stroke that we would see as first aiders include:
- Sudden severe headache or dizziness
- Difficulty speaking, slurred speech, dribbling
- Confusion, agitation or aggression
- One-sided weakness or paralysis – varies from just face to whole body
Quick tests and why they work
A person suffering a stroke needs treating within the ‘Golden Hour’ (see below). To have the stroke recognized, get them transported by ambulance and have them treated appropriately at hospital means that everything needs doing both quickly and accurately.
Thankfully we only have to do the recognition part (and call EMS). Here’s a few ways to do that:
1. Think FAST:
- Facial weakness or drooping is a significant sign of stroke
- Arms – any weakness or paralysis also suggests a stroke
- Speech – is it slurred? Confused? More signs of a stroke. Remember….
- Time is critical – call EMS if you suspect a stroke.
The FAST test helps you to recognize the essential signs of a stroke, and reminds you of the need to call for help quickly
2. Check if it’s a STRoke:
- Smile – ask them to smile at you. It should look natural. Facial weakness would show in a crooked or ‘droopy’ smile.
- Talk – ask them to say a simple sentence. Same as above – it shouldn’t be slurred or confused.
- Raise their arms – asking them to do this will show any weakness or paralysis – more signs of stroke.
The advantage to STRoke is that the reminder is in the name of the condition. The drawback is that it doesn’t tell you to call EMS quickly – you have to remember that bit yourself.
3. Ask them to stick out their tongue.
This is not a comprehensive assessment for stroke and is used in First Aid or EMS work for many things:
- It tells you the person can hear
- It tells you they have motor control (can make their muscles work)
- It tells you they can obey you (and they aren’t confused)
- It can show facial muscle weakness to someone who knows what to look for.
The advantage is that it’s very quick and easy as well as having several uses. The disadvantage is that you need to know what to look for and that it’s non-specific.
So, pick one to use yourself, or try to remember them all. We use FAST on our training courses: It covers the main signs/symptoms and reminds you to make the phone call. You just have to remember that it’s for stroke. So now you’ve done the quick recognition part, what’s your treatment?
Remember as always to check for your own safety. In the case of someone having a stroke, it’s unusual that there are any dangers or trigger events that would be a problem for you as a first aider.
As soon as you’re reasonably sure this is a stroke, call 9-1-1 (112, 999 or however you get help) and tell them so.
Beyond that there isn’t a lot you can do. Comfort and reassure the person – it can be frightening. In particular they may believe their speech makes perfect sense and wonder why you can’t understand them. Obviously paralysis of major body-parts will be frightening.
You may need to find ways to help the person communicate (eg: they may still be able to write even if they can’t speak) but this might not be necessary depending on how fast help arrives.
If the person is unconscious, then the recovery position is needed (we teach this in every course, so book a place and practice!).
Sometimes we are asked about the use of Aspirin/ASA. This is effective in heart attacks as a blood-thinner and is part of the treatment (for heart attack). It isn’t recommended as first aid for strokes. If you check back you’ll find that one type of stroke is caused by bleeding from a burst blood vessel. If you give these people a blood-thinner, it will/could make things worse. So there is nothing we can ‘give’ them as first aiders to make things better.
At hospital, they need to have the stroke recognized quickly. They will then have tests and imaging to decide if this is a clot or some other cause. The clots can be treated with ‘clot busting’ drugs. Obviously as above, you can’t give these to people who are bleeding. They are most effective if given within 1 hr of the stroke happening and this is often called the Golden Hour. It’s why your FAST recognition of the stroke is so critical. Tests and imaging take time, so quick recognition and transport gives the person the best chance of recovery. Some larger hospitals will have a team of staff on stand-by whose job is to deal with the stroke patients as quickly as possible.
TIA is a term often heard when people discuss strokes & CVAs and they’re sometimes called mini-strokes. (TIA stands for Transient Ischaemic Attack.) They’re caused by reduction in blood flow to the brain, but not a complete blockage of blood flow. TIAs may be a warning sign of worse things to come and anyone suffering should see a doctor.
Signs and Symptoms
TIAs may be similar to stroke, but symptoms may be more minor and will pass with time. For example there will often be a headache, but it can be relieved by the patient with medication and time. There may be unsteady balance and not paralysis. There may be some confusion, which clears up quickly.
If you’re unsure, get the person to hospital and checked out anyway. There is no first aid care for TIAs and they will clear up, but can come back time and again before a person eventually has a stroke. Anyone suffering should be advised to get a check-up with their own doctor.
Have you ever been involved in looking after someone with a stroke? Either as a first aider or afterwards? Is there anything you want to add, or something you wish people had known at the time? Feel free to comment!