Stroke: stages and tactics of intensive care (lecture)

From this article you will learn: what first aid should be for a stroke. Features of emergency measures at home and on the street, depending on the type of stroke.

First aid measures for stroke are a set of actions and measures aimed not only at saving the patient’s life. The possibility of restoring damaged brain cells and the functional abilities of the nervous system depends on the time and correctness of its provision. According to foreign and domestic experts, the optimal time for delivering a patient to a medical facility is 3 hours from the moment of illness (the sooner the better).

What should be done first when a person has a stroke?

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Wherever the stroke occurs and no matter what the stroke is, both the patient himself (if his condition allows) and those around him must act according to a clear algorithm:

1. Do not panic!!!
2. Assess the patient’s general condition: consciousness, breathing, heartbeat, blood pressure.
3. Identify the obvious signs of a stroke: unilateral paralysis of an arm and leg, a distorted face, speech impairment, lack of consciousness, convulsions.
4. Call an ambulance by calling 103!
5. Find out the circumstances of the illness (briefly if possible).
6. Provide resuscitation measures (artificial respiration, cardiac massage), but only if they are necessary (lack of breathing, heartbeat and dilated pupils).
7. Position the patient correctly - on his back or side, either with his head and torso slightly elevated, or strictly horizontally.
8. Provide conditions for good oxygen access to the lungs and blood circulation throughout the body.
9. Monitor the patient's condition.
10. Arrange transportation to the nearest hospital.

The emergency care described above is general and does not include some situations that are possible during a stroke. The sequence of events does not always have to be strictly the same as in the given algorithm. In case of critical impairment of the patient's condition, one has to act very quickly, performing several actions simultaneously. Therefore, if possible, 2-3 people should be involved in providing assistance. In any case, following the algorithm, you can save the patient’s life and improve the prognosis for recovery.

Stages of medical care for stroke

The main principle of managing patients with acute stroke is the staged organization of medical care.

The following stages are distinguished:

I. Diagnosis of stroke and emergency measures at the prehospital stage.

II. The earliest possible hospitalization of all patients with stroke.

III. Diagnosis of the nature of the stroke.

IV. Clarification of the pathogenetic subtype of stroke.

V. Selection of optimal treatment tactics.

VI. Rehabilitation and measures for secondary prevention of stroke.

Stages of medical care for acute stroke and the goals of its provision:

1. Prehospital

(doctor, family or local doctor, ambulance or FAP paramedic)

• Diagnosis of stroke
• Carrying out emergency treatment measures
• Hospitalization

Diagnostics:

History (presence of cerebrovascular pathology, high blood pressure and other risk factors). Acute development of neurological symptoms (weakness in the limbs, impaired speech, breathing, consciousness, facial asymmetry, etc.).

The main task at the prehospital stage is the correct and rapid diagnosis of stroke as such. An exact determination of the nature of the stroke (hemorrhagic or ischemic) is not required; it is only possible in a hospital after CT or MRI studies of the brain. The clinical picture of the development of stroke is characterized, as a rule, by the sudden (within minutes, less often hours) appearance of focal (or cerebral, and in the case of subarachnoid hemorrhage (SAH) - meningeal symptoms.

For correct and timely diagnosis of stroke, it is necessary to know the focal, cerebral and meningeal symptoms characteristic of this disease.

Detailed description of all emergency steps

Each activity that includes first aid for a stroke requires proper execution. It is very important to adhere to subtleties, since any “little detail” can be fatal.

No fuss

No matter how serious the patient’s condition, do not panic or fuss. You must act quickly, harmoniously and consistently. Fear, fuss, haste, and unnecessary movements lengthen the time it takes to provide assistance.

Reassure the patient

Every conscious person with a stroke is definitely worried. After all, this disease is sudden, so the body’s stress reaction cannot be avoided. Anxiety will aggravate the condition of the brain. Try to reassure the patient, convince him that everything is not so scary, this happens and doctors will definitely help solve the problem.

Call an ambulance

Calling an ambulance is the first priority. Even the slightest suspicion of a stroke is an indication to call. Specialists will better understand the situation.

Call 103, tell the dispatcher what happened and where. It will take no more than a minute. While the ambulance is on the way, you will provide emergency care.

Assess your general condition

First of all, pay attention to:

• Consciousness: its complete absence or any degree of confusion (lethargy, drowsiness) is a sign of a severe stroke. Mild forms are not accompanied by impaired consciousness.
• Breathing: it may not be impaired, or it may be absent, intermittent, noisy, frequent or rare. Artificial respiration can be performed only in the complete absence of respiratory movements.
• Pulse and heartbeat: they can be clearly audible, rapid, arrhythmic or weakened. But only if they are not detected at all, you can do indirect cardiac massage.

Assess the patient's condition and determine the need for cardiopulmonary resuscitation

Identify the signs of a stroke

Stroke patients may have:

• severe headache, dizziness (ask what is bothering the person);
• short-term or persistent loss of consciousness;
• distorted face (ask him to smile, bare his teeth, stick out his tongue);
• impaired or lack of speech (ask to say something);
• weakness, numbness of the arms and legs on one side, or their complete immobility (ask them to raise their arms in front of you);
• visual impairment;
• impaired coordination of movements.

Lack of consciousness or any combination of these signs is a high probability of a stroke.

Correct position of the patient

Regardless of whether the consciousness and general condition of a stroke patient is impaired or not, he needs rest. Any movements, especially independent movement, are strictly prohibited. The position could be:

• On the back with the head and chest raised - with preserved consciousness.
• Horizontally on the side with the head turned to one side - in the absence of consciousness, vomiting, convulsions.

Correct position of the patient in the absence of consciousness

• Horizontally on the back with the head slightly thrown back or turned to the side - during transportation and resuscitation measures.

It is forbidden to turn a person on his stomach or lower his head below his body position!

If there are cramps

Convulsive syndrome in the form of severe tension of the whole body or periodic twitching of the limbs is a sign of a severe stroke. What to do with the patient in this case:

• Lay on your side with your head turned to prevent saliva and vomit from entering your respiratory tract.
• If you can, place any object wrapped in cloth between the jaws. It is rarely possible to do this, so do not make much effort - it will do more harm than good. Do not try to push the jaws apart with your fingers - this is impossible. Better grab the corners of the lower jaw, try to bring it forward. Do not insert your fingers into the patient's mouth (risk of injury and loss of a finger).
• Keep the patient in this position until the convulsions end. Be prepared for the possibility that they may happen again.

On the importance of the circumstances of the disease

If possible, find out exactly how the person got sick. This is very important, since some symptoms of stroke can also be observed in other diseases:

• traumatic brain injury;
• diabetes mellitus;
• brain tumors;
• poisoning with alcohol or other toxic substances.

Resuscitation: conditions and rules

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An extremely severe stroke, affecting vital centers, or accompanied by severe cerebral edema, occurs with signs of clinical death:

• complete lack of breathing;
• dilation of the pupils of both eyes (if only one pupil is dilated - a sign of a stroke or hemorrhage in the hemisphere on the affected side);
• complete absence of cardiac activity.

Follow these steps:

1. Place the person on their back on a hard surface.
2. Turn your head to the side, use your fingers to free the oral cavity from mucus and foreign objects (dentures, blood clots).
3. Throw your head back well.
4. Grab the corners of the lower jaw with 2–5 fingers of both hands, pushing it forward, while using your thumbs to slightly open the patient’s mouth.
5. Artificial respiration: cover the patient’s lips with any cloth, and, pressing your lips tightly, take two deep breaths (mouth-to-mouth method).
6. Heart massage: Place your right hand on top of your left (or vice versa), interlocking your fingers. Applying your lower palm to the junction of the lower and middle parts of the patient's sternum, apply pressure to the chest (about 100 per minute). Every 30 movements should alternate with 2 breaths of artificial respiration.

What medications can be given for a stroke?

If an ambulance is called immediately after a stroke occurs, it is not recommended to give the patient any medications on your own. If delivery to the hospital is delayed, the following drugs (preferably in the form of intravenous injections) help support brain cells at home:

• Piracetam, Thiocetam, Nootropil;
• Actovegin, Ceraxon, Cortexin;
• Furosemide, Lasix;
• L-lysine escinate.

Self-help for stroke

The ability to help yourself with a stroke is limited. In 80–85% of cases, a stroke occurs suddenly, manifested by a sharp deterioration in condition or loss of consciousness. Therefore, patients cannot help themselves. If you experience stroke-like symptoms:

1. take a horizontal position with the head end raised;
2. tell someone you feel bad;
3. call an ambulance (103);
4. adhere to strict bed rest, do not worry and do not move excessively;
5. release the chest and neck from constricting objects.

Helping yourself if you have a stroke

Algorithm for managing a patient with ischemic stroke

Acute stroke is one of the leading causes of morbidity and mortality worldwide. According to WHO, stroke is the second most common cause of death. In Europe, about 1 million acute ischemic strokes (IS) occur every year. More than 400 thousand strokes are registered annually in Russia, of which 80-85% are ischemic. Until recently, views on the problem of emergency care for stroke patients were dominated by “therapeutic nihilism.” However, improved understanding of pathophysiological processes and new treatment technologies have changed the management of stroke patients.

The main stages of medical care for acute cerebrovascular accident (ACVA) are the following: prehospital, hospital, outpatient.

Pre-hospital stage

It includes the diagnosis of stroke, emergency treatment measures, as well as emergency hospitalization of the patient. Here it is necessary to call an emergency doctor, who must first examine the patient, collect anamnesis, exclude other causes of deterioration of the condition (they may be hyperglycemia, hypoglycemia, poisoning, infection, traumatic brain injury, fainting, migraine, renal or liver failure), and finally , establish a diagnosis of stroke of an as yet unspecified nature.

The main role in this case is played by the anamnesis, carefully collected from the words of relatives, those around or the patient himself, as well as the characteristics of the development of neurological disorders over time. Sudden and acute, within a few seconds or minutes, development of a neurological deficit in the form of weakness and/or numbness of the limbs, face and, often, speech impairment in persons, usually middle-aged or elderly, against the background of significant emotional, physical stress or immediately after sleep, taking a hot bath, with high or, conversely, low blood pressure allows you to accurately diagnose stroke.

The main stages of medical care for acute cerebrovascular accident:

1. Pre-hospital.

2. Hospital.

3. Outpatient clinic.

The onset of a stroke is usually accompanied by the sudden onset of the following symptoms in the patient:

However, we must remember about the possible development of other symptoms and their combinations. These are, for example, various types of disturbances in the level of wakefulness from stupor to stupor and coma, swallowing or coordination of movements; the appearance of double vision, dizziness.

Emergency treatment measures

The emergency measures of the emergency medical team upon arrival to a stroke patient should include a set of mandatory measures that are carried out immediately after a general examination of the patient.

Assessing the adequacy of oxygenation and its correction

Inadequate oxygenation is indicated by:

increased frequency and arrhythmia of respiratory movements;

cyanosis of visible mucous membranes and nail beds;

participation in the act of breathing of auxiliary muscles;

swelling of the neck veins.

The simplest way to improve oxygenation is to supply the patient with oxygen through the nasal passages at a rate of 2-4? l/min. Ensuring effective oxygenation, if necessary, is carried out by installing an airway and clearing the respiratory tract. For breathing problems, the following are contraindicated: lobeline hydrochloride (depresses breathing, can provoke tonic-clonic convulsions, lowers blood pressure (BP) and causes vomiting); cytisine (has a very short-term effect and does not stabilize normal breathing); camphor, procaine with sulfocamphoric acid, niketamide (promote the development of convulsive syndrome and depress breathing).

Correction of circulatory disorders

It is carried out by stabilizing blood pressure at 180/100 mm Hg. Art. in patients with arterial hypertension and at a level of 160/90?mm?Hg.?st. in normotensive people. Blood pressure should not be reduced in cases where it exceeds the specified values ​​by more than 15-20% of the original values. The most commonly used are captopril 6.25-12.5 mg or enalapril 5-10 mg. If the effectiveness is insufficient, it is possible to administer 1-2 ml of a 1% solution of proxodolol intravenously over 1 minute, again every 5 minutes until the effect is achieved, but not more than 10 ml of a 1% solution. It is not recommended to prescribe nifedipine due to the risk of a sharp decrease in blood pressure.

For arterial hypotension, the use of sympathomimetics, drugs that improve myocardial contractility (cardiac glycosides), and volume-replenishing agents (low molecular weight dextrans, starches and crystalloid solutions) is recommended.

Relief of psychomotor

excitement, seizures

For this purpose, short-acting benzodiazepines administered intravenously are used: diazepam 0.2-0.4 mg/kg, midazolam 0.2-0.4 mg/kg. If ineffective, sodium volproate is used (iv 6 mg/kg for 3 minutes, followed by a transition to 1-2 mg/kg/h); sodium thiopental (the bottle is dissolved with 10 ml of physiological sodium solution and administered intramuscularly at the rate of 1 ml per 10 kg of patient weight).

Determination of blood glucose levels

and its correction

Blood glucose levels are determined using a standard rapid test. Correction at high glucose levels is carried out with simple insulin, at low levels - using an intravenous 40% glucose solution. If it is not possible to determine blood glucose, but a violation of carbohydrate metabolism is suspected, one should be guided by the rule: hypoglycemia is more life-threatening than hyperglycemia. Based on this, intravenous administration of 50-60 ml of 40% glucose is recommended. In the presence of hypoglycemia, this can save the patient, while at the same time, in case of hyperglycemia, additional administration of this amount of glucose will not lead to tragic consequences.

The primary objectives of providing medical care to patients with acute severe stroke at the prehospital stage are maintaining vital functions and immediately transporting the patient to the appropriate hospital. The only contraindication for hospitalization of a patient with stroke is his agonal state.

Hospital stage

Upon admission of the patient to the hospital, all subsequent measures should be carried out as quickly as possible. This primarily applies to patients whose stroke developed less than 3 hours ago and there is still the possibility of determining the nature of the stroke and performing thrombolysis for its ischemic origin.

Thrombolytic therapy for IS should be carried out in emergency hospitals, in a neurointensive care unit or intensive care unit, subject to the mandatory presence in the hospital structure of round-the-clock neuroimaging services using computed or magnetic resonance imaging and laboratory diagnostics.

Thrombolysis can be carried out only after excluding the hemorrhagic nature of brain damage. It is also desirable to initially conduct and monitor transcranial Doppler ultrasound to clarify the fact of arterial occlusion, verify the localization of occlusion and monitor the gradual opening of the vessel.

The most important tasks in providing medical care to patients with acute severe stroke at the prehospital stage are maintaining vital functions and immediately transporting the patient to the hospital. The only contraindication for hospitalization of a patient with stroke is his agonal state.

It is necessary to strive as much as possible to reduce the time from the moment the patient is admitted to the hospital until the start of intravenous administration of alteplase (time “from door to needle”).

1. The emergency physician must telephone the intensive care unit of the neurological department to inform him that he is transporting a patient with an ischemic stroke who is indicated for thrombolytic therapy.
2. The unit's neurologist meets the patient in the emergency department and transports him, along with the medical staff of the emergency department, to a computed tomography scan. During transportation and carrying out this examination, the medical history is clarified from relatives or the patient himself.
3. Examination and assessment of neurological status using the NIHSS scale.
4. Measuring blood pressure levels in both arms.
5. Installation of a cubital peripheral venous catheter.
6. Measuring serum glucose levels.
7. Draw blood and perform the following laboratory tests:
   platelet count;
8. activated partial thromboplastin time;
9. international normalized ratio (INR).
10. If the patient meets the criteria for inclusion in thrombolytic therapy, after examination by a neurologist and a computed tomography scan of the brain, it is necessary to monitor the following vital functions in the unit for at least 48 hours:
    blood pressure level;
11. heart rate (HR);
12. respiratory rate (RR);
13. body temperature;
14. oxygen saturation (SaO2).

I emphasize that the administration of alteplase should be started as early as possible from the onset of the disease. The recommended dose is 0.9 mg/kg body weight (maximum dose 90 mg). 10% of the total dose for the patient is administered as a bolus intravenously over 1 minute. The remaining dose is administered intravenously over 1 hour.

During and after thrombolysis, monitoring of basic vital functions is extremely important: blood pressure, heart rate, respiratory rate, body temperature, SaO2. During the thrombolytic therapy procedure, it is necessary to monitor the dynamics of the neurological status; the most optimal is to use a scale for assessing neurological deficit (NIHSS scale).

A set of measures required to be carried out in a hospital:

• general medical activities—observation and care of the patient;
• prevention and treatment of major neurological complications;
• special treatments for stroke;
• prevention and treatment of extracerebral complications;
• rehabilitation measures;
• measures for early prevention of recurrent stroke.

Monitoring the patient

Monitoring the patient is necessary to develop adequate tactics for its management and includes a number of measures: monitoring of neurological status, blood oxygenation, blood pressure, ECG, intracranial pressure and cerebral perfusion pressure, central venous pressure; control of the main parameters of homeostasis.

Patient care

Caring for patients in the acute stage of a stroke, who often not only cannot turn over in bed on their own, but are also unconscious, is also an extremely responsible undertaking. It should include doing the following daily:

• turns from side to side;
• wiping the body;
• regular enemas and bladder emptying;
• administration of adequate fluid volume;
• toilet of the oro- and nasopharynx;
• sanitation of the tracheobronchial tree (during artificial ventilation of the lungs);
• control of swallowing and feeding;
• prevention of stress ulcers of the gastrointestinal tract;
• antibacterial therapy as indicated;
• prevention of DIC syndrome and pulmonary embolism;
• conducting passive gymnastics and massage.

Treatment of major neurological complications

The main pathogenetic changes in the brain during the development of cerebral infarction, accompanied by characteristic neurological disorders, include the following: cerebral edema and acute obstructive hydrocephalus.

To treat cerebral edema, hyperventilation is necessary under conditions of artificial ventilation, reducing PaCO2 to a level of 30 mm Hg. Art. Of the osmotic diuretics, mannitol is most often used intravenously drip at an initial dose of 0.5-2.0 g/kg body weight for 20-25 minutes, and then at a dose of half the original every 4-6 hours, no more 3-4 days. In the absence of mannitol or in case of unreplenished hypovolemia, 100-150 ml of 3% sodium chloride solution is administered intravenously every 3-6 hours for the same period.

The following model is optimal

staged rehabilitation after stroke:

Stage 1 – rehabilitation begins in the neurological department of the hospital, where the patient is taken by an ambulance;

Stage 2 – at the end of the acute period with complete restoration of impaired functions, the patient is discharged for outpatient follow-up treatment or transferred to a sanatorium, and the patient with severe motor deficit is transferred to the rehabilitation department.

Stage 3 – outpatient rehabilitation, rehabilitation at home.

The main treatments for acute obstructive hydrocephalus are drainage of the lateral ventricles, decompression of the posterior cranial fossa, and/or removal of necrotic tissue from cerebellar infarction.

Neuroprotection

Neuroprotection is a set of universal methods for protecting the brain from structural damage. It should begin at the prehospital stage of treatment and continue in the hospital.

For the purpose of metabolic protection of the brain in any type of stroke, drugs that correct energy metabolism, antioxidants and agents with neurotransmitter and neuromodulator effects are used:

• piracetam 12 g intravenously;
• glycine sublingually 1-2? g per day;
• Semax 1% 3 drops endonasally;
• deproteinized hemoderivat intravenous 10-20% infusion solution, 250 ml;
• magnesium sulfate 25% 20.2 ml in 200 ml of isotonic sodium solution intravenously 2 times a day;
• methylethylpyridinol 15 ml of 1% solution intravenously;
• Cerebrolysin 10-30 ml intravenously;
• Cortexin 10 mg intramuscularly;
• ethylmethylhydroxypyridine succinate 200-300 mg intravenously;
• choline alfoscerate 1 g intravenously, etc.

Antiplatelet drugs

• acetylsalicylic acid 1 mg/kg body weight;
• dipyridamole 25 mg 3 times a day;
• clopidogrel 75 mg once a day;
• pentoxifylline 200 mg intravenously, etc.

Vasoactive drugs

• vinpocetine 10-20 mg intravenously;
• nicergoline 4 mg intramuscularly;
• aminophylline 10 ml intravenously, etc.

Improving cerebral perfusion and improving the rheological properties of blood

• reopolyglucin 200-400 ml intravenously;
• dextran 400 ml intravenously.

Direct anticoagulants - according to indications

• heparin 5000 units 4-6 times a day subcutaneously;
• fraxiparine 7500 units subcutaneously 2 times a day.

Indirect anticoagulants (oral anticoagulants)

• warfarin 2-5 mg per day under INR control;
• phenindione 100 mg/day.

Outpatient stage

Rehabilitation is a set of measures (medicinal, physical, pedagogical, psychological, legal) aimed at restoring functions impaired as a result of the disease, social adaptation, quality of life, and, when possible, ability to work. Rehabilitation should also include the prevention of post-stroke complications and the prevention of recurrent strokes. The duration of rehabilitation is determined by the timing of restoration of impaired functions. It should be remembered that the maximum improvement in motor functions is observed in the first 6 months, everyday skills and ability to work - within 1 year, speech functions - within 2-3 years from the moment of stroke development.

The following model of staged rehabilitation after a stroke is optimal:

• Stage 1 - rehabilitation begins in the neurological department of the hospital, where the patient is taken by an ambulance;
• Stage 2 - at the end of the acute period with complete restoration of impaired functions, the patient is discharged for outpatient follow-up treatment or transferred to a sanatorium, and the patient with severe motor deficit is transferred to the rehabilitation department.
• Stage 3 - outpatient rehabilitation, rehabilitation at home.

If the stroke is hemorrhagic

Symptoms that speak in favor of hemorrhagic stroke:

• arose abruptly at the height of physical or psycho-emotional stress;
• there is no consciousness;
• have convulsions;
• the neck muscles are tense, it is impossible to bend the head;
• high blood pressure.

In addition to standard care, such patients need:

1. The position is strictly with the head end elevated (except for convulsions or resuscitation).
2. Applying an ice pack to the head (preferably to the half in which hemorrhage is suspected - opposite to the immobilized tense limbs).

Main risk factors for stroke

Features of providing assistance on the street

If a stroke occurs on the street, first aid has the following features:

• Involve several people to help. Organize the actions of each of them, clearly distributing responsibilities (someone calls an ambulance, and someone assesses the general condition, etc.).
• Having placed the patient in the desired position, free the neck and chest to make it easier for him to breathe (remove the tie, unfasten the buttons, loosen the belt).
• Wrap up the limbs, cover the person with warm clothes (in cold weather), massage and rub them.
• If you have a mobile phone or contacts with relatives, inform them about what happened.

Features of providing assistance at home or in any enclosed space

If a stroke occurs indoors (at home, in an office, in a store, etc.), then in addition to standard first aid, pay attention to:

• Free access of fresh air to the patient: open the window, door.
• Release your chest and neck.
• If possible, measure your blood pressure. If it is elevated (more than 150/90 - 160/100 mmHg), you can give antihypertensive drugs under the tongue (Captopress, Farmadipin, Metoprolol), lightly press on the solar plexus or on closed eyes. If it is low, raise your legs, but do not lower your head, massage the area of ​​the carotid arteries on the sides of the neck.

How to provide first aid for a stroke indoors

Signs and symptoms of stroke

A stroke manifests unexpectedly for a person, although sometimes it is preceded by certain symptoms. If you interpret them correctly, you can avoid a terrible vascular catastrophe.

Warning signs of an impending stroke include:

• Prolonged headaches. They do not have a clear localization. It is not possible to cope with them with the help of analgesics.
• Dizziness. It occurs at rest and can intensify when performing any actions.
• Ringing in the ears.
• Sudden attack of atrial fibrillation.
• Difficulty swallowing food.
• Memory impairment.
• Numbness of arms and legs.
• Loss of coordination.
• Insomnia.
• Increased fatigue.
• Decreased overall performance.
• Rapid heartbeat and constant thirst.

The listed signs may have varying intensities. You should not ignore them; you should consult a doctor.

Symptoms of ischemic stroke increase slowly. With hemorrhagic brain damage, the clinical picture unfolds rapidly.

You can suspect a brain catastrophe based on the following symptoms::

1. General cerebral symptoms . The patient experiences unbearable headaches. Nausea ends with vomiting. Consciousness is impaired, and both stupefaction and coma may occur.
2. Focal symptoms . They directly depend on where exactly the lesion is localized. The patient may have decreased or completely lost muscle strength on one side of the body. Half of the face is paralyzed, causing it to become distorted. The corner of the mouth lowers, the nasolabial fold smoothes out. On the same side, the sensitivity of the arms and legs decreases. The victim’s speech deteriorates and he has difficulty oriented in space.
3. Epileptiform symptoms . Sometimes a stroke provokes an epileptic attack. The patient loses consciousness, has convulsions, and foam appears at the mouth. The pupil does not react to the light beam; on the side of the lesion it is dilated. The eyes move right and left.
4. Other symptoms . The patient's breathing quickens and the depth of inspiration decreases. A significant decrease in blood pressure and increased heart rate are possible. Often a stroke is accompanied by uncontrolled urination and defecation.

When the first signs of a stroke appear, you should not hesitate to call an ambulance.

First aid effectiveness and prognosis

According to statistics, correctly provided emergency care for stroke patients with delivery to a medical facility within the first three hours:

• saves the lives of 50–60% of patients with severe massive strokes;
• in 75–90% it allows people with minor strokes to fully recover;
• improves the recovery abilities of brain cells by 60–70% in case of any stroke (better in case of ischemic stroke).

Remember that a stroke can happen to anyone at any time. Get ready to take the first step to help fight this disease!

How to care for a paralyzed person after a stroke

This situation cannot be taken lightly. Care should be regular and professional. The list of mandatory procedures includes taking medications to prevent a recurrent stroke. Massage and physiotherapy, sessions with a psychologist, rehabilitation therapist, and speech therapist are required. Speech restoration starts with the basics.

Rehabilitation in severe conditions is a complex and lengthy process. Care after a hemorrhagic stroke with irreversible consequences will be required for the rest of the patient's life. If all prescriptions are followed, some motor and speech functions can be partially restored, which will already improve a person’s life.