Request to Adam for saving lives

[Buckskin gal]

I so admired Adams post on saving lives and giving out information on doing CPR. It is very valuable information, to say the lest. Adam, would you also give out inforamtion to this group on what to look for and help to be given when someone has a stroke? It can make the difference between a death or being paralzed or being able to live a quality life. When my hubby had a stroke I was made out to be somekind of hero for the steps I took...I told them that any one would have done the same but hospital nurses, doctors, paramedics and all said it was amazing how many people don't know what to do when they see a stroke happening right before their eyes. I was told how important it is to get help as fast as possible because the sooner some drugs are administered, the better the chance for the patient to be saved and recover. Because our case tuned out so well they asked that we inform the area of the help that can be received if quick action is taken. They done a big write up on both the t.v. station and the newspaper and it is nice to know that we were part of this education program. Adam, I know you will be able to explain it all better thaqn I ever could. Thank you for your help, Mary

 

[alongman]

Mary -

You are right! Strokes are probably one of the most dangerous medical conditions that are completely looked over by most people as they DONT know what they are looking at. In the field, we see a wide variety of signs and symptoms of people having strokes - so attention to detail is the key.

Here is the down-low on strokes (aka CVA's or cerebral vascular accident). There are three types of strokes.

1) Ischemic strokes - the vessels in the brain have some type of occlusion, usually a clot, that prevents normal blood flow from reaching the brain. Account for about 80% of all strokes.

2) Hemorrhagic strokes - a vessel in the brain ruptures (aka aneurysm) and blood leaks from the vessel. Essentially, this type of stroke also prevents blood from reaching various parts of the brain.

3) Transiet Ischemic Attack (TIA) - a "quick" obstruction that clears itself within a short time frame. This is usually a warning sign of probably future strokes.

As for the "what to look fors", this is a list of the most common things that are easily recognized by either the person themselves or someone dealing with the person. Remember, that if the person is actually having a stroke, they may not be able to effectively communicate with anyone.

- sudden weakness in an arm, leg, face or an entire side of the body.

- sudden confusion (inability to remember even basic details.... name)

- vision changes

- incoordination, balance problems or weakness

- severe headache without any cause (trauma)

The "what to do's". Probably the biggest thing anyone having (or noticing) anything that could fall under the stroke list, should call 911 immediately. Don't wait to see if it will pass - each minute is probably brain tissue death. Do not attempt to take any type of medication (high blood pressure medications) namely Aspirin. Although the "clot-busting" power of aspirin may be effective for an ischemic stroke, if it is a hemorrhagic (or bleeding) stroke, the aspirin will actually prevent the blood from clotting and allow MORE bleeding.

What will happen in the ambulance and at the hospital? In the truck, we immediately perform a neurlogical assessment to try and localize where the complication is. You will be placed on a heart monitor - sometimes, if the condition is serious enough, the person may have cardiac problems in addition to the brain problem. Multiple IV's will be started so that medications can be given if/when needed. As a paramedic, I also watch your breathing. Some people with CVA's will develop breathing issues (stop breathing) so we can manage your airway completely if needed. At the hospital, you will get a CT scan of your head which will determine if there is a bleed (or hemorrhagic stroke). If there is, you will get immediate surgery. If there is a clot (ischemic stroke) there are options for the physicians - some will give clot-busting medications to break the clot, others will perform surgery to remove the clot. The big thing to remember is, all these procedures are TIME based!!! The clot-busting drugs cannot be given if you have developed signs more than 2-4 hours prior! After that time-frame, the clot will have already done its damage and most physicians will opt to just leave it and deal with rehab issues. This is where the ambulance comes into play - we can travel quickly to an appropriate facility (and YES we do have only certain hospitals that can handle a stroke) and we can often arrange for expediting in the hospital.

Common risk factors:

- age (older people are more susceptible)

- African Americans

- people with high blood pressure

- Male more than female

- Smokers

- People with family history of problems

- obese people

- prior stroke/CVA

- decreased activity or sedentary lifestyle

- alcoholics

- heart problems of any type (namely Atrial Fibrillation)

- drug abusers

For more information on strokes, visit the American Stroke Association website.

There.... I think that about covers what I can type in one sitting...

I hope it helps. Please feel free to contact me or ask any more questions - I love to do homework. It really does keep me on top of my game as well!

 

[Pepipony]

Thanks!!! Please add as well what to look for, for those of us who have fibrin problems and are prone to PEs , DVTs etc. Since most people dont even know they have this clotting factor, they wont know to look out for it. Thanks!!

 

[Alex]

Wow, thanks Adam!

Some great info to know!!

 

[Mona]

Adam, since I live so far out in the country, it would take no less than 35 minutes for the nearest ambulance to get here, and most probably 45-60 minutes. So, with that said, is there anything a person can do at home during this time to help reduce the risk of long term damage?

 

[alongman]

Mona -

GREAT QUESTION! There are some things you can do while waiting for an ambulance. I'll touch on that in a bit.

Let me clarify, that an ambulance is still the way to go despite the distance. We have areas of our service area that are nearly 40 miles from a stroke hospital - our dispatch center (the people you talk to when you call 911) can start an air ambulance BEFORE we ever get there on the ground. That 40 miles is covered in less than 12 minutes back to the hospital, but it will take them about the same time to get TO you (they have to push the helicopter onto the helipad, start it up (a 5 minute warm-up), take off, fly to you and then land). If they can't fly, we are still on the way as well. There are also parts of our service area that we can start administering medications to start treating the stroke BEFORE we get to the hospital as well.

In the meantime, before any ambulance gets to you, you should:

1) Look at the clock! I need an EXACT time that things started.

2) Unlock your doors and put your pets away - a happy dog can go to a mad dog when their owner is injured or sick.

3) Lay down - ABSOLUTELY no activity. Stay calm, relax.

4) Do not eat or drink anything.

5) Have a list of your medications (or the bottles) ready to go.

6) Have a list of your medical conditions, allergies, emergency contact information, social security number, primary doctors' name, etc...

The last one is probably one of the most important and should be prepared NOW! Even if you aren't having a stroke - this one piece of paper can provide me with all the information I need. This list MAY become your lifeline in the event that you can't provide the information yourself (either can't speak or write) due to any medical condition. Most people will either carry it in their wallet/purse or put it in their freezer (in a Ziploc bag on the door) of their fridge (both preferred) with a sign on the fridge stating "FILE OF LIFE IN FREEZER". It's one of the first places I look.

 

[Sterling]

This is great information! Thanks for taking your time and posting for all of us to be informed!

 

[Mona]

Thanks for the information Adam! That is good to know. I guess I better get that information filled out on both myself and my husband. Better yet, I will make 2 copies of each and keep one in my purse/his wallet and the other for each of us in the freezer!

 

[MInx]

Well I have had two strokes..one bad one two years ago and one last March..first required intensive care, last one a regular room across from nursing station..wouldn't you know it we were in Florida for three months!

On first one I noticed a bit of trouble pronouncing words night before but thought I was just tired from knee replacement surgery 14 days prior..woke up at 8am next morning unable to talk or see on right side..I was lucky Carl was right there and rushed me to hospital himself calling along the way to alert them so they were waiting when I arrived..except for weakness on right side and vertigo I was able to come back. It took a year.

Last March I again awoke unable to talk well, words wouldn't form but no warning this time..and when I tried to get up out of bed I just jutted forward to the left and couldn't stop! Again my wonderful husband got me right in and I've pretty well come back although very difficult to get enough excercize and I still have 50-60 lbs I need to lose..

after this next eye surgery next Wed, heals I will again get into the therapy pool. I can't wait. I can work out hard in there

Anyway I had blood clots that caused mine and I'm now on Aggrenox to hopefully prevent any more..got off the Coumadin as I was bleeding way to easily.

Don't hesitate! Get in there! Another hour and I would have been in really big trouble. Oh I also had at the same time a Pulminary Embolism! Didn't realize it thought it was the stroke..that's blood clots in the lungs and it can and should have killed me! (So threy told me)

That's my 2 cents worth

Maxine

 

[alongman]

Maxine posted some really good points, somewhat indirectly. She was at a huge risk, and one that I forgot to point out. She had surgery recently. When you have surgery there are clots that are formed (not only on the outside, but on the inside as well). Those clots can break off and travel throughout your body - they easily travel through some of the larger vessels, but there are areas that have much smaller vessels that are more at risk of these clots for getting stuck. These areas include, but aren't limited to, the brain and the heart. These areas can cause stroke (ischemic) and myocardial infarction (aka heart attack) when blood and oxygen supply are cut off to the areas those vessels supply.

Other times that clots are able to form in people are during long times of sitting (sedentary lifestyle). Most people assume this to be in the obese or elderly who routinely sit for long periods of time. One other risk group is those that travel long distances (overseas flights or over the road truckers) while sitting. Clots form during these times and when they start moving again, the clots break free to "travel".

She also pointed out the garbled speech pattern - VERY COMMON! Some stroke patients can "think" of the words they want to say, but just can't get them to come out correctly. I actually had a younger gentleman recently who was out with some friends - he began inappropriately saying words and his friends laughed it off as him "having had one too many". We found him several hours later, feeling embarassed as he didn't know why he couldn't say his name. He ended up with serious complications of his stroke.

Good job Mona! I hope everyone in the horse world starts making those lists and we start a new trend of being proactive! Remember, you can't just make the list and forget about it - keep it updated with new addresses, phone numbers, current medications or health conditions. I update my list on a monthly basis!

 

[Kathy2m]

My Mom had her first one at 3 A.M. Thursday morning, she lived with my brother he heard her fall, by the time I got to the hospital she was sitting up and trying to talk but couldn't, like you said it was all messed up. She remained in the hospital and doing well, I came home Friday night (I lived about 1 hour away) my sister called me Sat morning 8 AM. she had a massive stroke that morning, she never recovered she passed Tues afternoon. She was a heavy smoker. Looking back my sister, who lived across the street from her, saw signs of confusion, we over looked it because we figured it was just her age, so please don't take these signs lightly or attribute them to aging. Kathy

 

[AppyLover2]

Kathy I'm so sorry about your mom.

Mary...great post and Adam....thank you so much for your detailed response!!

 

[sfmini]

Adam, thank you so much for this information and keep it coming.

I never thought to put my list of meds anywhere as the main hospital system has it on file from my knee replacement, but you got me thinking about some what ifs, like what if they for some reason can't get to it, or I end up in a hospital that isn't linked.

Come on electronic health records!

So, where should I keep that list besides the freezer? I do have five meds I take, plus an amoxicillin allergy, and one that could throw them into a spin, low platelets. Could lose valuable time chasing those platelet counts if they don't know about them, plus if there is an injury, I may bleed heavier than normal.

I do keep a spreadsheet in my PDA, but I am sure nobody would look there. Where do you guys look other than the fridge/freezer?

 

[alongman]

Those are the two big ones that I look for medical information (wallet/purse and in the freezer). The other place that I tell people is to have an ICE (In Case of Emergency) number programed into their cell phone. I do often check cell phones (or at least grab them) mostly on people who have been in car accidents. It's a great resource to contact families at a time when there are free hands. I have 3 ICE numbers in my cell phone ICE - Mom, ICE - brother, ICE - roommate. These people also have copies of all my medical information (or at least know about it).

Other helpful items are medical alert bracelets - this is great for conditions like Diabetes (this sometimes leaves people unable to talk or relate a condition to us in an emergency) and also is great for listing allergies. I ALWAYS see a persons' arms during my exam, so its a great (and somewhat permanent) place to keep limited information.

Sorry, PDA's are above my knowledge level..... you'd be the only one looking at that darling!

Any other questions?

 

[AngieA]

I am proud of me...I have done all the things you said to do...lol I have done them for years...although my family laughed at me for doing ti...But I have traveled a lot and wanted to be found if nothing else if something happened..I do have another question though...I had to have a Kidney removed last year do to a prior surgery. Does anyone other than me need to know about this in an emergency? Thank you for all of your ideas.

 

[alongman]

Angie -

I would say YES! Each and every medical condition should be noted - including major surgeries. Removal of a kidney would/could result in extra work being done by your functioning kidney and therefore may alter some CT scan results. I would say the only things to not include on the "medical condition" list would be routine stuff (sore throats, stubbed toe, etc...) but others including (hysterectomy, renal conditions, heart problems, high blood pressure, transplant of any type) should be.

Also, just want to point out - if you take a medication for a condition and this has resulted in the absence of the condition (aka......you take high blood pressure medications and THEREFORE don't have high blood pressure) those should be listed!!!!

Last night picked up a friendly elderly lady - she said she had NO medical problems what-so-ever (impressive at 98!). She then showed me her list which included medications for high blood pressure, atrial fibrillation and congestive heart failure. NONE of which caused her any problems WHEN she was taking her medications. In her mind - SHE HAD NO PROBLEM! OH!

 

[sfmini]

Adam, I finally got out my roundtoit and am looking at medic alert bracelets. Hmmm, gotta fit diabetes, high bloodpressure, amox allergy....

Anyway what do you think of the E-Health Key? Looks interesting....

 

[alongman]

I talked to several of my co-workers and we did some research. I hadn't personally experienced one in the field. Here are their comments:

• Looks interesting.....
• We wouldn't be able to use them in the field - we don't have computer access in an emergency.
• I don't know if the hospitals would have a compatible system to pull up the information.
• I don't ever look at a persons' key-chain to find medical information.
• KISS (keep it simple stupid!) - I'm not technologically inclined..... prefer the read it and use it information.
• If there are many medical conditions, they could write "the essentials" for an emergency - like where to find the other information.

Another thing I forgot to mention to include with your "medical checklist" is if you are DNR (Do not resuscitate) or DNI (Do not intubate) or DNR/DNI. This is a separate form that is able to be downloaded from the internet or available at your MD's. It would be the ONE thing, other than obvious death, that would prevent me from attempting to resuscitate a person against their unspoken will. If we don't have that information and you are indeed DNR/DNI, then we would proceed with the resuscitation and sort out the details later. This, unfortunately, places your family in a position of "pulling the plug" or having to make those decisions without your input. EVERYONE should have some form of advanced directive - age doesn't mean anything!

 

[justanothercowgirl]

Adam I honestly don't know how you do your job! I had an elderly friend who I used to take shopping and she had a stroke in my car one day, it was one of the worst days of my life! Her son-in-law is a Dr. specializing in internal medicine so I pulled over and called him on my cell phone and told him we'd been chatting and she started speaking garbled words and was now barely responding. He asked where I was told me to put her oxygen tank on her(she was not in good health already) and bring her to emerg-he would meet me there. Oh sure! No prob! AHHHHHHH!!! So I beat him to the emergency room and they were on critical care bypass and the triage nurse ripped me a new one because she had told him when he called saying his mother-in-law was en route not to have her sent there because they had no room, so I said "but she's in my car, please take her out" and then she really freaked because for some reason she thought I had arrived just ahead of an ambulance. UGGG!! Not good. He ended up having to resusitate only to be reminded when his wife got there that his MIL had a DNR. OH! I don't believe they ever told her that she had been resusitated. I am positive I got some grey hair that day and I have no idea how you could do that over and over again.

Thank God for people like you that can do the job, I have two brothers and two BIL's that are volunteer fireman and respond to all sorts of calls in our area too. They have asked my hubby to join too but he is like me and said if you need a guy to run in circles with his hand over his mouth yelling "oh my God" then I'm your guy but other than that I will not be of any use to you sadly.

An animal in distress I can handle but not a person.

 

[MountainMeadows]

Adam

Some time ago I saw a list of things to do if you suspected someone was having or had had a stroke -I think it was S T R O K E spelled out - I think S = Speak, can you elaborate, I might have the word wrong, but I am pretty sure that "Speak" was one of the things you needed to ask the person to do. I wrote the list down, but of course it is a work OH!

Like many before me, I am so awed by what you and your fellow medics do day in & day out -- and still manage to keep a smile and be the great guy that you are.

Stac

PS I am so excited about Angel