AUSTRALIAN RESUSCITATION COUNCIL

GUIDELINE 9.2.2
STROKE
INTRODUCTION Stroke (previously known as cerebrovascular accident) occurs when the supply of blood to part of the brain is suddenly disrupted. Blood is carried to the brain by blood vessels called arteries. Blood may stop moving because the vessel is blocked by a blood clot or plaque, or because the vessel ruptures. When blood flow to a part of the brain is inadequate, that part cannot get the oxygen it needs and brain cells in the area die and the brain can become permanently damaged. Brain cells usually die within an hour of the onset of a stroke but may survive up to a few hours. Areas of the brain where the blood supply is reduced but not completely cut off can survive for some hours. These brain cells can either recover or die depending on what happens in the minutes or hours that follow. Stroke is the second most common cause of death after heart disease.1, 2, 3, 4 There is good evidence that outcome can be improved through urgent admission to hospital and specialised care highlighting the need for early recognition and management.2,5 RECOGNITION Some people may experience a mini stroke (transient ischaemic attack or TIA) with symptoms and signs generally not lasting longer than 60 minutes. However the risk of stroke for people with TIA may be as high as 28% within 90 days.6 Recognition and early assessment and treatment are therefore vital in preventing the progression from TIA to stroke. Warning signs ! Stroke is a life-threatening emergency and most people who suffer a stroke will experience some warning signs. Weakness in the face or arm and speech difficulties are the most common signs of stroke. Even if the warning signs have resolved it is still important to seek urgent medical assessment and management Guideline 9.2.2 December 2007 Page 1 of 3
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The warning signs of stroke may include one more of these symptoms: ! Weakness, numbness or paralysis of the face, arm or leg on either or both sides of the body ! Difficulty speaking or understanding ! Difficulty swallowing ! Dizziness, loss of balance or an unexplained fall ! Loss of vision, sudden blurred or decreased vision in one or both eyes ! Headache, usually severe and of abrupt onset or unexplained change in the pattern of headaches ! Drowsiness. FAST is a simple way for remembering the signs of stroke.5,7 Facial weakness - can the person smile? Has their mouth or eye drooped? Arm weakness - can the person raise both arms? Speech difficulty - can the person speak clearly and understand what you say? Time to act fast seek medical attention immediately Call for an Ambulance (Dial Triple Zero - 000) MANAGEMENT ! ! ! ! ! Call an Ambulance (Dial Triple Zero - 000) and stay with the victim If victim is conscious provide reassurance, make the victim comfortable and do not give anything to eat or drink. Stay with the victim until ambulance arrives. Administer oxygen if trained to do so. If the person becomes unconscious follow the ARC Basic Life Support Flow chart Guideline 8.

LEVEL OF EVIDENCE Level III-2 and IV CLASS OF RECOMMENDATION Class A - Recommended

Guideline 9.2.2 December 2007

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REFERENCES 1. 2. 3. 4. 5. 6. 7. AIHW: Senes S (2006). How We Manage Stroke in Australia. AIHW cat. no. CVD 31. Canberra: Australian Institute of Health and Welfare. Clinical Guidelines for Stroke Rehabilitation and Recovery. National Stroke Foundation 2005 & National Clinical Guidelines for Acute Stroke Management. National Stroke Foundation 2007. Hankey GJ et al. Long-term disability after first-ever stroke and related prognostic factors in the Perth Community Stroke Study 1989-1990. Stroke 2002;33:731-735. Johnston et al. Validation and refinement of scores to predict very early stroke risk after transient ischeamic attack. Lancet 2007; 369:283-292. National Stroke Foundation. Stroke Care 2007. www.strokefoundation.com.au Thrift AG, Dewey HM, Macdonell RAL, McNeil JJ, Donnan GD. Stroke Incidence On The East Coast Of Australia. The North East Melbourne Stroke Incidence Study (NEMESIS). Stroke 2000; 31:2087-2092. Nor AM, McAllister S, Louw J, Dyker G, Davis M, Jenkinson G, Ford A. Agreement Between Ambulance Paramedic and Physician-Recorded Neurological Signs With Face Arm Speech Test (FAST) in Acute Stroke Patients. Stroke 2004; 35(6): 1355-1359

FURTHER READING ARC Guideline 8 Cardiopulmonary Resuscitation

Guideline 9.2.2 December 2007

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