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Thread: Stroke

  1. #1
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    Default Stroke

    The S has HTF, griddown, no help coming, you're on your own, yada-yada-yada, and Dad/Grandpa appears to be having a stroke. What can we do to limit further damage and help their recovery?

    Guessing not a whole lot, and seems to me after 20 minutes of intensive research that maybe the most definitive first-aid for an ischemic stroke (sublingual aspirin?) is exactly what you wouldn't want to give for a hemorrhagic stroke - and there's no way to tell the two apart without imaging. But are there any recommendations?

    Lay them flat? Inclined, head or feet up? Recovery position?

    Is stroke a situation where a single small tank of O2 in your preps might make a real difference for the victim? If so, nasal cannula or do they need a full mask (and rebreather or non-rebreather)?

    And if you knew the victim's medical history could that help diagnose whether it's a ischemic or hemorrhagic stroke with any accuracy, and maybe change how you'd want to treat it (play the odds basically)? High blood pressure = 80% likelihood it's hemorrhagic, or prior TIA (mini-stroke) = 80% likelihood this one is ischemic too?

    In the longer term, special diet or vitamin/mineral supplements?
    Everything marked, everything 'membered. You wait, you'll see.

  2. #2
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    Default

    If no help is coming...
    Pray... If one believes that helps... One can't diagnose the type of stroke without specific radiological testing... And it really doesn't matter if you can't do the supportive care afterwards... An oxygen tank will only last a few hours... A small tank even less... And believe it or not, you do not want to drop a patients blood pressure to what we'd consider a normal level so not to impede what oxygen profusion is reaching the brain...
    leave the gun... take the cannoli...

    In times of strength prepare for times of weakness...

  3. #3
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    I swear Hate, you are the most depressing and defeatest Dr I've ever met. Do you ever get invited a second time to parties?
    Everything marked, everything 'membered. You wait, you'll see.

  4. #4
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    Lol... I'm an RN... I can only reflect on my 34 years in the biz... Actually health care isn't what most of the public thinks it is... Once you're in the system for a chronic illness, it's a slippery slide... Prevention is the key...

    But you're right, most friends are in health care... We're a jaded bunch...
    leave the gun... take the cannoli...

    In times of strength prepare for times of weakness...

  5. #5
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    Default

    Couldn't handle your career field, I'm a break/fix tech guy and it fits my psychological profile. Every problem has a solution you just have to find it, and my patients never die while I'm trying to find it either.

    But speaking of psychology - if the person with the most medical knowledge in the group see's someone having a stroke and does nothing but begin reciting the Lord's Prayer what impact is that going to have? When it's over you at least want to be able to say, "we couldn't do much, but we did everything we could". So what is "everything we could" when it comes to a stroke? 2 hours of O2 unlikely to have any benefit even for a TIA they'll likely survive anyway?

    Aspirin? Roll the dice, might help and if it doesn't it speeds their passing?
    Everything marked, everything 'membered. You wait, you'll see.

  6. #6
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    Not all strokes are fatal... One of my greatest fears is having a big one that isn't fatal... Contractions, diapers and a feeding tube is not my idea of a end of life program...

    If there is no hope of medical care, the best you can hope for is good luck.... And that depends on what you call 'good luck'... There are worse things than dying....
    leave the gun... take the cannoli...

    In times of strength prepare for times of weakness...

  7. #7
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    Default

    Strokes come in two flavors: hemorrhagic where there is a bleed from a vessel in the brain, and ischemic, where a blood vessel is blocked by a clot, fat, or something.

    Of the two, the hemorrhagic is more dangerous. Blood is actually pretty toxic outside of the blood vessels, and damages tissue. Fortunately, they are less common, and have higher mortality.

    For ischemic stroke, once they are diagnosed, a class of drugs called tPA (tissue plasminogen activator) is administered. If done quickly enough (within a couple of hours of onset) it helps dissolve the clot. Under the best circumstances, the patient can be out of the hospital the next day, with no issues. More often, it helps, some....but the patient may still have serious neurological issues, such as paralysis, loss of memory, loss of speech, etc. It depends on where the stroke happened in the brain.

    However, giving tPA to the wrong patient (like one with a hemorrhagic stroke) will kill them.

    How to tell the difference? We use diagnostic imaging (CT, MRI, ultrasound) along with some blood work. Unfortunately, the CT and MRI probably won't be available post SHTF.

    So, what to do? First of all, prevention is better than treatment. A good diet, not smoking, and moderate exercise isn't a bad thing. While the evidence is somewhat equivocal, aspirin 81mg (a baby aspirin) a day will go a long way at making your blood less likely to clot, but that can lead to other problems so speak to your OWN doctor before starting it.

    If someone in your group does have a stroke, the only treatment I'd recommend post SHTF is supportive. They will either survive it, or not. If they do survive it, they are likely to be debilitated to some extent, and require special care, depending on how the stroke affected them.

    It's a crappy situation.....all the way around.
    Good medicine in bad places

  8. #8
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    I had one, 5 years ago. I was lucky, my wife had the presence of mind to call an ambulance. I was eight days in the hospital and another 5 weeks to recover. Scary stuff. Not all strokes are the same I learned, mine affected my sense of balance and later on found out that it affected my sense of taste. For the longest time I was using Siracha sauce like ketchup, one of those big bottles every week.

    As far as in a shtf scenario? I don't know, eat some rat poison? (Just kidding)

  9. #9
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    Lol... Don't...
    leave the gun... take the cannoli...

    In times of strength prepare for times of weakness...

  10. #10
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    Default

    Quote Originally Posted by HatetosayItoldyouso... View Post
    Lol... Don't...
    I'd say either way the rat poison idea would work it all out.
    Common sense is so uncommon nowadays it ought to be reclassified as a super power

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