What is taking him so long? Oh there he is. What is he doing? He’s just sitting there, staring. Honey, you okay? What’s he saying? Well put, honey. Sadly, I didn’t understand a word.
Wait a minute. He’s sweating. And the left side of his face looks… I don’t know what it looks like … droopy? Is that drooping! I’ve read about this. This is really not happening… He needs a doctor. Like right now!
Ok… so he’s not going to stand up. I can’t carry him. Should I call a neighbor? Forget that. I’m calling an ambulance. Where’s the phone? Five phones in this house and I can never find one! There it is…
Time = Brain: Call 9-1-1
You may have heard the FAST acronym for stroke symptoms (Face drooping, Arm weakness, Speech difficulty, Time to call 9-1-1).
That last one is most important: Call 9-1-1 to go to the hospital. The best indicator in treating a stroke effectively is time—how fast doctors are able to start treatment. The faster you begin treatment, the less damage to your brain. Calling an ambulance means that EMTs can assess you at home and take you to the right hospital for stroke care. They can alert the stroke team to be ready to continue testing and start treatment.
Strokes deprive parts of your brain of blood and oxygen, which kills brain cells. A 2005 study quantified it: For each minute a stroke is not treated, a patient loses 1.9 million neurons. A stroke patient is not someone overreacting or making a fuss. They need treatment. Now. Call 9-1-1.
9-1-1 call is done. Help is on the way. Now what? Better call the kids…
He’s looking a little better! Thank goodness, he’s making sense. So it was nothing after all. Should I cancel the paramedics? Probably. They’re going to think I was crazy, probably take me instead of him. If I cancel now, we could probably still meet the kids for lunch at ... too late, the ambulance is here. I hope we didn’t waste their time…
Oh, ok, so I guess we’re going to the ER anyway. Seems like we could just go to the doctor now that he seems better, but the EMTs strongly suggested we go to the ER. I’ll call his doctor just in case on the way.
What Will the ER Team Want to Know About Stroke-Like Symptoms?
In the emergency room, the ER team will want to take a complete history to rule out other problems that have similar symptoms. They’ll ask questions like these:
- When did the symptoms begin?
- What were you doing when it started?
- How long have they lasted?
- Has it been constant or does it come and go?
- Did you faint or lose consciousness?
- Does anything make it better or worse?
- Do you have high blood pressure or high cholesterol or take medications for them?
- Are you on any medications?
- Are you taking any aspirin products?
- Have you ever smoked?
- Has anyone in your family had similar symptoms?
- Were you sick or injured recently?
- Has this happened before?
- If you did have a past event, how is this one the same or different?
- Do you have any other symptoms, like nausea, vomiting, fever, cough, sweating…anything else?
- Have you had a recent period of inactivity, such as resting up after a surgery?
If you’re at the ER with someone who may have had a stroke, be prepared to answer these questions. Tell the doctors anything unusual that has happened, like garbled speech, or any ways the patient does not seem normal to you—more or less irritable, not making sense, etc.
At the ER… so many questions… he’s in for a CAT scan now. They want to make sure there’s not any bleeding in his brain. His doctor said I was smart to call 9-1-1, and he’s going to stop in later.
What Tests May be Used to Evaluate Stroke-Like Symptoms?
Tests to diagnose a stroke concentrate on the brain, blood vessels and heart. Some of these tests include:
- Blood tests
- Imaging tests/radiology
Ischemic vs. Hemorrhagic Stroke
There are two types of stroke and the treatment for each is very different. So the first step in the ER will be to figure out which type is happening (usually with a CT scan).
- Ischemic stroke. A clot blocks a blood vessel in the brain. Most strokes are ischemic strokes.
- Hemorrhagic stroke. A weakened blood vessel in the brain ruptures. Blood vessels can rupture from uncontrolled high blood pressure, aneurysms or arteriovenous malformations (AVM).
We were lucky. Really lucky. It was a stroke and we got him to the ER soon enough for these special drugs that only work in the first few hours after symptoms start. We caught it soon enough that he might not need rehab! If I hadn’t been home … not going there.
It’s not over yet, there will be more time in the hospital and then changes at home (no more skipping his blood pressure medicine!). But, it could have been much, much worse.
Get Help, Even if Symptoms Go Away
You may have stroke symptoms like headache or one-sided numbness that went away after a few minutes. You should still go to the emergency room. You may have had what many people call a mini-stroke, or transient ischemic attack (TIA).
During a TIA, a clot blocks a blood vessel briefly and then clears. It puts you at greater risk for a stroke, and that risk is greatest in the first few days after a TIA.
Seeking medical care for TIA symptoms, even after they have stopped, means doctors can diagnose you and start you on treatment to prevent a stroke.
Why Call 9-1-1 Instead of Getting a Ride to the Hospital?
The second stroke symptoms start, an invisible countdown clock begins. The most effective treatment for strokes is a clot-busting drug called tPA that must be given within 3 to 4.5 hours of the start of symptoms. But you can’t just walk into an ER and expect an IV of tPA.
Doctors need to get your medical history (some patients can’t get tPA) and a CT scan of your brain (to be sure your stroke is ischemic – tPA would worsen a hemorrhagic stroke). That all eats into your precious tPA window. Now imagine an hour delay getting to the hospital because you got stuck in traffic.
Ambulances don’t get stuck in traffic and EMS teams can get your medical history en route, so you arrive at the ER ready to go for a CT scan. You’ve increased your chances to get tPA and increased the likelihood of a good outcome.