STROKE ACT FAST - What to Do if a Patient Has a Stroke?

Strokes can be life-threatening, and they are also not uncommon. As such, it is important to understand what strokes are, and how you can help care for someone who is suffering or has suffered from a stroke. In the case of a stroke, act FAST.

What is a stroke?

Strokes occur when blood supply to a part of the brain is temporarily cut off, so is sometimes referred to as a ‘brain attack’. This results in the brain being unable to get access to the nutrients and oxygen that it needs, and so neurons in the brain start to rapidly die off. Whilst the effects are identical, there are two main causes of strokes. The most common, accounting for 85% of strokes, is called an ischaemic stroke.

This occurs when a blood clot forms in an artery leading to the brain, which has been narrowed in a process known as atherosclerosis, and thus blocks the supply of blood. Arteries naturally narrow as you grow older, meaning the elderly can be at particular risk of strokes, but lifestyle choices and certain medical conditions also impact the risk of strokes. Smoking, obesity and excessive alcohol consumption can damage arteries. Diabetes, high blood pressure, and high cholesterol levels have a similar effect.

The other type is called a haemorrhagic stroke, which happens when a blood vessel in the skull, that has been weakened, bursts entirely, making it impossible for blood to be carried through it to the brain. The primary cause of haemorrhagic strokes is high blood pressure, which makes arteries weaker. Things that can make you at risk of having high blood pressure include: a lack of exercise; obesity; heavy drinking; smoking; and stress (as this induces temporarily higher blood pressure, so the more frequently you suffer from stress, the more likely you are to suffer a stroke).

There is another type of stroke, known as a transient ischaemic attack (TIA). These are often called a ‘mini stroke’ because they normally only last a few minutes and the victim typically recovers within 24 hours. Ordinarily, TIAs tend to indicate an imminent risk of a full stroke, so should be treated just as seriously.

Risk factors - Stroke Awareness

It is possible to significantly reduce the risk of having a stroke by making changes to your lifestyle, which will help avoid high blood pressure or atherosclerosis. However, there are some factors which you can’t change, which means it is important to be aware of how to deal with strokes since it is impossible to fully prevent them. These factors include:

• Ethnicity - Asian, Caribbean, or African ethnicities are at higher risk of strokes because of higher blood pressure and rates of diabetes in these groups
• Age - Around 75% of strokes occur in people over the age of 65
• Medical history - if you’ve previously had a stroke, TIA, or heart attack, you have a higher risk of suffering a stroke
• Family history - if a close relative (such as parents, siblings, or grandparents) has suffered a stroke, you are typically at higher risk of suffering one yourself

A final thing to have checked by a doctor is an irregular heartbeat if you believe your patient suffers from one. Irregular heartbeats can be a sign of a condition called atrial fibrillation, which is associated with strokes.

Act FAST - statistics

The stroke 'Act FAST' campaign was launched by the UK government to help raise awareness of strokes.

A survey in 2016 by Public Health England released statistics detailing that one in six people will have a stroke in their lifetime. These figures explain how 57,000 people had their first-time stroke in 2016. It is estimated that around 30% of people who have a stroke will go on to experience another stroke.

Stress hormones increase blood pressure, and when those hormones are around long-term, it can lead to high blood pressure, the leading cause of stroke. Stress hormones are also known to lead to diabetes, atherosclerosis, and heart disease – which are all stroke risk factors.

Identifying a stroke

The signs and symptoms of a stroke do vary from person to person. However, there are three main symptoms, and an immediate method of response, that can be easily remembered using the stroke act FAST acronym:

• FACE - the eye, mouth or whole side of the face may have drooped. The person might not be able to smile
• ARMS - the person suffering a suspected stroke may not be able to lift and hold both arms up because of numbness or particular weakness in one arm
• SPEECH - the person may have garbled or slurred speech caused by weakness. Alternately, despite being fully awake and aware, they may not be able to speak at all
• TIME - the most critical thing to do in an expected stroke, is to call for an ambulance as quickly as possible. If the person goes untreated and is suffering from a stroke, death is a strong possibility

If you see any patient develop any of the above symptoms call 999 immediately. Think stroke, act FAST.

Caring for someone recovering from a stroke

There are a variety of health problems that are caused by the brain being starved of oxygen during a stroke and, because these people who have had a stroke typically express psychological issues, stroke sufferers can suffer from conditions like depression or anxiety, as well as a general sense of anger or frustration. The most important thing in this situation is to be understanding and accommodating to their needs, which will vary on an individual basis.

Some people have cognitive issues, reducing their spatial awareness or communication skills. Memory, coordination, and concentration can all be affected by a stroke as well. Therefore, to help these people, you should do whatever helps them individually. Speaking slower, or enunciating more clearly, can help someone understand you, or you could assist someone with negatively affected memory by writing out schedules to help remind them to do particular tasks like taking medicine.

Some stroke victims suffer from movement issues, caused by weakness or paralysis in particular parts of the body. These people will be given sessions with a physiotherapist, but you can assist by aiding them in performing exercises at home. It is also helpful for you to encourage the victim to stick to the goals set by their physiotherapist and to remind them that their condition will improve with time.

Finally, some people suffering from strokes will have communication issues. In such cases, the victim will be given exercises to improve control over speech muscles and may be encouraged to use speech aids (like letter charts or electronic aids) or experiment with alternative communication techniques. You should encourage them in a similar way to those who suffer from movement difficulties, helping them practice exercises, and encouraging them to use their aids even if they feel awkward using them around you.

To further your understanding of strokes, try our e-learning Stroke Awareness course, teaching learners the different types of strokes, stroke treatment and rehabilitation, and emergency response. Staff working in the health and social care sector can find more suitable courses like this on our Clinical Care training page.