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Assess the patient’s calves for erythema, swelling and tenderness which may suggest a deep vein thrombosis. All community medical services and ambulance services (including call handlers) should be trained to treat patients with symptoms suggestive of an acute stroke as an emergency requiring urgent transfer to a centre with specialised hyper-acute stroke services.
The oldest person to have lived, Jeanne Calment, reached 122, though she was perhaps not the greatest example of good health: she smoked until she was 117. The most successful life-extension methods we know of seem to be those we have known all along: eat well, sleep well, exercise, reduce stress and rely on modern medicine, which has prolonged average lifespans significantly over the past 160 years. If the patient is conscious, sit them upright as this can also help with oxygenation. Assisted ventilation Are we anywhere near to a breakthrough? So far, research has produced modest yields. Gerontologists speak prophetically of potential, but most warn a significant human development remains somewhere far off in the distance – almost in sight but not quite. Richard Hodes, the director of the National Institute of Aging, a US government agency, told me that, though research in animals has led to “dramatic increases in lifespan”, some of them multi-fold, “There has been far less quantitative effect as those models have moved towards mammalian species.” The biologist Laura Deming, who in 2011 established the Longevity Fund, a venture capital firm that supports “high-potential longevity companies”, told me that startups continue to successfully root out biological markers of ageing – inefficient cells, mitochondrial decline – but that, in humans, “We really don’t know right now what will work and what won’t.” Alert a senior immediately if you have any concerns about the consciousness level of a patient. A GCS of 8 or below warrants urgent expert help from an anaesthetist. In the meantime, you should re-assess and maintain the patient’s airway as explained in the airway section of this guide. CPR
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A temperature < 36°c may also be caused by sepsis or cold exposure (e.g. drowning, inadequate clothing outside).
Hypertension can cause stroke through end-organ damage (this is known as a hypertensive emergency and tends to occur at BP >200 mmHg systolic) Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing.
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There are two kinds of haemorrhagic stroke, intracerebral haemorrhage (ICH) and subarachnoid haemorrhage (SAH): If a patient does meet these criteria, a referral should be made to the closest mechanical thrombectomy centre. Patients who do not fit the criteria for thrombolysis/thrombectomy You should have another member of the clinical team aiding you in your ABCDE assessment, such a nurse, who can perform observations, take samples to the lab and catheterise if appropriate.
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