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A blood glucose level may already be available from earlier investigations (e.g. ABG, venepuncture). A normal blood pressure (BP) range is between 90/60mmHg and 140/90mmHg but you should review previous readings to gauge the patient’s usual baseline BP. 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 Stroke is a medical emergency. If you experience any of the symptoms below, you should call 999. How to identify a stroke
Discuss the patient’s current clinical condition with a senior clinician using an SBAR style handover. These investigations should not delay the emergency management of stroke, including arranging neuroimaging and thrombolysis (if indicated). Arterial blood gas
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Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. In any case, it is likely that one single longevity strategy alone won’t help us much. Life extensionists enjoy a metaphor: humans are complicated machines, they say, like cars, but mushy. And what happens to a machine if you don’t look after it? It rusts. It splutters and spurts, until it reaches its inevitable conclusion. De Grey considers ageing a “multifaceted problem”. Humans incur many different types of damage. We don’t just rust. We scratch. We dent. Rubbish accumulates in our footwells and grime develops in our engines. We require multiple strategies of repair – constant fine-tuning. What’s the point in removing those senescent cells if that molecular junk continues to build up?
A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. NPAs should not be used in patients who may have sustained a skull base fracture, due to the small but life-threatening risk of entering the cranial vault with the NPA. MRI FAST head: sometimes performed in an acute setting, especially in wake-up strokes. Comparing different sequences can show if there is still perfusion and if someone would benefit from thrombolysis. The NIHSS is a systematic, quantitative assessment tool for stroke-related neurological deficits. The higher the number, the greater the deficit and the bigger the stroke. A normal SpO 2 range is 94-98% in healthy individuals and 88-92% in patients with COPD who are at high risk of CO 2 retention. Thrombolysis involves administering a thrombolytic agent (e.g. alteplase) to break down a clot. Thrombolysis can be used in patients with an ischaemic stroke who present within 4.5 hours of symptom onset.
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Nevertheless, he persisted. He considered himself fortunate to work in a field that meant he was privy to insider information and he became convinced a significant breakthrough was around the corner. To fully prepare his body for the rigmarole of centuries-long life, he adopted a strict health regimen. He fasted, juiced, cleansed and devoured supplements, inviting audiences to do the same. Eventually, a community formed, driven by a shared, urgent aversion to death. “We felt then how important it was to do everything you could to stay alive,” he says 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.
Others claim they can already prevent aging in animals. George Church, a Harvard professor and the founder of Rejuvenate Bio, uses gene therapy to add anti-aging instructions to DNA. Church says he has succeeded in making mice live twice as long, and the secretive company is said to be planning imminent testing on dogs. Request a CT head immediately in all cases of suspected stroke. A CT head is important to identify intracranial haemorrhage (as these patients must not receive thrombolysis). An irregular pulse is associated with arrhythmias such as atrial fibrillation. Atrial fibrillation is a common cause of thromboembolic stroke due to blood pooling and clotting in the heart.
A temperature < 36°c may also be caused by sepsis or cold exposure (e.g. drowning, inadequate clothing outside). Most stroke patients are not hypoxaemic. Evidence suggests high concentrations of supplemental oxygen should be avoided in stroke patients unless required to maintain oxygen saturations. Hypoglycaemia is defined as a plasma glucose of less than 3.0 mmol/l. In hospitalised patients, a blood glucose ≤4.0 mmol/L should be treated if the patient is symptomatic. If your patient is unconscious and their respiratory rate is inadequate (too slow or irregular with big pauses), you can provide assisted ventilation through a bag-valve-mask (BVM): ventilate at a rate of 12-15 breaths per minute (roughly one every 4 seconds). CPR Strole has been an evangelist of human immortality since he was a child, when his grandmother died, and he felt “a pain you can’t even describe, it’s so deep in your gut.” He was 11, still new to the world, and he came to think of death, like most of us do at some point or another, as deeply unfair.
A LACS (lacunar stroke) is subcortical; therefore, higher cerebral functions (e.g. language) are preserved. Hence, these can be pure motor, sensory, sensorimotor, or cause ataxic hemiparesis alone. 3 Bamford stroke classification Haemorrhagic stroke
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Ambulance paramedics are trained in stroke and will ensure the person receives emergency medical care and specialist treatment. Other symptoms of a stroke If the patient is conscious, sit them upright as this can also help with oxygenation. Assisted ventilation Blood pressure lowering: aim for BP < 140 mmHg systolic (if <6 hours of onset) or < 180 mmHg systolic (if >6 hours of onset). Use labetalol 10mg IV, then consider GTN infusion. It is important to follow local guidelines and pathways when managing patients with suspected stroke. An example of a patient pathway for a pre-hospital stroke is shown below: After each fluid bolus, reassess for clinical evidence of fluid overload (e.g. auscultation of the lungs, assessment of JVP).
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