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Well, another year that passes is another year that CVA surpass MI in cardiovascular deaths. Out with the old, in with the new, turns out it's way cooler to get a little droopy and confused over clutching your chest and collapsing. Who woulda thought?
The good news is, CVAs are a lot more easier to recognize, as heart attacks present mostly with nausea and chest pain- which could honestly be anything until whoa hey man not to freak you out but you're throwing tombstones and you're about to be really popular. Nothing will make the 85$ you paid for nipple piercings worth it like a cardiovascular episode... or so I'm told.
There's a variety of stroke scales available, all meant to gauge things in varieties of levels- if you recall the acronym FAST rotated around for a while. Everyone and their mom knew to look for Facial droop, Arm of leg weakness, Speech difficulty, and Time importance- and just if you forgot it all came together into the word FAST to specify that time is tissue and you should act immediately.
Pretty good, huh? Probably the best medical hurdle we've jumped, next to when scientists were injecting 200 units of insulin directly into dog's renal arteries and trying to figure out why it was killing them (the bigger breakthrough would be why it didn't).
As time progresses things change and now we've settled on BEFAST, the reason for this being that although ischemic and (some) hemorrhagic strokes were being identified the now more common Large Vessel Occlusions were being overlooked. A LVOs being the larger vessels that run along the bottom of your brain and into it, this obstruction of large proximal cerebral arteries is still technically an ischemic stroke (a clot obstructing blood flow)- however present differently, making them easier to miss, in addition to having a blockage in a brain artery is about as good for you as it sounds. With ischemic stroke the standard of care, as long as the last seen well was less than 4.5 hours tPA is given to break up the clot. Usually working pretty well- however not so much for LVOs, at least not as a stand alone treatment usually requiring surgical interference.
LVOs strokes present mainly with Balance issues since the limbic system is in such close proximity of the supply and demand issue, as well as Eye sight issues also due to proximity of the occipital lobe. Usually presenting as dizziness and blurred vision but can also present in different segments of vision being absent.
So how can I tell if I'm having a stroke? Well for a true ruling out bloodwork and a CT scan are needed. tPA cannot be given during a hemorrhagic stroke- as tPA's entire job is to break up clots the idea of unclottable blood pouring into your brain cavity is enough to say as mind boggling. For prehospital troubleshooting, consider blood sugar- even in people who are not diabetic. Low blood sugar can mimic a stroke. This is also where stroke scales come into play, and where you apply BEFAST. Strokes (as well as MI) are more likely to happen in the earlier hours of the morning, specifically 6am to noon. Why? In the early hours of the morning our vessels are thicker and have more difficulty dilating and blood consistency is thicker. So thick smoothie gets stuck in your coffee stir straw. Strokes are also more likely to occur after exercise, however, this doesn't mean don't exercise- people who live sedentary lifestyles are much more likely to suffer from strokes due to lack of vascular resistance.
With that, remember to BEFAST for yourself and your loved ones- time is tissue.
Balance
Eyesight
Facial droop
Arm/leg weakness
Speech
Time
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francis, fran
thank you. i was sadly uninformed of all of this. as a senior in high school, i have never once learned how to do basic things like use an epipen, recognize signs of stroke, or other basic but useful safety skills.
oh shit i just read the "minors DNI"
fuck
by francis, fran; ; Report
The minor DNI is for social communication private messages, etc. Medical knowledge is a human right.
Fun fact, most first responders don't use epi-pens, we're trained once on what they look like, where to jab, and given the 'hey the instructions are on the side bozo, so easy a cop can do it'. Granted in a situation where someone needs an epi-pen isn't one where you're carefully reading the side and trying to recall a class from years ago where the only thing you remember is jabbing at your buddy with a tester pen.
We actually use draw-up epinephrine! This is important because it shows a greater failing of our medical system not only to the people, but now for a bleed in onto first responders. Epi-pens should be a necessity for anyone with allergies, but considering they run anywhere from 600-700$ people are less likely to spend a 3 month grocery bill on something they may or may not use. This is the same for EMS forces, where you would have to buy 4 epi pens- 2 adult and 2 pediatric. If you don't use them before they expire? Tough shit, go buy more. Which becomes taxing and takes from supplies which could be put to greater use in the system, how did we learn to combat this? The answer used to be veterinarian surplus, rural communities would buy epi vials (1mg/ml) for about 5 cents, and just use the injection supplies allocated for other medications- yes it was a few more seconds to draw up and inject but boy was it manageable. It's now become a more standardized thing, if you had someone open up their work drug box there wouldn't be an epi-pen in there, there would be a vial with a purple top that says adrenalin. This became an issue as epinephrine is also a cardiac drug, so there are two potencies- 1:1,000 (your anaphylactic dosage) and 1:10,000 (your cardiac dosage). Your anaphylactic dose is much more concentrated because it is deposited in the muscle (via epi-pen or traditional injection) and blood flow travels through the muscle absorbing the medication into the blood stream. For cardiac epinephrine it is much more diluted since the medication is placed in the bloodstream directly via intravenous line. This is important because one of these you want in your bloodstream, one you don't- so it's very important to check these vials for the right concentrations before administration. Now organizations keep them in separate boxes with labels and locks (hey so easy a cop can do it) to prevent any disaster. The fear with injecting is that you may accidentally get a blood vessel (since they're running around the same area as the muscle). Until the art of injection is mastered we use a technique called aspirating where we pull back on the syringe and see if blood enters the syringe, if it does- you're in a vessel get out of there. Ideally, as long as you are at a 90 degree angle (straight into the muscle) there will be no vessel involvement and if there is it will 'collapse' (not uptake this fluid directly into the vessel itself).
Granted with a lack of epi-pens providers are forced to memorize doses to administer- which is super easy, 0.30 for adults and 0.15 for kids (33-60lbs). With this injection method it's also easier to visualize depth and navigate difficult anatomy- which epi-pens do not provide.
I'm intersex and have been doing hormone injections on and off my whole life, they're not hard- in fact intramuscular injections are painless and easy. The most rookie mistake is that people measure the bottom line of the syringe instead of the top (I'll probably make a blog on how to read and use a syringe). For this reason I recommend manual injection of epinephrine over Epi-pens there are more pros than cons, and a big thing for it- we've figured out how to shit in Big Pharma's hands. Granted epi-pens are easier to transport, but this has been eased by the transgender community, as they're putting out carrying cases for vials and syringes and needles which honestly look so much better than an epi-pen anyway.
by Glorified Craigslist Bonesaw; ; Report
i was not aware of drawn up epinephrine as an alternative to epipens. nor was i aware of the difference between injecting into muscle and into vessel, as well as aspirating. cool shit, important, and thank you!
by francis, fran; ; Report