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Any medications or fluids will need to be prescribed at the time (in some cases you may be able to delegate this to another member of staff). Maintain head-tilt chin-lift or jaw thrust and assess the patency of the patient’s airway by looking, listening and feeling for signs of breathing. Nasopharyngeal airway (NPA) If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Re-assessment Revisit history taking to identify risk factors for stroke and explore relevant medical history. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate.

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. 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 There’s millions of people now who won’t see death if they choose,” said James Strole, the director of the Coalition of Radical Life Extension, an organization which brings together scientists and enthusiasts interested in “physical immortality”.After each fluid bolus, reassess for clinical evidence of fluid overload (e.g. auscultation of the lungs, assessment of JVP).

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 Assess direct and consensual pupillary responses which may reveal evidence of intracranial pathology.Insert at least one wide-bore intravenous cannula (14G or 16G) and take blood tests as discussed below. In the context of a stroke, the handover may be from nursing staff (for in-hospital strokes) or ambulance staff (for pre-hospital strokes). Introduction Stroke is a medical emergency. If you experience any of the symptoms below, you should call 999. How to identify a stroke

A PACS (partial anterior circulation stroke) is caused by an infarct that only affects part of the anterior circulation and causes two of the above, or higher cerebral dysfunction alone. 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. Clearly communicate how often would you like the patient’s observations relayed to you by other staff members. Terminal internal carotid, middle cerebral artery (M1 or proximal M2) occlusion or basilar artery occlusion For patients who do not fit the criteria for acute management (thrombolysis/thrombectomy), general medical management involves: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. 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 Someone in the UK will have a stroke every 5 minutes, with 100,000 people having strokes yearly. Cerebrovascular diseases are the 4 th most common cause of death in the UK, with 75% of those deaths being from stroke. 1

Assess the patient’s calves for erythema, swelling and tenderness which may suggest a deep vein thrombosis. At present our bodies are built to last – “if you took perfect care of your body” – 125 years, according to Strole. The problem is that if someone did live to be 125, they are unlikely to remain spry into their final decades. Use an effective SBAR handover to communicate the key information effectively to other medical staff. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Management of ischaemic stroke Thrombolysis An oropharyngeal airway is a curved plastic tube with a flange on one end that sits between the tongue and hard palate to relieve soft palate obstruction. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration.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). It may be necessary to expose the patient during your assessment: remember to prioritise patient dignity and conservation of body heat. Clinical assessment