stroke question

Ok, my mom's friend was having a stroke the other day & someone that was with her said to give her an aspirin, now i know im in the beginning stages of nursing school & learning the different drugs & i know you give aspirin for chest pain(ami) & ive never heard you give aspirin while having a stroke, ive read that a person takes aspirin to PREVENT STROKES NOT WHILE HAVING A STROKE. I also know that asprirn is an platelet aggregation inhibitor drug which in that drug class its more of prevention or reduction of risk. Am i wrong or was that person right?

I don't want to cross the line into medical advice, so I will (hopefully) lead you to the correct answer. Aspirin inhibits platelet aggregation, preventing clots from becoming larger. Well, what if the stoke is hemorrhagic (i.e. bleeding into the brain)...would you want to inhibit clot formation by giving an aspirin?

P.S. After a stroke pt is foind not to have a head bleed, they are giving aspirin if they are not getting tPA.

Hmmmm I am in my last semester of an RN program and we covered strokes on the first test. I remember aspirin being part of prevention but not in emergency management before it was determined which type of stroke had occured.

If it is the common type of stroke, ischemic, then it might be appropriate and given in the ER, but not for hemorrhagic. I believe we learned the only way to tell was by a quick non-contrast CT in the ER. Until then we were taught to remain with the patient, keep them calm, monitor the ABC's.

Ok thanks thats what i thought! The people that was with her didnt give the aspirin because none of her family was there to give consent they just called 911. I was just curious because ive never heard giving it like right then & there while having it. I understand afterward at the hospital AFTER giving thrombolytics & as a prevention measure.

ASA used to be recommended for stroke symptoms, but now that CT is done routinely to rule out ischemic vs. hemorrhagic I do not know why it would be needed. I have not seen the recommendation in the literature recently but have not been looking either

I'd like to say never, ever give someone aspirin before the hospital. It's 100% contraindicated. I don't care what anyone says about prior history or ability to interpret presentation. A CT head (stroke panel) must be done before anything is given per NIH standards. Period. As mentioned above, there is absolutely no way to know if the stroke is from a bleed or a clot. If someone is having a stroke, all you do is call 911, make sure they are not in a position to fall, have someone get their med list, and watch for signs of airway/breathing/circulation compromise. Fyi... The only reason it is ok to give ASA to chest pains (non-trauma) is b/c heart attacks are not caused by bleeds. Strokes are a flip of the coin...bleed or ischemia. Even in the hosital, the first thing you do when you think a pt is stroking, you immediately do a stat CT stroke panel.

It's in our nature to want to give a medication or offer some type of treatment to a loved asap, but the consequence of acting without initial critical thinking can be disastrous. ASA will (and I mean will) make the bleed worse. Plus, it will buy multiple infusions of plasma and /or platelets. This also includes any NSAIDS like Motrin and Naproxen.

I like saying the following statement to students. Medicine is not only knowing what to do. It's also knowing what not to do.

In addition to calling 911, make sure the exact time of symptom onset is communicated to the medics (or a family member/friend going to the hospital). This can be key if the pt is a candidate for thrombolytic therapy.

We had strokes from our last class but what was not covered was how to treat hemorhaggic strokes. What do they do in that case? I know tpa within the first three hours and then they said heparin if its been longer in an ischemic or thrombotic. But nothing about hemorhaggic strokes.

Hemorrhagic strokes require surgery, according to my professor (who just finished teaching us about strokes a few weeks ago).

We had strokes from our last class but what was not covered was how to treat hemorhaggic strokes. What do they do in that case? I know tpa within the first three hours and then they said heparin if its been longer in an ischemic or thrombotic. But nothing about hemorhaggic strokes.

The location of bleed is important. You can have an epidural hematoma (bleeding above the dural lining). These bleeds are bad b/c epidurals are from artery rupture. They can bleed a lot in a very short time b/c it is under arteriole pressure and the space between the cranium and dura is close to nothing. Many of these go straight to surgery. A subdural hematoma (below the dura) is mainly a venous bleed. There is less pressure so the bleeding may be less, however, pt's can have massive SDH's and it can be deadly. Since the bleed is below the dura, there is a little more wiggle room but it still be an emergency. Both can be treated with a burr hole in the skull to drain the blood/pressure or a craniotomy. There's a subarachnoid hemorrhage (located below the arachnoid mater). This can be caused by trauma, an arteriovenous malformation, or ruptured aneurysm. You can also have a brain stem bleed or any other part of the brain.

First thing is to prevent any further bleeding. Pt's usually have numerous repeat head CT's to assess this. If it continues to bleed, that will most likely result in surgery. Obviously, they can't have any nsaids, anti-platelets, or anticoagulation. You keep the head of bed at least 30 degree to decrease head pressure. SCD's or even an inferior vena cava filter to prevent DVT or PE. Neuro assessment Q1hr. NIH stroke scales. Plasma and/or platelets to decrease bleeding or counteract blood thinners. Elderly are always on something...plavix, asa, coumadin, etc. Some pts lose their airway and require intubation. You check for signs of herniation by change in LOC, unilateral pupils changes, tachycardia followed by severe bradycardia, loss of reflexes.

Another main treatment is B/P control and this a big one. These pts are usually hypertensive and you have to strictly maintain their B/P. Doctors usually want the systolic

If you treat them medically (without surgery), you hopefully see the bleed decrease over time. The body has the ability to breakdown the bleed and reabsorb it. It can be anywhere from days to months depending on the size or location. One neurosurgeon told me that bleeds can have the consistency of motor oil to even peanut butter. Some pt's can have chronic bleeds that remain longer than 6 months. Along with all this, you have to treat them with everything that goes along with stroke.

If the stoke was ischemic in nature, the blood pressure control may be different. It depends on the physician/neurologist. I remember taking care of a patient with an ischemic stroke and the neurologist called me to tell me to not give any antihypertensives unless the SBP was >180.

I had a pt who had had a CVA and BP parameters were SBP 180-200 on IV Labetolol *rolls eyes*

If the stoke was ischemic in nature, the blood pressure control may be different. It depends on the physician/neurologist. I remember taking care of a patient with an ischemic stroke and the neurologist called me to tell me to not give any antihypertensives unless the SBP was >180.

Obviously BP control is important if they are getting TPA (or, obviously, if they are a bleed). One of our ER attendings said that the prevailing logic is that a higher BP will help to "push" blood past the clot if they are an ischemic stroke and not a TPA candidate.