First aid treatment of stroke
Stroke can occur as quickly as the wind and rain and as quickly as lightning. The onset of the disease does not distinguish occasions, or in the room, or in the workplace, or even in the street, the countryside, the market, on the way, can suddenly onset of disease.
1, if you encounter a sudden stroke patient, first of all, do not panic, learn some simple measures to deal with. If you find that the patient’s condition is serious, or quickly into a coma, the condition is dangerous, brain hemorrhage is more likely. At this time, the patient can be lifted to the bed, head cushion a low pillow, and turn the head sideways; remove the dentures, timely removal of vomit and sputum in the mouth and nose to prevent asphyxiation; untie the collar to keep the airway open; if there is a convulsion, a small towel can be placed in the mouth to prevent tongue bites; do not attempt to wake the patient and shake his body and head. At the same time, we should contact the ambulance to send the patient to the hospital as soon as possible for treatment.
2. Before escorting the patient, ask the first aid station or local doctor to check the patient, measure blood pressure, observe pupils, breathing or pulse. If the patient is critical, temporary treatment should be done. Those with elevated blood pressure should be given antihypertensive drugs, and dilated pupils or breathing difficulties often indicate cerebral edema and increased intracranial pressure, which should be treated with dehydrating agents immediately.
3.Protect the patient during transportation to the hospital. The patient should be flattened up so that it lies flat in the car; if there is no emergency vehicle, a flatbed tricycle can be used to escort the patient; along the way, there should be special personnel to protect the patient’s head to avoid violent head shaking and vibration; the position of the head to the side to facilitate the flow of vomit from the mouth, so as not to accidentally into the trachea suffocation; respiratory distress can be given oxygen inhalation; if the patient is still clear, to give more persuasion and comfort If the patient is still conscious, give more persuasion and comfort so as not to aggravate the condition by excessive mental tension.
4, the patient should be sent to the hospital to avoid long-distance transport, as far as possible to local treatment. As stroke is a common disease, general hospitals have the conditions for treatment. Send the nearest hospital can get timely treatment, but also to reduce the shaking and bumps in the road. Long-distance transport is sometimes very dangerous and can lead to a sudden deterioration of the condition, depriving the patient of the opportunity to be rescued.
Care of stroke patients
1.How to care for patients in the acute stage of stroke?
The acute care of stroke patients is very crucial to the success of the disease rescue.
(1) Quiet rest and avoid unnecessary moving: Stroke patients, especially those with cerebral hemorrhage, should minimize visits and avoid unnecessary examinations and moving. Choose a quiet and light-proof room for irritable patients to reduce stimulation; add bed stalls if necessary to prevent bruises from falling to the ground.
(2) Timely oxygenation: all stroke patients have cerebral hypoxia, and oxygen is often administered clinically by nasal cannula, so pay attention to whether the patient’s nasal cavity is clear and the nasal cavity is clean.
(3) Closely observe the condition, such as consciousness, respiration, pupils and blood pressure, pulse, and body temperature.
(4) Pay attention to diet and nutrition: Generally, patients should not eat during the first 3 days of illness because they may have coma and vomiting, etc. Reluctantly eating may lead to food aspiration into the lungs and cause infection, but there must be an appropriate amount of intravenous rehydration, and those who still cannot eat after 3 days should ensure the supply of nutrition through nasal feeding.
(5) Change position regularly to prevent bedsores; maintain functional position to prevent deformity of paralyzed limbs.
(6) Maintain oral hygiene: help patients brush their teeth in the morning and evening and rinse their mouths after meals to prevent diseases from entering through the mouth.
(7) Urinary and fecal care: stroke patients often have difficulty in defecation, so the patient can eat more vegetables and fruits, drink more water, and use gentle laxatives and massage the abdomen to make them defecate regularly. For patients with urinary incontinence, they can be trained to urinate on time to establish a conditioned reflex; for patients with urinary retention, if abdominal hot compresses or acupuncture are not effective, they can retain catheterization, but try to shorten the catheterization time and prevent urinary tract infection.
2.How to care for the patient in a stroke coma?
Eye care: The eyes of stroke coma patients often do not close together, the transient reflex disappears, and the physiological protection of the eye is lost. This makes it easy for a foreign body to fall in and damage the cornea; secondly, it is easy to change position when the pillow or quilt touches the cornea, resulting in keratitis, corneal ulcers and conjunctivitis; thirdly, corneal dryness can occur. Therefore, special attention should be paid to eye care. For those with incomplete eyelid closure, wash the eyes with 1% boric acid or saline once a day, then use 0.25% or 0.5% aureomycin eye drops and apply aureomycin eye ointment or boric acid ointment, then cover with gauze or protect the cornea with an eye shield; for those with better eyelid closure, use 0.25% chloramphenicol eye drops or 0.5% aureomycin eye drops 3 to 4 times a day.
Oral care: If there are dentures, remove them; remove oral secretions frequently; apply suction for deeper secretions; keep the respiratory tract open; use saline-soaked cotton balls or swabs for oral care daily, and apply nail violet for ulcers.
Skin care: Care can be provided according to the method of preventing bed sores.
In addition, the patient should be put in the lateral position, not supine, so that secretions and vomit can be prevented from accidentally entering the trachea and causing asphyxia. Patients with cerebral hemorrhage and subarachnoid hemorrhage should be absolutely bedridden for 1 month.
3.How to prevent and care for bedsores?
Stroke patients often have paralyzed limbs and cannot turn over and change positions on their own, so localized pressure on the body, combined with decreased skin nutrition of paralyzed limbs, makes decubitus ulcers most likely to occur. Decubitus ulcers, also known as pressure ulcers, are red, swollen and blistered in the early stages of the disease, and later become purplish red and begin to break down. Bed sores are more likely to occur on the back of the chest, buttocks, hip, heel and ankle, where they are compressed by weight. Prevention of bedsores is most important and should be done as follows.
(1) Turn and massage the patient regularly, at least once every 2 hours.
(2) Use soft cushions, air rings, sponge pads, etc. in the areas where decubitus ulcers are likely to occur.
(3) Keep the skin clean and dry. When there is urinary or fecal incontinence and vomit, scrub them clean in time. Do not let the patient sleep directly on the rubber mat.
(4) Keep the bed clean and dry, and change the bedding whenever it is wet. For patients who are incontinent, do not put the bedpan under the patient for convenience. Patients with sensory impairment should not use hot water bags as much as possible to prevent burns.
(5) Strengthen nutrition in the diet, ensure the supply of protein, and increase the resistance of the patient’s skin.
(6) For decubitus ulcers that have occurred, keep the wound surface dry, apply anti-inflammatory and muscle-generating ointments, and use physical therapy, etc.
In short, good prevention of bedsores means turning over regularly and checking whether the skin, clothes and sheets are flat and dry when turning over; when the skin under pressure is red, rubbing with the palm of the hand to promote blood circulation in the skin, so as to achieve early prevention, early detection and early treatment.
4.How to take care of paralyzed limbs?
Most of the paralysis caused by stroke is hemiplegia, or single limb paralysis, and two episodes involving bilateral limb paralysis. Patients often have speech impairment, choking and coughing due to ball palsy, or some degree of mental decline. Patients must be given better care, and the following points should be done.
(1) Good psychological care: pay attention to the patient’s ideological work. Paralysis brings a heavy burden to the patient’s mind. The family must encourage the patient to be optimistic and open-minded, establish confidence in overcoming the disease, so that he can cooperate with the medical staff and family members, and carry out functional exercises of the paralyzed limb as early as possible to prevent the occurrence of joint deformity and muscle atrophy.
(2) Maintain the functional position of the limbs: the finger joints of the paralyzed limbs should be extended and slightly flexed, and a sponge ball can be placed in the patient’s hand; the elbow joints should be slightly flexed; the shoulder joints of the upper limbs should be slightly abducted to avoid joint inversion; the hip and knee joints should be extended; to prevent the foot from drooping, the ankle joints should be slightly dorsiflexed; to prevent the lower limbs from external rotation, sandbags or other supports should be placed in the lateral part.
(3) Strengthen the activities of paralyzed limbs: including limb massage, passive activities and sitting up, standing and walking exercises, etc., which can prevent limb contracture and deformity.
(4) Prevention of complications: Because of the motor and sensory impairment of the paralyzed limb and poor local vascular nerve nutrition, decubitus ulcers can easily occur if the compression time is long. Therefore, attention should be paid to changing the position, usually turning once every 2 hours, and gently massaging the parts that are pressed red, or using saffron alcohol massage to improve local blood circulation. The bed should be dry and flat, and good personal hygiene should be maintained, and a bath should be taken, but attention should be paid to keeping warm and preventing cold. The water temperature should be appropriate when applying hot water bags or baths to prevent skin burns. Appropriate tapping on the back should be done when turning to encourage coughing up sputum to prevent crushing pneumonia. Have enough intake, especially in summer to be well hydrated and ensure adequate nutrition. Choose vegetables and fruits rich in fiber and vitamins, and develop bowel habits to prevent constipation. Give 1 cup of hot drink (hot water, tea, milk or coffee, etc. depending on the habit) before breakfast, which can stimulate the rectal bowel reflex by increasing intestinal peristalsis. In order to promote defecation, you can also massage the abdomen, from the lower right abdomen to the upper right, to the upper left abdomen, and then to the lower left abdomen, repeatedly 5 to 10 times, to promote the upper end of the colon contents downward peristalsis, to help defecation. In case of constipation, glycerin suppositories or Chinese herbal medicine can be used, and if defecation is still not possible, enema should be given. In case of urinary retention or incontinence, a urinary catheter should be placed and aseptic operation should be strictly performed to prevent urinary tract infection.
(5) Training of self-care ability and vocational ability: When the paralysis has improved, the patient should actively exercise daily living skills; medical staff and family members should give correct guidance and enthusiastic help, and encourage the patient to do things within his ability, such as taking off and putting on clothes, washing face, eating, etc.
5.How to adjust the bedding and clothing of hemiplegic patients?
It is better for hemiplegic patients to sleep on a bed with guardrails to prevent falling and to facilitate future rehabilitation exercises. A thick and soft mattress can be laid on the wooden bed, or an air mattress can be used if possible. If you are incontinent, you can put a rubber pad under the sheet and a diaper on top of the sheet so that you can change it in time and keep it dry.
The clothes worn by hemiplegic patients should be fat and soft, easy to put on and take off, preferably with zipper or Velcro for easy replacement. When changing clothes, the upper limb on the healthy side should be changed first, and the replacement clothes should be put on immediately after one side is taken off to avoid getting cold; when changing the affected side, the shoulder joint should be protected to prevent dislocation; when the temperature is low, the room temperature should be raised, light and warm quilt should be covered, and no hot water bag should be placed to prevent the patient from getting burned due to sensory impairment; when the temperature is high in summer, it is more convenient not to wear pajamas on the upper body, and a thick towel quilt can be covered, but attention should be paid to prevent the shoulder from getting cold.
6.What conditions should a hemiplegic rehabilitation patient have at home to send to hospital?
Cerebrovascular disease not only has a high morbidity, disability and mortality rate, but also a high recurrence rate. A considerable number of stroke patients will have a second or even a third stroke. Usually the second stroke is more serious than the first stroke and the mortality rate is much higher than the first stroke, so it is necessary to send the patient to the hospital and get timely treatment.
A patient recovering at home may have another stroke if the following conditions occur: increased weakness in the paralyzed limb; numbness in the hemiplegic body or numbness and weakness in the other limb; unclear speech or stuttering; choking and coughing when drinking, difficulty swallowing; unstable walking, vertigo attacks with vomiting; severe headache and vomiting, or even coma or seizure. In this case, it is necessary to send to the hospital immediately.
In addition, stroke patients with fever, cough and phlegm, or abdominal pain and diarrhea, or palpitations, precordial pain, chest tightness and other symptoms, indicating that the patient has other medical aspects of the disease, should also be immediately sent to the hospital for examination and treatment.