Question 302 · LEK · Cross-cutting topics

The rescue team’s doctor or paramedic on arrival to the patient with left-side hemiparesis of sudden origin and the blood pressure of 180/110 mmHg, after examining the patient and , if needed, securing of basic life functions, should immediately:

1. AA. take the medical history (from the patient or from the witnesses) about the hour and minute when the symptoms occurred, previous diseases and find out if and what drugs the patient takes and put it in the medical record.
2. BB. administer acetylsalicylic acid at the dose of 300 mg orally, because ischemic stroke is the most frequent cause of sudden hemiparesis.
3. CC. administer acetylsalicylic acid at the dose of 300 mg orally and low-molecular weight heparin (e.g. enoxaparin sodium) at prophylactic dose 20-40 mg subcutaneously, but not at the therapeutic dose (e.g. 80 mg) in order not to exclude the possibility of thrombolytic therapy later on.
4. DD. low the blood pressure as quickly as possible to the level below 140/90 mmHg by administering calcium channel blocker (ex. nifedipine) 5 mg sublingually or with intravenous drugs (e.g. furosemide 20 mg i.v).
5. EE. administer low-molecular weight heparin (e.g. enoxaparin sodium) at prophylactic dose 20-40 mg subcutaneously, but not at therapeutic dose (e.g. 80 mg) in order not to exclude the possibility of thrombolytic therapy later on.