91 186 Definition Impairment of blood flow to the brain resulting in permanent damage to brain tissue. The obstruction can result from cerebral thrombosis, cerebral hemorrhage, or cerebral embolism. There are 2 main types of strokes: ● Ischemic strokes are caused by the blockage or narrowing of a cerebral artery from cere- bral thrombosis or embolism. ● Hemorrhagic strokes result from rupture of a cerebral artery. Brain damage occurs from decreased circulation and pressure from the bleeding into surrounding brain tissue. Transient ischemic attacks caused by a temporary blockage of a cerebral artery produce symp- toms resembling a stroke, which spontaneously resolve after seconds, minutes, or hours. Characteristics Weakness of an extremity, unilateral numbness, dizziness, confusion, severe headache, tin- nitus, difficulty speaking, shortness of breath, difficulty swallowing, paralysis, decreased level of consciousness, seizures, facial weakness with a one-sided droop of the mouth or drooling, decerebrate or decorticate posturing, unequal or dilated pupils, irregular respira- tions, amnesia, visual difficulties, and coma. Policy Evaluate employee in the occupational health unit or call emergency response team. Refer person with transient ischemic attack for immediate medical care. A cerebrovascular accident (CVA) is a medical emergency and requires immediate emer- gency transportation to the hospital. Objectives Clinical Assessments and Interventions Referral for Medical Action Cerebrovascular Accident (CVA) ● Immediate medical evaluation and treatment (i.e., transport to hospital). Follow-up Actions ● Collaborate with personal health care provider regarding follow-up treatment plan. ● Assist in returning employee to the workplace when feasible in appro- priate job placement or with reason- able accommodations as needed. ● Discuss activities of daily living and a healthy lifestyle to include nutri- tion, rest and relaxation, smoking cessation, exercise, and the like. ● Instruct in use of medications and their potential side effects. Determine em- ployee status and severity of attack, and stabilize em- ployee. ● Assess employee status. ● Assess employee level of consciousness. ● Assess and maintain patent airway. ● Avoid giving anything by mouth. ● Assess glucose level if available because hypoglycemia can present as CVA. ● Position employee on affected side or maintain position of comfort. ● Record vital signs every 5 minutes check and record pupil response. ● Administer oxygen per standing order. ● Obtain a medical history, if possible. ● Obtain the approximate onset of symp- toms and document. ● Arrange for medical transport. Guideline continues on next page