What injections are given in the first hours of a stroke?

Treatment of stroke of any type and location is usually complex and multi-stage. At different stages of the patient’s pathological process, different medications and differentiated routes of their administration are indicated.

There is a widespread belief that IVs are the optimal way to administer medications in a hospital, especially after a stroke. This is partly true. However, as with any medical procedure, there are indications and contraindications for intravenous drip administration of drugs. As well as treatment schemes and protocols approved by the Ministry of Health. In this article we will try to analyze in detail what intravenous drip administration of drugs is and when it is necessary for a stroke.

IVs for stroke

To restore brain function, the patient is prescribed IV drips. In addition to Actovegin, a solution of Vinpocetine is used, and Cerebrolysin and Piracetam are also used. These drugs can be supplemented with Pentoxifylline.

Recently, pharmacologists have been actively developing organic preparations containing amino acids that accelerate the resorption of blood clots and restoration of blood circulation. Such drugs must be used during an attack - within two hours after the onset.

In the case of a hemorrhagic stroke, sodium chloride is used to help redistribute fluid and eliminate swelling of the brain. With the help of saline solution, the absorption of medications is improved.

Prescribed medications

It is difficult to cope with a stroke only with the help of medications: the patient has a complex pathology. So it is important to know what medications to take after a stroke.

To eliminate disorders, you must take at least three medications belonging to different groups. During the period of rehabilitation therapy, the most popular medications are after a stroke, the list of which is as follows:

1. Muscle relaxants that help reduce reactive tension in the muscles.
2. Antidepressants that make it easier to deal with the post-hospital crisis.
3. Anticonvulsants that eliminate seizures.
4. Anticoagulants can help prevent blood clots from recurring.
5. Antihypertensive drugs reduce blood pressure.
6. To restore brain activity, the patient is prescribed a neurometabolic cerebroprotector.

To normalize metabolism and hormone synthesis, the patient is prescribed vitamin therapy, which complements medications for cerebral stroke, the list of which is recommended by the doctor.

Tablets used

In case of a stroke, the patient must be given antihypertensive drugs - for example, Clonidine or Reserpine. These drugs are classified as sympatholoks. They affect blood vessels and the medulla oblongata. These are the best post-stroke medications for recovery.

The patient is also prescribed ganglion blockers, for example, Pentamin. Such drugs act on the autonomic ganglion through the cholinergic receptor.

For the best effect of treatment, the patient is prescribed sympatholytics. For example, Phentolamine or Guanidine. Such drugs act on the adrenergic receptor of smooth muscle vessels.

Patients are often prescribed inhibitors, for example, Gordox and Trasinol. Such drugs are humoral regulators.

Therapy is supplemented with endotheliotropic agents, for example, Dobesylate and Parmedin. These drugs realize their functions through the vascular endothelium. But it is also affected by drugs with a different pharmacological mechanism, for example, Etamzilat.

A useful antiplatelet agent is acetylsalicylic acid. It prevents platelets from sticking together and optimizes tissue blood flow.

Vitamin Rutin is an oxidation inhibitor that improves circulation by reducing the level of radicals that damage the endothelium.

Doctors' recommendations

According to European recommendations, when prescribing medications, doctors must take into account the characteristics of the patient’s body. This is necessary for the treatment to be effective. The most commonly prescribed drugs are:

• Ceraxon, which contains Citicoline. The principle of action of this medicine is to improve metabolic processes in cells. Thanks to the drug, cerebral edema is relieved, and the intensity of cognitive abnormalities and brain dysfunction is reduced. This medicine can be taken both during an exacerbation and during the recovery stage.
• For ischemia of the brainstem, the patient is prescribed a Gliatilin tablet. Drug therapy with this drug is recommended for patients in a coma. The principle of action of this remedy is to increase blood flow. The duration of treatment is three months. If necessary, you can repeat the course.
• If the patient has diabetes, he is prescribed Actogevin. This remedy is used for prevention and recovery. This drug can be combined with any medications. It stimulates brain function. Actogevin is the optimal measure for patients with any form of pathology.
• Mexidol is an injection drug. Its important advantage is increasing the resistance of tissues to hypoxia. This drug is combined with Mexidol, which creates conditions for rapid rehabilitation of the patient. The medicine can be combined with Cortexin, aimed at reducing the effects of ischemia.

Today there are injections for stroke that completely eliminate the consequences of impaired blood circulation in the brain. It must be administered within two hours after an exacerbation. Due to enzymes, the likelihood of complications is reduced. Injections in the abdomen should only be given by medical professionals.

After a stroke, the first six hours are important

Employees of the Stroke Research Institute tell you how you can prevent most of the unpleasant consequences of one of the most unexpected diseases for people - stroke.

Our brain cells are very sensitive to lack of oxygen and quickly die without it. To maintain life in them, a constant flow of oxygenated arterial blood to the head is necessary. Nature has created an extensive network of cerebral arteries that provide intensive blood circulation. When these vessels become blocked or ruptured, a stroke occurs. “The disturbance can occur in the vessels of the anterior surface of the neck - the carotid arteries, and less often - in the vertebral vessels on the posterior surface of the neck,” explains Galina Ivanova, Doctor of Medical Sciences, Head of the Department of Medical and Social Rehabilitation of the Research Institute of Stroke of the Russian State Medical University for Infox.ru.

Types of stroke

There are two main types of stroke: hemorrhagic, which occurs when blood vessels rupture (cerebral hemorrhage), and ischemic, which occurs when blood vessels are blocked - thrombosis of cerebral blood vessels. “If nothing is done with the patient in the first hours, then the possibilities for his further recovery melt away, and melt away with the hours. This is a fairly short period of time,” Vladimir Lelyuk, Doctor of Medical Sciences, Chief Researcher at the Research Institute of Stroke of the Russian State Medical University, tells Infox.ru .

Possible complications

A stroke causes the death of brain cells and entails severe and very dangerous vascular damage to the central nervous system: impaired speech, consciousness, coordination of movements, vision, sensitivity and paralysis. When a circulatory disorder affects the right hemisphere of the brain, paralysis and sensory disturbances occur in the left side of the body. When the left side of the brain is damaged, the same phenomena are observed in the right side of the body. “The patient is examined by a neuropsychologist at the very beginning of the disease and during treatment. This allows us to understand whether there is any dynamics of those disorders that appeared for the first time, whether the mistakes he made when performing tasks are decreasing or whether they have remained,” explains neuropsychologist, Doctor of Psychology, leading researcher at the Department of Neuroscience to Infox.ru. and Pathopsychology, Faculty of Psychology, Moscow State University Yuri Mikadze .

Stroke treatment

A person who has suffered a stroke is not able to adequately assess the situation. No other disease is capable of instantly destroying everything in a person: consciousness, memory, intellect, and the ability for free independent movement. Post-stroke existence can last for years and even decades.

Stroke is not a domestic disease. It can only be treated in a hospital. At the first symptoms, you should urgently call an ambulance service. Patients in a deep unconscious state with impaired vital functions should not be transported to the hospital. As a first-priority measure, a person is given an injection: a drug is injected that improves cerebral circulation or stimulates metabolic processes in the brain and normalizes blood pressure. Patients with stroke must be urgently hospitalized in the neurological department, where there are intensive care units. “The patient undergoes a set of studies, which allows one to very quickly determine the subvariant or at least the type of stroke - hemorrhagic or ischemic,” says Vladimir Lelyuk. “Then the patient is admitted to a specialized intensive care unit.”

The Stroke Research Institute operates on the basis of the central clinical city hospital No. 31. The clinic is equipped with the most modern diagnostic equipment and operates around the clock. “A round-the-clock service is important,” says diagnostician, candidate of medical sciences Leonid Gubsky, “since patients arrive in large numbers at night and in the early morning. The fact is that, as a rule, a person wakes up after a night’s sleep and suddenly it turns out that he has neurological disorders that suggest the development of a stroke, and it is necessary to urgently examine him and regulate treatment issues.”

First six hours

The patient is admitted to the intensive care unit, bypassing the emergency department. This significantly saves time, which is so necessary for effective treatment. You need to act quickly and accurately. Six hours from the onset of a stroke is called the therapeutic window. During this time, you can prevent the death of brain cells without surgery. Then the consequences of a stroke will be minimal. Neurologist, Candidate of Medical Sciences, Head of the Department of Diagnostics and Treatment of Stroke Nikolai Shamalov comments: “If the patient is admitted in the first three hours after the disease, he is given the systemic platelet method, when a drug that dissolves the blood clot is injected into the blood. If the patient arrives within three to six hours, then the patient undergoes an angiographic examination, and the same drugs are injected directly into the area of ​​the thrombus - into the artery that was blocked, and the damage to which caused the ischemia pattern.”

The prognosis for the course of a stroke depends on the speed of recovery of consciousness: if it returns to the patient after a few minutes or even hours, the outcome is likely to be favorable. If consciousness does not return within three days or more, the outcome can be sad. “In the intensive care unit, patients are connected to tracking equipment and cardiac monitors, with the help of which all basic vital functions are monitored,” explains Nikolai Shamalov.

The recovery time is individual for each patient. It all depends on the care, treatment, general physical condition, intensity of the blow, as well as the patient’s own mood.

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Essential vitamins

For a speedy recovery, the patient needs vitamins. Most often, the patient is prescribed the following medications:

1. The drug Cerebrolysin can be taken without fear for the patient’s condition. This drug allows you to restore blood circulation to the brain and reduce the likelihood of relapse. People with chronic hypertension are advised to keep this medication with them.
2. Mannitol is a strong diuretic that reduces swelling of the affected areas.
3. Patients who have suffered a cerebrovascular accident know the drug Glycine very well. It improves memory and brain function. Thanks to him, rehabilitation is accelerated.

At the first stage of the disease, vitamin therapy is supplemented with homeopathy, which gives a positive result and does not affect other remedies.

The patient is also prescribed antihypertensive medications containing vitamins. Thanks to them, not only blood pressure is normalized, but also the number of relapses is reduced. Such drugs must be used for a long time. This is the best stroke prevention.

In addition to medications, the patient is recommended to take vitamins in their natural form. Foods containing vitamin A include kidneys and grapes. It is recommended to include foods with a high concentration of vitamin B in the diet, for example, fish, walnuts, carrots.

Biologically active additives

Heart diseases are dangerous, and rehabilitation after them is long. During treatment, the patient is prescribed the following list of medications containing vitamins:

• Dietary supplements that improve the functioning of the nervous system and the general condition of the body.
• Papaya extract strengthens the immune system and normalizes metabolism. It also improves cerebral circulation.
• To remove waste and prevent thrombosis, the patient is prescribed a second fraction of the ASD drug.
• You can use the drug Perga, which contains a large amount of amino acids that strengthen blood vessels and remove toxins. It is recommended to take five grams of this medicine on an empty stomach.

Before taking a dietary supplement or injection, consult your doctor. When prescribing vitamins, he will take into account the general condition of the patient who has suffered a stroke.

Venous catheter placement sites

Droppers can be placed in veins of various sizes and locations. Among them:

1. Peripheral venous access. Smaller veins are used. Most often these are the familiar veins of the forearm. However, theoretically, placing a catheter in any superficially located peripheral vein is possible. What are these accesses? The veins of the hand and lower extremities, in particular the dorsum of the foot and lower leg, can be used. If it is impossible to use the classic approach to the forearm, the nurse or doctor may decide to work with any other peripheral vein. There are no global differences between them, with the exception of moderate pain when inserting a catheter into the veins of the hand and foot.

2. Central venous access. Often used after a major stroke, especially in intensive care units. A special central catheter is installed in larger veins, such as the subclavian, femoral or jugular. These approaches are performed exclusively for strict indications: the patient’s serious condition, the need for long-term and volumetric infusion therapy, the impossibility of installing a peripheral vein. The catheter is inserted into the central vein only by a doctor under aseptic conditions using sterile material. It is performed under local anesthesia due to pain during placement. Locations: femoral vein - in the area of ​​the inguinal fold, subclavian - in the area of ​​the collarbone, jugular - on the lateral surface of the neck.

After an illness

The patient needs not only dietary supplements, but also medications. To speed up recovery from heart disease, the patient is prescribed the following list of effective medications:

1. To thin the blood, the patient is prescribed Aspirin. To improve blood flow and reduce vascular resistance, therapy is supplemented with Curantil.
2. To improve blood flow and suppress thrombus formation, the patient is prescribed Trental.
3. To increase calcium levels and decrease potassium concentrations, treatment is supplemented with intravenous calcium chloride. This drug improves the functioning of nerve cells.
4. If it is necessary to stop bleeding, the patient is prescribed aminocaproic acid.

After such an illness, it is not recommended to use drugs, the names of which will be given below. Thus, it is not recommended to use Furosemide to treat cerebral edema, because it sharply lowers blood pressure and promotes blood thickening. It is worth giving up nootropics, as they cause brain exhaustion.

The effectiveness of drug therapy

Stroke is an ancient disease. It was described back in the time of Hippocrates, but no definitively working cure for stroke has been developed to this day. The main symptoms of a stroke have not changed over thousands of years:

• disturbance of movements of the limbs, facial muscles, tongue;
• impaired sensitivity in the limbs, head, torso;
• loss of coordination;
• headache;
• loss of consciousness;
• speech disorder;
• inability to make symmetrical movements on the right and left;
• thinking disorder;
• changes in mood and behavior;
• and many others.

The manifestations of a stroke can vary significantly and depend on where in the brain the disease develops. At first glance, it will be difficult to identify the type of disease; this will be done definitively only after instrumental diagnosis.

The two main types of stroke on which further treatment depends are ischemic and hemorrhagic.

The key to successful stroke treatment is timely seeking qualified medical help. With all types of stroke, brain cells have a time during which the changes are reversible.

Inhibitors and diuretics

After a mini-stroke, the patient is prescribed inhibitors. These medications help reduce the activity of angiotensin-converting enzymes. As a result, pressure decreases. The most common drugs in this group are listed below:

1. Enalapril and its analogue Enap.
2. Quinapril, also known as Accupro.
3. Ramipril, otherwise called Tritace.
4. Moexipril.

Captopril is also prescribed as an inhibitor. Among its disadvantages, it is worth highlighting the ability to provoke a dry cough and a low level of activity. In addition, it must be used frequently, since it has a short period of action.

After a stroke, the functioning of the joints and knees deteriorates. In this case, the patient is prescribed a diuretic, for example, Arifon or Indapamide.

These drugs can reduce swelling of the vascular walls and reduce blood pressure. In addition, they have a vasodilating effect.

These medications worsen gout, so they are not recommended for use in patients with kidney failure.

Men who use these good drugs may experience impotence, which goes away after stopping the drugs.

Decreased blood clotting

Most often, a stroke occurs due to increased blood clotting. It also impairs brain function. In this case, the concentration of the liquid medium is less than platelets. Doctors must bring the platelet count back to normal within the first two hours after the patient is admitted to the hospital. For this, the following drugs are prescribed:

• Antiplatelet agents, for example, Tiklid. This drug improves blood flow and eliminates stagnation. But it also improves blood circulation in the brain.
• Warfarin is prescribed as an anticoagulant. It prevents platelets from sticking together. This medicine is prescribed during the period of intensive treatment of a stroke victim. People use this medication not as a permanent medication for therapy, but as an emergency aid in the form of injections.
• The patient is prescribed Streptodecas. This drug is used only after surgery to prevent blood clots and restore blood flow.
• In case of high blood pressure, the patient is prescribed Clonidil.
• If the patient is hospitalized with low blood pressure, he is prescribed Gutron. Prednisol is used as an analogue of this drug.

Medications

• The exchange of nucleic acids in neurons improves.
• The synthesis of phospholipids and proteins in neurons (and red blood cells too) increases. Thanks to this, membrane structures are normalized.
• Glucose penetrates the blood-brain barrier more easily and quickly. This is important for increasing its utilization by cells of different parts of the spinal cord and brain.
• Inhibition of lysosomal enzymes occurs.
• Harmful free radicals are eliminated.
• Cerebral cholinergic conduction increases.
• The integrative activity of the brain improves.
• The aggregation of activated platelets is inhibited.
• Blocking excessive neuronal activity.
• If hypoxia is present, brain cells will need less oxygen and their death will slow down.

Recovery Tools

Pantogam is used to quickly recover from this serious illness. This is a nootropic drug with neuroprotective properties. This medicine makes the brain resistant to oxygen starvation and intoxication. Pantogam accelerates anabolic processes and has a sedative effect. This drug also has an anticonvulsant effect and helps reduce motor excitability.

If calcium channel blockade is necessary, the patient is prescribed Verapamil. This medicine is taken not only after heart attacks and strokes, but also as a prevention of angina pectoris. This medication prevents calcium ions from penetrating into the walls of blood vessels. Verapamil also reduces the heart rate and reduces the contractility of the myocardial muscle.

To recover from illness, the patient is prescribed Digoxin. This drug belongs to the class of glycosides. The medicine is sold both in solution and tablet form. Thanks to Digoxin, the concentration of calcium ions in the body increases. It helps remove excess sodium ions. Due to the reduction in systole as a result of using this medicine, it becomes economical.

Pros and cons of intravenous drug administration

The intravenous route of drug administration is the most widely used, along with intramuscular and oral (i.e., oral administration). This delivery method is indeed very convenient, especially in hospital settings for seriously ill patients, in particular after a stroke.

Advantages

• Fast delivery of medicines. This is especially important in emergency situations, when it is important to immediately get drugs into the body. When tablets or any other oral dosage form enters the stomach, it takes time to be absorbed and enter the bloodstream. Only after this, the drugs are carried through the bloodstream throughout the body, providing the desired effect. This is unacceptable in emergency medicine. Droppers and intravenous bolus injections ensure that the necessary substances immediately enter the bloodstream.
• Possibility of slower introduction. Some medications are not recommended or even prohibited from being administered quickly. Droppers allow you to dilute a certain dosage of medication in saline solution of sodium chloride or any other infusion medium and slowly administer it over several hours.
• Often after a stroke, patients are unconscious or unable to swallow. For them, intravenous drip administration is practically the only way to receive treatment.
• Greater bioavailability. Medicines, being absorbed in the intestines, always enter the liver and undergo metabolic processes there. This happens because all blood flowing from the intestines first passes through the liver barrier to be neutralized. Thus, the concentration of the active substance in the blood plasma decreases, which does not happen with intravenous administration.

• The need to administer large volumes of solutions. For example, during neurosurgical operations after intracerebral hemorrhages or during intensive care after a stroke.
• There are drugs that can only be administered intravenously. This is provided by the manufacturer and the chemical structure of the drug.

Flaws

• If an acute allergic reaction or side effect of the drug occurs, it is no longer possible to “cancel” the administration. For comparison, if the medicine gets into the gastrointestinal tract, it is possible to rinse the stomach or give the patient an adsorbent.
• With prolonged standing and insufficient care, peripheral and central venous catheters can become gateways to infection and cause inflammation of the veins (phlebitis). Such complications significantly aggravate the recovery period after a stroke.
• The likelihood of extravasation is the penetration of infusion solutions past the catheter into soft tissues. Prolonged undetected extravasation often causes inflammatory reactions and even ulceration of the skin.
• A potential complication is air embolism, which is when a large amount of air from the line enters a large vein.
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• Placement of intravenous catheters is a moderately painful and unpleasant procedure for the patient.

Now it becomes clear what the pros and cons of the intravenous method of drug administration are. Placement of an intravenous catheter is an invasive procedure with potential risks that must be performed by medical personnel using clean gloves and aseptic technique.

Patients should understand that IVs are not always necessary, especially in the late recovery period after a stroke. When the condition has stabilized, they can easily be replaced by intramuscular administration or tablet forms of drugs.