The mainstay of treatment following acute recovery from a TIA should be to diagnose and treat the underlying cause. Most patients who are diagnosed at a hospital's Accident & Emergency Department as having suffered from a TIA will be discharged home and advised to contact their primary physician to organize further investigations.
An electrocardiogram (EKG) may show atrial fibrillation
, a common cause of TIAs, or other arrhythmias that may cause embolisation to the brain. An echocardiogram
is useful in detecting thrombus within the heart chambers. Such patients benefit from anticoagulation.
If the TIA affects an area supplied by the carotid artery
, an ultrasound scan may demonstrate carotid stenosis
. For people with a greater than 70% stenosis within the carotid artery, removal of atherosclerotic plaque by surgery, specifically a carotid endarterectomy
, may be recommended.
Some patients may also be given modified release dipyridamole or clopidogrel.
This is a life threatening emergency.
You can not tell the difference between a CVA (stroke) and a TIA in the field.
Ensure the patient's airway remains open.
A person having a stroke may suddenly lose consciousness. Get the patient to sit down.
Watch for any changes in the patient's speech or level of consciousness. If the patient loses consciousness, monitor respirations and pulse and be ready to perform CPR. Look for muscle droop on one side of the patient's face, or weakness on one side of the patient's body. Note if the pupil in one eye is larger than the other. If possible, record the patient's pulse and respiratory rate
every five minutes and provide this information to the EMS or the treating physician.
There is almost nothing that can be done in the field for a patient suffering a stroke or a TIA.
If you have oxygen, administer it at low concentration, high concentration if the patient has difficulty breathing
DON'T GIVE ASPIRIN.
If it is a stroke, it might be caused by a blood clot (embolism) or a ruptured blood vessel (hemorrhage.) Aspirin is a blood thinner. If given to a person who is bleeding, it will make it worse.
Incidentally, there is not much an EMS crew can do for a patient who is suffering from a stroke. If the ambulance is delayed, the best thing you can do is put the patient in your car and go to the nearest hospital without any delay. Seconds count.