Page 25 - Journal of Special Operations Medicine - Fall 2017

Administration of ASA before ruling out hemorrhagic stroke Conclusion
is, admittedly, a less-than-ideal choice. However, in a truly
emergent situation, and with a careful history and physical Multiple large studies show the benefits of early administra-
examination, some of the risks can be mitigated. The history tion in hospital of ASA for suspected AIS—primarily the pre-
should include recent head injury event or major trauma and vention of recurrent stroke and decreased morbidity. Several
family history of Berry aneurysm, arterial venous malforma- sources discourage training paramedics to administer ASA for
tions, and polycystic kidney disease. The demographics of the suspected AIS in a prehospital setting, because of possible dys-
patient are also vitally important. Exponential increase in ICH phagia and potential harm to patient and on the assumption
and SAH are seen with increased age, particularly after age 65 that a hospital with CT and MRI capabilities and a physician
years. A study of the demographics of patients between age is nearby (within 1 hour).
0 and 34 years reported ICH and SAH each occurred at an
incidence rate equal to or less than 10 per 100,000 patients. In an operational setting with unknown or limited access to
An ICH incidence rate of greater than 50 per 100,000 patients CT/MRI, in the absence of an acute traumatic injury, early
was found in those age 65 years and older, and the incidence administration of ASA for suspected AIS could save an Op-
rate for SAH was 20 per 100,000 in those age 75 years and erator from death or permanent disability if proper measures
older. 9 are taken to mitigate the risk of causing intracranial bleeding.
Our case is only one example, and although other anecdotal
If the administration of an antiplatelet worsens the patient’s examples exist for prehospital administration of ASA for sus-
symptoms and a hemorrhagic stroke is now suspected, the pected AIS, we recommend additional studies in this area be-
health-care professional should know how to manage a hem- fore officially recommending routine administration of ASA
orrhagic stroke. The first step is to protect the patient’s air- for suspected AIS.
way via intubation in anticipation of aspiration and/or airway
compromise. Second, the professional must take precautions Disclosures
against elevated intracerebral pressure by raising the head of The authors have no conflicts of interest or financial disclo-
the bed to 30 degrees and administering mannitol 20% at a sures to disclose.
dose of 1g/kg. The mean arterial blood pressure should be
maintained below 130mmHg systolic. Third, platelets and References
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