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71-437: The purpose of basic life support (abbreviated BLS) is to save lives in a variety of different situations that require immediate attention. These situations can include, but are not limited to, cardiac arrest, stroke , drowning , choking, accidental injuries, violence , severe allergic reactions , burns , hypothermia , birth complications, drug addiction , and alcohol intoxication . The most common emergency that requires BLS

142-425: A broken bone ), air, cancer cells or clumps of bacteria (usually from infectious endocarditis ). Because an embolus arises from elsewhere, local therapy solves the problem only temporarily. Thus, the source of the embolus must be identified. Because the embolic blockage is sudden in onset, symptoms are usually maximal at the start. Also, symptoms may be transient as the embolus is partially resorbed and moves to

213-405: A severe headache . The symptoms of stroke can be permanent. Long-term complications may include pneumonia and loss of bladder control . The biggest risk factor for stroke is high blood pressure . Other risk factors include high blood cholesterol , tobacco smoking , obesity , diabetes mellitus , a previous TIA , end-stage kidney disease , and atrial fibrillation . Ischemic stroke

284-541: A British Columbian woman with amyotrophic lateral sclerosis could not secure permission for assisted suicide. There are many therapies and techniques that may be used by clinicians to achieve the goal of sustaining life. Some examples include: These techniques are applied most commonly in the Emergency Department , Intensive Care Unit and Operating Rooms . As various life support technologies have improved and evolved they are used increasingly outside of

355-473: A CT scan. Other tests such as an electrocardiogram (ECG) and blood tests are done to determine risk factors and possible causes. Low blood sugar may cause similar symptoms. Prevention includes decreasing risk factors, surgery to open up the arteries to the brain in those with problematic carotid narrowing , and anticoagulant medication in people with atrial fibrillation . Aspirin or statins may be recommended by physicians for prevention. Stroke

426-444: A complete blockage of one of the carotid arteries, the risk of stroke on that side is about one percent per year. A special form of embolic stroke is the embolic stroke of undetermined source (ESUS). This subset of cryptogenic stroke is defined as a non-lacunar brain infarct without proximal arterial stenosis or cardioembolic sources. About one out of six cases of ischemic stroke could be classified as ESUS. Cerebral hypoperfusion

497-441: A different location or dissipates altogether. Emboli most commonly arise from the heart (especially in atrial fibrillation ) but may originate from elsewhere in the arterial tree. In paradoxical embolism , a deep vein thrombosis embolizes through an atrial or ventricular septal defect in the heart into the brain. Causes of stroke related to the heart can be distinguished between high- and low-risk: Among those who have

568-400: A high risk for ischemic stroke. There are two main types of hemorrhagic stroke: The above two main types of hemorrhagic stroke are also two different forms of intracranial hemorrhage , which is the accumulation of blood anywhere within the cranial vault ; but the other forms of intracranial hemorrhage, such as epidural hematoma (bleeding between the skull and the dura mater , which is

639-515: A patient or their family. A person cannot live without food and water, and because of this, it has been argued that withholding food and water is similar to the act of killing the patient or even allowing the person to die. This type of voluntary death is referred to as passive euthanasia . In addition to patients and their families, doctors also are confronted with ethical questions. In addition to patient life, doctors have to consider medical resource allocations. They have to decide whether one patient

710-441: A person, when asked to raise both arms, involuntarily lets one arm drift downward) and abnormal speech are the findings most likely to lead to the correct identification of a case of stroke, increasing the likelihood by 5.5 when at least one of these is present. Similarly, when all three of these are absent, the likelihood of stroke is decreased (– likelihood ratio of 0.39). While these findings are not perfect for diagnosing stroke,

781-452: A problem. Its appearance makes it advisable to seek medical review and to consider prevention against stroke . In thrombotic stroke, a thrombus (blood clot) usually forms around atherosclerotic plaques. Since blockage of the artery is gradual, onset of symptomatic thrombotic stroke is slower than that of hemorrhagic stroke. A thrombus itself (even if it does not completely block the blood vessel) can lead to an embolic stroke (see below) if

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852-399: A prospective study conducted by T J Predergast and J M Luce from 1987 to 1993, when physicians recommended withholding or withdrawing life support, 90% of the patients agreed to the suggestion and only 4% refused. When the patient disagreed with the physician, the doctor complied and continued support with one exception. If the doctor believed the patient was hopelessly ill, they did not fulfill

923-540: A severe headache known as a thunderclap headache ) or reveal evidence of a previous head injury . Stroke may be preceded by premonitory symptoms, which may indicate a stroke is imminent. These symptoms may include dizziness, dysarthria (speech disorder), exhaustion, hemiparesis (weakness on one side of the body), paresthesia (tingling, pricking, chilling, burning, numbness of the skin), pathological laughter, seizure that turns into paralysis, "thunderclap" headache, or vomiting. Premonitory symptoms are not diagnostic of

994-432: A stroke, and may be a sign of other illness. Assessing onset (gradual or sudden), duration, and the presence of other associated symptoms are important, and premonitory symptoms may not appear at all or may vary depending on the type of stroke. Stroke symptoms typically start suddenly, over seconds to minutes, and in most cases do not progress further. The symptoms depend on the area of the brain affected. The more extensive

1065-519: A stroke. In 2021, stroke was the third biggest cause of death, responsible for approximately 10% of total deaths. In 2015, there were about 42.4 million people who had previously had stroke and were still alive. Between 1990 and 2010 the annual incidence of stroke decreased by approximately 10% in the developed world , but increased by 10% in the developing world. In 2015, stroke was the second most frequent cause of death after coronary artery disease , accounting for 6.3 million deaths (11% of

1136-415: A subarachnoid hemorrhage or an embolic stroke. If the area of the brain affected includes one of the three prominent central nervous system pathways —the spinothalamic tract , corticospinal tract , and the dorsal column–medial lemniscus pathway , symptoms may include: In most cases, the symptoms affect only one side of the body (unilateral). The defect in the brain is usually on the opposite side of

1207-415: Is cerebral hypoxia , a shortage of oxygen to the brain due to heart or respiratory failure . A victim of cerebral hypoxia may die within 8–10 minutes without basic life support procedures. BLS is the lowest level of emergency care, followed by advanced life support and critical care . As technology continues to advance within the medical field, so do the options available for healthcare. Out of respect for

1278-800: Is a community hospital in Winnipeg , Manitoba , Canada . It was founded in 1911 by the City of Winnipeg as the Winnipeg Municipal Hospital. The hospital consisted of two buildings called the King Edward Memorial Hospital which was built in 1911 and the King George Hospital built in 1914. The Princess Elizabeth Hospital was added in 1950 as the first long-term care facility in Canada. In 1983

1349-445: Is a medical emergency. Ischemic strokes, if detected within three to four-and-a-half hours, may be treatable with medication that can break down the clot , while hemorrhagic strokes sometimes benefit from surgery . Treatment to attempt recovery of lost function is called stroke rehabilitation , and ideally takes place in a stroke unit; however, these are not available in much of the world. In 2023, 15 million people worldwide had

1420-400: Is a related syndrome of stroke symptoms that resolve completely within 24 hours. With the availability of treatments that can reduce stroke severity when given early, many now prefer alternative terminology, such as "brain attack" and "acute ischemic cerebrovascular syndrome" (modeled after heart attack and acute coronary syndrome , respectively), to reflect the urgency of stroke symptoms and

1491-431: Is a worthwhile investment of limited resources versus another. Current ethical guidelines are vague since they center on moral issues of ending medical care but disregard discrepancies between those who understand possible treatments and how the patient's wishes are understood and integrated into the final decision. Physicians often ignore treatments they deem ineffective, causing them to make more decisions without consulting

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1562-409: Is an irritant which could potentially destroy cells since it is an acid and disrupts the normal acid-base balance in the brain. The ischemia area is referred to as the "ischemic penumbra ". After the initial ischemic event the penumbra transitions from a tissue remodeling characterized by damage to a remodeling characterized by repair. As oxygen or glucose becomes depleted in ischemic brain tissue,

1633-442: Is less reliable in the recognition of posterior circulation stroke. The revised mnemonic BE FAST , which adds balance (sudden trouble keeping balance while walking or standing) and eyesight (new onset of blurry or double vision or sudden, painless loss of sight) to the assessment, has been proposed to address this shortcoming and improve early detection of stroke even further. Other scales for prehospital detection of stroke include

1704-409: Is the reduction of blood flow to all parts of the brain. The reduction could be to a particular part of the brain depending on the cause. It is most commonly due to heart failure from cardiac arrest or arrhythmias , or from reduced cardiac output as a result of myocardial infarction , pulmonary embolism , pericardial effusion , or bleeding. Hypoxemia (low blood oxygen content) may precipitate

1775-447: Is the second leading cause of death in people under 20 with sickle-cell anemia. Air pollution may also increase stroke risk. An embolic stroke refers to an arterial embolism (a blockage of an artery) by an embolus , a traveling particle or debris in the arterial bloodstream originating from elsewhere. An embolus is most frequently a thrombus, but it can also be a number of other substances including fat (e.g., from bone marrow in

1846-522: Is typically caused by blockage of a blood vessel, though there are also less common causes. Hemorrhagic stroke is caused by either bleeding directly into the brain or into the space between the brain's membranes . Bleeding may occur due to a ruptured brain aneurysm . Diagnosis is typically based on a physical exam and supported by medical imaging such as a CT scan or MRI scan . A CT scan can rule out bleeding, but may not necessarily rule out ischemia, which early on typically does not show up on

1917-536: Is used to sustain life while the underlying injury or illness is being treated or evaluated for prognosis. Life support techniques may also be used indefinitely if the underlying medical condition cannot be corrected, but a reasonable quality of life can still be expected. Stroke Stroke is a medical condition in which poor blood flow to a part of the brain causes cell death . There are two main types of stroke: ischemic , due to lack of blood flow, and hemorrhagic , due to bleeding . Both cause parts of

1988-422: The cerebral cortex is involved, the central nervous system pathways can again be affected, but can also produce the following symptoms: If the cerebellum is involved, ataxia might be present and this includes: In the days before a stroke (generally in the previous 7 days, even the previous one), a considerable proportion of patients have a "sentinel headache": a severe and unusual headache that indicates

2059-501: The High Court and wanted permission to end life support for their son. The Court decided that his "existence in a persistent vegetative state is not a benefit to the patient," but the statement did not cover the innate value of human life. The court interpreted the sanctity of life as only applicable when life could continue in the way that the patient would have wanted to live their life. If the quality of life did not fall within what

2130-650: The Los Angeles Prehospital Stroke Screen (LAPSS) and the Cincinnati Prehospital Stroke Scale (CPSS), on which the FAST method was based. Use of these scales is recommended by professional guidelines. For people referred to the emergency room , early recognition of stroke is deemed important as this can expedite diagnostic tests and treatments. A scoring system called ROSIER (recognition of stroke in

2201-538: The World Health Organization defined "stroke" as a "neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours", although the word "stroke" is centuries old. This definition was supposed to reflect the reversibility of tissue damage and was devised for the purpose, with the time frame of 24 hours being chosen arbitrarily. The 24-hour limit divides stroke from transient ischemic attack , which

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2272-487: The ventricular system , CSF or the pial surface. A third of intracerebral bleed is into the brain's ventricles. ICH has a mortality rate of 44 percent after 30 days, higher than ischemic stroke or subarachnoid hemorrhage (which technically may also be classified as a type of stroke ). Other causes may include spasm of an artery. This may occur due to cocaine . Cancer is also another well recognized potential cause of stroke. Although, malignancy in general can increase

2343-461: The Bamford or Oxford classification) relies primarily on the initial symptoms; based on the extent of the symptoms, the stroke episode is classified as total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), lacunar infarct (LACI) or posterior circulation infarct (POCI). These four entities predict the extent of the stroke, the area of the brain that is affected,

2414-675: The DNR. The "do not resuscitate" order was withdrawn. In the case law to date in 1988, the courts decided that a decision to withhold or withdraw treatment was only for the physician to make, not the courts. However, the Manitoba court decided that given the scarcity of related cases and how none of them considered the Canadian Charter of Rights and Freedoms , it would try the case. Previous courts had held that physicians should not be bound by law to provide treatment that they did not believe

2485-501: The area of the brain affected, the more functions that are likely to be lost. Some forms of stroke can cause additional symptoms. For example, in intracranial hemorrhage, the affected area may compress other structures. Most forms of stroke are not associated with a headache , apart from subarachnoid hemorrhage and cerebral venous thrombosis and occasionally intracerebral hemorrhage. Systems have been proposed to increase recognition of stroke. Sudden-onset face weakness, arm drift (i.e., if

2556-408: The blood supply to the brain, while hemorrhagic stroke results from the rupture of a blood vessel or an abnormal vascular structure . About 87% of stroke is ischemic, with the rest being hemorrhagic. Bleeding can develop inside areas of ischemia, a condition known as " hemorrhagic transformation ." It is unknown how many cases of hemorrhagic stroke actually start as ischemic stroke. In the 1970s

2627-401: The blood supply by narrowing the lumen of blood vessels leading to a reduction of blood flow by causing the formation of blood clots within the vessel or by releasing showers of small emboli through the disintegration of atherosclerotic plaques. Embolic infarction occurs when emboli formed elsewhere in the circulatory system, typically in the heart as a consequence of atrial fibrillation, or in

2698-471: The body. However, since these pathways also travel in the spinal cord and any lesion there can also produce these symptoms, the presence of any one of these symptoms does not necessarily indicate stroke. In addition to the above central nervous system pathways, the brainstem gives rise to most of the twelve cranial nerves . A brainstem stroke affecting the brainstem and brain, therefore, can produce symptoms relating to deficits in these cranial nerves: If

2769-567: The brain and places the person at increased risk for both transient ischemic attack and major stroke in the future. Conversely, those who have had major stroke are also at risk of having silent stroke. In a broad study in 1998, more than 11 million people were estimated to have experienced stroke in the United States. Approximately 770,000 of these were symptomatic and 11 million were first-ever silent MRI infarcts or hemorrhages . Silent stroke typically causes lesions which are detected via

2840-461: The brain to stop functioning properly. Signs and symptoms of stroke may include an inability to move or feel on one side of the body , problems understanding or speaking , dizziness , or loss of vision to one side . Signs and symptoms often appear soon after the stroke has occurred. If symptoms last less than 24 hours, the stroke is a transient ischemic attack (TIA), also called a mini-stroke. Hemorrhagic stroke may also be associated with

2911-426: The carotid arteries, break off, enter the cerebral circulation, then lodge in and block brain blood vessels. Since blood vessels in the brain are now blocked, the brain becomes low in energy, and thus it resorts to using anaerobic metabolism within the region of brain tissue affected by ischemia. Anaerobic metabolism produces less adenosine triphosphate (ATP) but releases a by-product called lactic acid . Lactic acid

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2982-424: The cells of the nervous system is normally kept low by so-called uptake carriers, which are powered by the concentration gradients of ions (mainly Na ) across the cell membrane. However, stroke cuts off the supply of oxygen and glucose which powers the ion pumps maintaining these gradients. As a result, the transmembrane ion gradients run down, and glutamate transporters reverse their direction, releasing glutamate into

3053-525: The doctor decided that the patient needed a cuffed tracheotomy tube, which Mrs. Sawatsky opposed. In response, the hospital applied to have a Public Trustee become the patient's legal guardian and the Trustee consented to the operation. In late October, without consulting another physician or the patient's wife, the physician again made a "do not resuscitate" order after the patient developed pneumonia. Mrs. Sawatzky went to court for an interim order to remove

3124-510: The dying process. Another type of life support that presents ethical arguments is the placement of a feeding tube. Decisions about hydration and nutrition are generally the most ethically challenging when it comes to end-of-life care. In 1990, the US Supreme Court ruled that artificial nutrition and hydration are not different from other life-supporting treatments. Because of this, artificial nutrition and hydration can be refused by

3195-411: The emergency room) is recommended for this purpose; it is based on features from the medical history and physical examination. Loss of consciousness , headache , and vomiting usually occur more often in hemorrhagic stroke than in thrombosis because of the increased intracranial pressure from the leaking blood compressing the brain. If symptoms are maximal at onset, the cause is more likely to be

3266-606: The exception of a renovation of the Princess Elizabeth, and a new complex was constructed. The new facility opened in 1997, following a delay due to the Flood of the Century . Currently, Riverview Health Centre operates multiple areas of specialized care, including: This Canadian hospital–related article is a stub . You can help Misplaced Pages by expanding it . This article about a building or structure in Manitoba

3337-444: The extracellular space. Glutamate acts on receptors in nerve cells (especially NMDA receptors), producing an influx of calcium which activates enzymes that digest the cells' proteins, lipids, and nuclear material. Calcium influx can also lead to the failure of mitochondria , which can lead further toward energy depletion and may trigger cell death due to programmed cell death . Riverview Health Centre Riverview Health Centre

3408-721: The fact that they can be evaluated relatively rapidly and easily make them very valuable in the acute setting. A mnemonic to remember the warning signs of stroke is FAST (facial droop, arm weakness, speech difficulty, and time to call emergency services), as advocated by the Department of Health (United Kingdom) and the Stroke Association , the American Stroke Association , and the National Stroke Association (US). FAST

3479-560: The first purpose-built Geriatric Day Hospital was opened as an outpatient rehabilitation centre for seniors. It was named after the late MLA (1966-1969) and City of Winnipeg Mayor (1977-1979) Robert Ashley Steen . In 1993 the facility separated from the City of Winnipeg and became incorporated as a community hospital, changing its name to Riverview Health Centre. In 1995 the Municipal Hospital buildings were demolished, with

3550-424: The hospital environment. For example, a patient who requires a ventilator for survival is commonly discharged home with these devices. Another example includes the now-ubiquitous presence of automated external defibrillators in public venues which allow lay people to deliver life support in a prehospital environment. The ultimate goals of life support depend on the specific patient situation. Typically, life support

3621-535: The hypoperfusion. Because the reduction in blood flow is global, all parts of the brain may be affected, especially vulnerable "watershed" areas—border zone regions supplied by the major cerebral arteries. A watershed stroke refers to the condition when the blood supply to these areas is compromised. Blood flow to these areas does not necessarily stop, but instead it may lessen to the point where brain damage can occur. Cerebral venous sinus thrombosis leads to stroke due to locally increased venous pressure, which exceeds

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3692-593: The life of the patient. Because such treatment is available, families are often faced with the moral question of whether or not to treat the patient. Much of the struggle concerns the ethics of letting someone die when they can be kept alive versus keeping someone alive, possibly without their consent. Between 60 and 70% of seriously ill patients will not be able to decide for themselves whether or not they want to limit treatments, including life support measures. This leaves these difficult decisions up to loved ones and family members. Patients and family members who wish to limit

3763-482: The need to act swiftly. During ischemic stroke, blood supply to part of the brain is decreased, leading to dysfunction of the brain tissue in that area. There are four reasons why this might happen: Stroke without an obvious explanation is termed cryptogenic stroke ( idiopathic ); this constitutes 30–40% of all cases of ischemic stroke. There are classification systems for acute ischemic stroke. The Oxford Community Stroke Project classification (OCSP, also known as

3834-417: The patient or representatives. However, when they decide against medical treatment, they must keep the patient or representatives informed even if they discourage continued life support. Whether the physician decides to continue to terminate life support therapy depends on their own ethical beliefs. These beliefs concern the patient's independence, consent, and the efficacy and value of continued life support. In

3905-427: The patient valued as a meaningful life, then sanctity of life did not apply. The accuracy of a proxy's decision about how to treat a patient is influenced by what the patient would have wanted for themselves. However, just because the patient wanted to die did not mean the courts would allow physicians to assist and medically kill a patient. This part of the decision was influenced by the case Rodriguez (1993) in which

3976-403: The patient would want. Otherwise, the physician would be acting against his conscience and his duty as a physician. However, if the patient disagreed, they can sue the physician for negligence. To avoid this, Justice Beard ruled in favor of the patient. Resuscitation is not controversial and only requires CPR, which would be performed by the first qualified person on the scene. Even if resuscitation

4047-410: The patient's autonomy, patients and their families are able to make their own decisions about life-sustaining treatment or whether to hasten death. When patients and their families are forced to make decisions concerning life support as a form of end-of-life or emergency treatment, ethical dilemmas often arise. When a patient is terminally ill or seriously injured, medical interventions can save or prolong

4118-563: The physicians were members of the European Society of Intensive Care Medicine. Mr. Sawatsky had Parkinson's disease and had been a patient at the Riverview Health Centre , Manitoba , Canada since May 28, 1998. When he was admitted to the hospital, the attending physician decided that if he went into cardiac arrest, he should not be resuscitated. Mrs. Sawatsky opposed the decision and the doctor complied. Later,

4189-721: The pressure generated by the arteries. Infarcts are more likely to undergo hemorrhagic transformation (leaking of blood into the damaged area) than other types of ischemic stroke. It generally occurs in small arteries or arterioles and is commonly due to hypertension, intracranial vascular malformations (including cavernous angiomas or arteriovenous malformations ), cerebral amyloid angiopathy , or infarcts into which secondary hemorrhage has occurred. Other potential causes are trauma, bleeding disorders , amyloid angiopathy , illicit drug use (e.g., amphetamines or cocaine ). The hematoma enlarges until pressure from surrounding tissue limits its growth, or until it decompresses by emptying into

4260-423: The production of high energy phosphate compounds such as adenosine triphosphate (ATP) fails, leading to failure of energy-dependent processes (such as ion pumping) necessary for tissue cell survival. This sets off a series of interrelated events that result in cellular injury and death. A major cause of neuronal injury is the release of the excitatory neurotransmitter glutamate. The concentration of glutamate outside

4331-464: The question is more, "Is continued life a benefit to this person" instead of, "Is it possible to treat this person". These questions are beyond the scope of the medical profession and can be answered philosophically or religiously, which is also what builds our sense of justice. Both philosophy and religion value life as a basic right for humans, rather than as the ability to contribute to society, and purposely encompasses all people. Mr. Sawatzky fell under

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4402-462: The risk of stroke, certain types of cancer such as pancreatic, lung and gastric are typically associated with a higher thromboembolism risk. The mechanism with which cancer increases stroke risk is thought to be secondary to an acquired hypercoagulability . Silent stroke is stroke that does not have any outward symptoms, and people are typically unaware they had experienced stroke. Despite not causing identifiable symptoms, silent stroke still damages

4473-480: The surrogate's request for resuscitation. In a survey conducted by Jean-Louis Vincent MD, PhD in 1999, it was found that of European intensivists working in the Intensive Care Unit, 93% of physicians occasionally withhold treatment from those they considered hopeless. Withdrawal of treatment was less common. For these patients, 40% of the physicians gave large doses of drugs until the patient died. All of

4544-592: The thick outermost layer of the meninges that surround the brain) and subdural hematoma (bleeding in the subdural space ), are not considered "hemorrhagic stroke". Hemorrhagic stroke may occur on the background of alterations to the blood vessels in the brain, such as cerebral amyloid angiopathy , cerebral arteriovenous malformation and an intracranial aneurysm , which can cause intraparenchymal or subarachnoid hemorrhage. In addition to neurological impairment, hemorrhagic stroke usually causes specific symptoms (for instance, subarachnoid hemorrhage classically causes

4615-479: The thrombus breaks off and travels in the bloodstream, at which point it is called an embolus . Two types of thrombosis can cause stroke: Anemia causes increase blood flow in the blood circulatory system. This causes the endothelial cells of the blood vessels to express adhesion factors which encourages the clotting of blood and formation of thrombus. Sickle-cell anemia , which can cause blood cells to clump up and block blood vessels, can also lead to stroke. Stroke

4686-402: The total). About 3.0 million deaths resulted from ischemic stroke while 3.3 million deaths resulted from hemorrhagic stroke. About half of people who have had stroke live less than one year. Overall, two thirds of cases of stroke occurred in those over 65 years old. Stroke can be classified into two major categories: ischemic and hemorrhagic . Ischemic stroke is caused by interruption of

4757-451: The treatment provided to the patient may complete a do not resuscitate (DNR) or do not intubate (DNI) order with their doctor. These orders state that the patient does not wish to receive these forms of life support. Generally, DNRs and DNIs are justified for patients who might not benefit from CPR, who would result in permanent damage from CPR or patients who have a poor quality of life prior to CPR or intubation and do not wish to prolong

4828-472: The umbrella, so the judge ruled in his favor. The Airedale NHS Trust v. Bland case was an English House of Lords decision for a 17-year-old comatose survivor of the Hillsborough disaster . He had been artificially fed and hydrated via life support for about three years, but he had not shown any improvement while in his persistent vegetative state. His parents challenged the therapeutic life support at

4899-691: The underlying cause, and the prognosis. The TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification is based on clinical symptoms as well as results of further investigations; on this basis, stroke is classified as being due to (1) thrombosis or embolism due to atherosclerosis of a large artery, (2) an embolism originating in the heart , (3) complete blockage of a small blood vessel, (4) other determined cause, (5) undetermined cause (two possible causes, no cause identified, or incomplete investigation). Users of stimulants such as cocaine and methamphetamine are at

4970-407: The use of neuroimaging such as MRI . Silent stroke is estimated to occur at five times the rate of symptomatic stroke. The risk of silent stroke increases with age, but they may also affect younger adults and children, especially those with acute anemia . Ischemic stroke occurs because of a loss of blood supply to part of the brain, initiating the ischemic cascade . Atherosclerosis may disrupt

5041-497: Was an ethical dilemma, it was minor given that the doctor had allowed resuscitation for several months already. In contrast with related cases in which patients were comatose, Mrs. Sawatzky provided evidence that her husband was able to communicate and believed that he could recover, but the doctor disagreed. The uncertainty of recovery pushed the Court to order the physician to allow resuscitation. Where rulings discuss end of life issues,

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