Do you know the first three things you should do if someone’s having a stroke?

Even a middle aged person can be stricken by this very common condition. Time is truly of the essence when it comes to a stroke.

The most common type of stroke is the ischemic type, in which a blood clot in the brain cuts off blood flow – and therefore oxygen – to the area of the brain that the blood vessel feeds.

The less common type is the hemorrhagic, in which a blood vessel ruptures, spilling blood onto brain tissue.

Both are life-threatening situations, and anyone nearby needs to act super-fast.

Time Is Brain

For some, time is money. But for all who have a stroke, time is brain. Fast thinking and fast action are crucial to prevent death and brain damage.

First Three Things to Do when Someone Is Having a Stroke

“The main thing is to immediately contact 9-1-1 and get the patient to the hospital,” says Sendhil Krishnan, MD, a board-certified adult general cardiologist with advanced subspecialty training in interventional cardiology.

“In the interim one should continue to monitor their neurological response and continuously check for a pulse (start CPR if necessary.)”

So that’s 1) call 9-1-1, 2) observe the patient, and 3) continuously check for a pulse.

“Patients should not be given any medications including aspirin,” says Dr. Krishnan.

“The reason for this is the stroke may be due to a bleed (hemorrhagic) or ischemic (due to clot). Giving blood thinners may only worsen the bleed and their brain.”


Speaking of blood thinners worsening a bleed – another condition can mimic a stroke for which blood thinners can make worse: a delayed subdural hematoma from recent head trauma that the patient may have forgotten about, such as hitting their head on the door frame of a car when getting out.

This seemingly minor head trauma can cause a delayed brain bleed in a person over 65. The symptoms are nearly identical to that of an ischemic stroke.

Recognizing an Ischemic Stroke

Symptoms are sudden-onset.

• Any trouble with vision

• Paralysis of one side of the face or body/limb

• One side of the face drooping

• Weakness on one side of the body

• Slurred speech or difficulty talking

• Confusion or altered mental status

• Not being able to communicate even though seemingly conscious

• Stroke is even more suspicious if more than one of these symptoms are occurring or if there’s an accompanying bad headache.

Age is a risk factor, but In 2009, 34% of people hospitalized for stroke were younger than 65. Source:

Signs of a Hemorrhagic Stroke

• Sudden “thunderclap” headache that takes a person’s breath away

• Patient reports they’ve never had a headache so agonizing.

• Nausea, vomiting may precede the headache.

• Vision problems

• One eyelid is drooping.

• Pupils of unequal size

“If the patient is diabetic and is profoundly hypoglycemic, they may act and behave as if having a stroke,” says Dr. Krishnan.

“In this case I would recommend giving them something sweet or sugary to raise their blood glucose levels.

“I would recommend things that can be absorbed through their cheeks (i.e., a lollipop or sugar tabs).”

This way the patient won’t have to chew and swallow, which – if they are having a stroke – could lead to choking and aspiration, says Dr. Krishnan.

Diabetes is a risk factor for stroke, so just because a person is diabetic doesn’t mean that you should automatically assume that the sudden-onset symptoms are from low blood sugar.

Even an ER doctor can’t officially confirm diagnosis of a stroke without a brain scan. Thus, the layperson family member or friend absolutely should not try to diagnose the absence of a stroke just because the patient has had similar symptoms in the past from diabetes or is “too young to have a stroke.”

Ischemic and Hemorrhagic Stroke Risk Factors

• Age 65+
• Atrial fibrillation
• Carotid artery disease or peripheral artery disease
• Chronic/congestive heart failure
• Coronary artery disease
• Diabetes
• Diet high in sodium or bad fats (saturated, trans)
• Family history of stroke or cerebral aneurysm
• High blood pressure
• High cholesterol
• Obesity
• Previous diagnosis of a cerebral (brain) aneurysm
• Previous heart attack
• Previous transient ischemic attack (TIA)
• Sedentary lifestyle
• Smoking

Time lost is brain lost when it comes to a stroke. Seconds, not minutes, count.

Dr. Krishnan is with Pacific Heart & Vascular, where you can view his videos on heart disease and healthy living. He has numerous publications and often speaks at local and regional events.