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An irregular pulse is associated with arrhythmias such as atrial fibrillation. Atrial fibrillation is a common cause of thromboembolic stroke due to blood pooling and clotting in the heart. In the context of a stroke, a patient’s consciousness level may be reduced if the stroke is large or affects the brainstem. If your patient is unconscious and their respiratory rate is inadequate (too slow or irregular with big pauses), you can provide assisted ventilation through a bag-valve-mask (BVM): ventilate at a rate of 12-15 breaths per minute (roughly one every 4 seconds). CPR

What good is all of this? The current life-extensionist strategy is twofold. First, achieve a “wellness foundation,” Strole says. Second, stay alive until the coming gerontological breakthrough. All that is required is to “live long enough for the next innovation,” and presuming you do, “You can buy another 20 years.” Twenty years here, 20 years there, it all adds up, and suddenly you’re 300. This is a common view. Last year the British billionaire Jim Mellon, who has written a book on longevity, titled Juvenescence, said: “If you can stay alive for another 10 to 20 years, if you aren’t yet over 75 and if you remain in reasonable health for your age, you have an excellent chance of living to more than 110.” To most, 110 seems a modest target. Why not forever? “It’s not some big quantum leap,” Strole says, by way of explanation. He invokes the analogy of a ladder: “step by step by step” to unlimited life. In 2009 the American futurist Ray Kurzweil, another supplement enthusiast, coined a similar metaphor, referring instead to “bridges to immortality”. See our guides to recording and interpreting an ECG for more details. Interventions Intravenous fluids The FAST test helps spot the three most common symptoms of stroke. But there are other signs that you should always take seriously. These include:

Look for signs of airway compromise: these include cyanosis, see-saw breathing, use of accessory muscles, diminished breath sounds and added sounds. Regardless of the underlying cause of airway obstruction, seek immediate expert support from an anaesthetist and the emergency medical team (often referred to as the ‘crash team’). In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. Head-tilt chin-lift manoeuvre The oldest person to have lived, Jeanne Calment, reached 122, though she was perhaps not the greatest example of good health: she smoked until she was 117. The most successful life-extension methods we know of seem to be those we have known all along: eat well, sleep well, exercise, reduce stress and rely on modern medicine, which has prolonged average lifespans significantly over the past 160 years. If the patient is unconscious or unresponsive, start the basic life support (BLS) algorithm as per resuscitation guidelines.

Maintain head-tilt chin-lift or jaw thrust and assess the patency of the patient’s airway by looking, listening and feeling for signs of breathing. Nasopharyngeal airway (NPA) In an ischaemic stroke, the CT head may be normal or show hypodensity. A CT may identify other intracranial pathology, including a space-occupying lesion. Any medications or fluids will need to be prescribed at the time (in some cases you may be able to delegate this to another member of staff). A PACS (partial anterior circulation stroke) is caused by an infarct that only affects part of the anterior circulation and causes two of the above, or higher cerebral dysfunction alone. Inspect the airway for obvious obstruction. If an obstruction is visible within the airway, use a finger sweep or suction to remove it.You may also be interested in our overview of the ABCDE approach and other emergency management guides.

In the context of a stroke, the handover may be from nursing staff (for in-hospital strokes) or ambulance staff (for pre-hospital strokes). Introduction Soft tissue swelling: causes include anaphylaxis and infection (e.g. quinsy, necrotising fasciitis).Revisit history taking to identify risk factors for stroke and explore relevant medical history. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. Hypertension can cause stroke through end-organ damage (this is known as a hypertensive emergency and tends to occur at BP >200 mmHg systolic) Open the patient’s mouth to ensure there is no foreign material that may be pushed into the larynx. If foreign material is present, attempt removal using suction. Strole has been an evangelist of human immortality since he was a child, when his grandmother died, and he felt “a pain you can’t even describe, it’s so deep in your gut.” He was 11, still new to the world, and he came to think of death, like most of us do at some point or another, as deeply unfair. In some patients who receive early imaging, the thrombus or embolus may be visible within the vessel. This appears as hyperdensity within the vessel (e.g. hyperdense middle cerebral artery).