Sierra Sciences is another company racing to cheat death. Its focus is on treatments that can lengthen telomeres – the “caps” at the end of each strand of DNA. Telomeres get shorter each time a cell copies itself. Because our cells copy themselves throughout our lives, the telomeres eventually get very short, and our cells cannot regenerate: we get old. Your assessment and management should be documented clearly in the notes, however, this should not delay initial clinical assessment, investigations and interventions. All community medical services and ambulance services (including call handlers) should be trained to treat patients with symptoms suggestive of an acute stroke as an emergency requiring urgent transfer to a centre with specialised hyper-acute stroke services.

Review the patient’s drug chart for medications which may cause neurological abnormalities (e.g. opioids, sedatives, anxiolytics). National Institutes of Health Stroke Scale (NIHSS) Others claim they can already prevent aging in animals. George Church, a Harvard professor and the founder of Rejuvenate Bio, uses gene therapy to add anti-aging instructions to DNA. Church says he has succeeded in making mice live twice as long, and the secretive company is said to be planning imminent testing on dogs. Most stroke patients are not hypoxaemic. Evidence suggests high concentrations of supplemental oxygen should be avoided in stroke patients unless required to maintain oxygen saturations. Terminal internal carotid, middle cerebral artery (M1 or proximal M2) occlusion or basilar artery occlusion

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If the patient is suspected to have suffered significant trauma with potential spinal involvement, perform a jaw-thrust rather than a head-tilt chin-lift manoeuvre: Nevertheless, he persisted. He considered himself fortunate to work in a field that meant he was privy to insider information and he became convinced a significant breakthrough was around the corner. To fully prepare his body for the rigmarole of centuries-long life, he adopted a strict health regimen. He fasted, juiced, cleansed and devoured supplements, inviting audiences to do the same. Eventually, a community formed, driven by a shared, urgent aversion to death. “We felt then how important it was to do everything you could to stay alive,” he says After each fluid bolus, reassess for clinical evidence of fluid overload (e.g. auscultation of the lungs, assessment of JVP). In any case, it is likely that one single longevity strategy alone won’t help us much. Life extensionists enjoy a metaphor: humans are complicated machines, they say, like cars, but mushy. And what happens to a machine if you don’t look after it? It rusts. It splutters and spurts, until it reaches its inevitable conclusion. De Grey considers ageing a “multifaceted problem”. Humans incur many different types of damage. We don’t just rust. We scratch. We dent. Rubbish accumulates in our footwells and grime develops in our engines. We require multiple strategies of repair – constant fine-tuning. What’s the point in removing those senescent cells if that molecular junk continues to build up?

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. Ambulance paramedics are trained in stroke and will ensure the person receives emergency medical care and specialist treatment. Other symptoms of a stroke A LACS (lacunar stroke) is subcortical; therefore, higher cerebral functions (e.g. language) are preserved. Hence, these can be pure motor, sensory, sensorimotor, or cause ataxic hemiparesis alone. 3 Bamford stroke classification Haemorrhagic stroke A POCS (posterior circulation syndrome) is caused by an infarct affecting the posterior circulation, which supplies the cerebellum and brainstem, and it causes: Until the end of time: James Strole, 70, founder of the Coalition for Radical Life Extension in Arizona, with some of the many pills and supplements he takes dailyIntroduce yourself to whoever has requested a review of the patient and listen carefully to their handover. Interaction Insert at least one wide-bore intravenous cannula (14G or 16G) and take blood tests as discussed below. Soft tissue swelling: causes include anaphylaxis and infection (e.g. quinsy, necrotising fasciitis). Further investigations will depend on the clinical context and may be required to exclude stroke mimics. Interventions 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:

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. MRI FAST head: sometimes performed in an acute setting, especially in wake-up strokes. Comparing different sequences can show if there is still perfusion and if someone would benefit from thrombolysis. You should have another member of the clinical team aiding you in your ABCDE assessment, such a nurse, who can perform observations, take samples to the lab and catheterise if appropriate.Blood pressure lowering: aim for BP < 140 mmHg systolic (if <6 hours of onset) or < 180 mmHg systolic (if >6 hours of onset). Use labetalol 10mg IV, then consider GTN infusion. Inspect the airway for obvious obstruction. If an obstruction is visible within the airway, use a finger sweep or suction to remove it. Intracerebral haemorrhages present with stroke symptoms, similar to those of an ischaemic stroke, depending on the area of the brain that has been affected. They can also present with a reduced level of consciousness and headache.

Discuss the patient’s current clinical condition with a senior clinician using an SBAR style handover. With your index and other fingers placed behind the angle of the mandible, apply steady upward and forward pressure to lift the mandible.

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It may be necessary to expose the patient during your assessment: remember to prioritise patient dignity and conservation of body heat. Clinical assessment 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). Further interventions will depend on the clinical context and may be required to manage stroke mimics. CPR Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing.