The clock literally starts ticking upon the first signs of a stroke. The key to maximizing your outcome after stroke symptoms begin is to immediately call 9-1-1. Paramedics in Genesee County have protocols in place to stabilize and urgently transport all patients with stroke symptoms to the Emergency Department.
Whether the patient arrives to McLaren's Emergency Department (ED) by ambulance or car, the physicians and emergency staff immediately begin the evaluation process as treatment of acute stroke is clearly time dependent. Similar to treating a heart attack, evidence based medicine shows there is a "treatment window" for maximizing outcomes for stroke patients, and that time limit is three hours from the time symptoms begin, until a special "clot buster drug" can be safely administered.
Patients arriving to the ED with stroke symptoms are taken "straight back" to a treatment area, bypassing the triage process and evaluated immediately by ED nursing personal and an Emergency Physician. If stroke symptoms are less than two hours old, and the patient meets certain criteria for treatment with tPA (Tissue Plasminogen Activator-a clot buster drug administered by IV and designed to "dissolve" the blood clot in the brain causing the stroke) the ED staff initiates a series of events, all designed to rapidly evaluate the patient via a team approach.
First, the ED doctor requests a hospital operator to initiate an overhead "Stroke Team Alert" announcement and a simultaneous "burst" page is sent to several key areas within the hospital. Laboratory staff immediately prepare to receive the patient's blood which ensures rapid results. ED radiology staff makes the CAT scan area immediately available for the patient to have a rapid brain scan.
When the patient returns from X-ray, laboratory studies begin to arrive via computer, and at the same time an attending radiologist calls the ED doctor with a report on the patient's CAT scan. If there are no abnormal labs, no bleeding on the CAT scan, and the patient and or family agrees to proceed with the tPA treatment, the ED doctor then urgently pages the on-call neurologist, the case is discussed, and unless certain reasons are identified to withhold treatment (for example the patient is on certain blood thinners, has very high blood pressure not responsive to treatment, or has evidence of bleeding on the CAT scan), the tPA will be given to the patient in the ED.
tPA may only be given, at this time, to certain patients within three hours of clear symptom onset. If patients wake up from sleep with stroke symptoms, are unsure when the symptoms began, or present to the ED more than two hours after symptoms began, the TPA medicine IS NOT an option. Giving the medication after the three hour time limit has shown to increase bleeding within the brain (the most concerning side effect) and not improve patient outcomes.
Once treatment with tPA is completed (the medicine takes an hour to give through the patient's IV), patients are transferred to an ICU bed for at least one day in order to monitor their response to the drug, and to monitor their stroke symptoms. It is in the ICU area where patients will also see their primary care doctor, an intensive care unit physician and the consulting neurologist contacted early in their ED management. If the tPA is successful, symptoms may begin to improve immediately in the ED or within a day of the ICU stay. Once patients are well enough to be moved from the ICU they are transferred to 10 South.
Most stroke patients do not have to go to the ICU and instead are admitted to 10 South, McLaren's dedicated stroke unit. The nursing staff on 10 South are all specially trained to care for stroke patients. Their training and education includes monitoring patients for any new signs and symptoms of neurological changes. For example, they assess that patients are swallowing normally, speaking clearly, identifying objects appropriately and evaluating for any extremity weakness. In addition the nursing staff provides extensive education to both the patient and their family members regarding signs and symptoms of stroke, and risk factor modifications including dietary changes impacting cholesterol levels and blood pressure, medication compliance, as well as the importance of physical activity.
McLaren's therapy staff including physical and occupational therapists also evaluate each patient following their transfer to, or admission to 10 South, for any physical weaknesses, walking or balance problems. Therapy staff treat patients who are determined to benefit from therapy during their stay in the hospital. Speech language pathologists see patients when nursing staff have concerns about a patient's speech or swallowing capabilities. When therapy staff determine a patient will benefit from physical, occupational or speech therapy beyond their hospital stay they notify McLaren's rehabilitation physicians for a final evaluation. These physicians then refer patients to McLaren's inpatient rehab unit or the McLaren Neurologic Rehabilitation Institute (MNRI), click here for more information on these services.