Are You at Risk For a Stroke? Brian Huettl, MD Department of Emergency Medicine Saint Francis Hospital

Agenda Stroke Definition and statistics Evidence-based medical literature Prevention Risk factors Early identification, diagnosis, treatment Organized care What can you do?

Stroke

Definition and statistics

Evidence-based medical literature

Prevention

Risk factors

Early identification, diagnosis, treatment

Organized care

What can you do?

Stroke: Statistics Fact: Stroke is our nation’s #3 killer and a leading cause of disability 780,000 Americans have a stroke each year 600,000 are first time strokes One stroke occurs every 40 seconds on average Every 3-4 minutes, someone dies of stroke Of those who survive, 90% have a functional deficit Stroke kills 2 million brain cells per minute Stroke costs approximately $60 billion/year in the U.S.

Fact: Stroke is our nation’s #3 killer and a leading cause of disability

780,000 Americans have a stroke each year

600,000 are first time strokes

One stroke occurs every 40 seconds on average

Every 3-4 minutes, someone dies of stroke

Of those who survive, 90% have a functional deficit

Stroke kills 2 million brain cells per minute

Stroke costs approximately $60 billion/year in the U.S.

Stroke: Statistics Fact: Some people have a higher risk of stroke. About 60,000 more women than men suffer a stroke each year African-Americans have almost twice the risk of a first ever stroke compared to Caucasians People with high blood pressure (140/90+) have about twice the risk of stroke as people with blood pressure under 120/80

Fact: Some people have a higher risk of stroke.

About 60,000 more women than men suffer a stroke each year

African-Americans have almost twice the risk of a first ever stroke compared to Caucasians

People with high blood pressure (140/90+) have about twice the risk of stroke as people with blood pressure under 120/80

Stoke: Definition Ischemic stroke Hemorrhagic stroke Transient Ischemic Attack (TIA)

Ischemic stroke

Hemorrhagic stroke

Transient Ischemic Attack (TIA)

Ischemic Stroke Approximately 83% of strokes are caused by ischemia Large vessel (Atherosclerotic) = 30% Small vessel (Lacunar) = 25% Embolic = 30% Results from blockage within the blood vessels that supply blood to the brain *Reference: American Heart/Stroke Association 2008

Approximately 83% of strokes are caused by ischemia

Large vessel

(Atherosclerotic) = 30%

Small vessel

(Lacunar) = 25%

Embolic = 30%

Results from blockage within the blood vessels that supply blood to the brain

Hemorrhagic Stroke Approximately 17% of strokes are from hemorrhage Intracerebral hemorrhage Subarachnoid hemorrhage Results from a weak brain vessel that ruptures *Reference: American Heart/Stroke Association 2008

Approximately 17% of strokes are from hemorrhage

Intracerebral hemorrhage

Subarachnoid hemorrhage

Results from a weak brain vessel that ruptures

TIA aka, “mini stroke” Blood clot temporarily blocks the blood vessel Stroke prevention factors Medical treatment Surgical evaluation

aka, “mini stroke”

Blood clot temporarily blocks the blood vessel

Stroke prevention factors

Medical treatment

Surgical evaluation

Evidence-Based Medical Literature Prevention Early detection Early diagnosis and treatment Organized care

Prevention

Early detection

Early diagnosis and treatment

Organized care

Prevention: Controllable Risk Factors High blood pressure Cigarette smoking Diabetes mellitus Carotid or other artery disease Atrial fibrillation Other heart disease Obstructive sleep apnea Sickle cell disease High cholesterol Poor diet Decreased physical activity Obesity Alcohol/drug abuse

High blood pressure

Cigarette smoking

Diabetes mellitus

Carotid or other artery disease

Atrial fibrillation

Other heart disease

Obstructive sleep apnea

Sickle cell disease

High cholesterol

Poor diet

Decreased physical activity

Obesity

Alcohol/drug abuse

Prevention: Uncontrollable Risk Factors Age Family history Race Gender Prior stroke, TIA, heart attack

Age

Family history

Race

Gender

Prior stroke, TIA, heart attack

Secondary Prevention Blood pressure management Aspirin Plavix Coumadin Statin Smoking cessation Eliminating alcohol intake Weight reduction/modified diet Exercise

Blood pressure management

Aspirin

Plavix

Coumadin

Statin

Smoking cessation

Eliminating alcohol intake

Weight reduction/modified diet

Exercise

Early Identification Fact: Stroke is highly treatable within the first three hours Time is brain!

Fact: Stroke is highly treatable within the first three hours

Time is brain!

Stroke Signs/Symptoms When a part of the brain begins to die, there are signs and symptoms that this is happening 2 million brain cells die each minute Remember as much as possible about a person’s responses Actions or lack of actions What time did the signs begin?

When a part of the brain begins to die, there are signs and symptoms that this is happening

2 million brain cells die each minute

Remember as much as possible about a person’s responses

Actions or lack of actions

What time did the signs begin?

Stroke signs/symptoms

Stroke Signs/Symptoms

Stroke signs/symptoms

Is their BALANCE off? Things to look for or ask: Can they stand and sit straight and tall? Do they slump of lean to the right or left? Can they walk in a straight line or do they veer to the left or the right? Do they drag a right or left leg or foot? Do they let a right or left arm hang when they walk?

Things to look for or ask:

Can they stand and sit straight and tall?

Do they slump of lean to the right or left?

Can they walk in a straight line or do they veer to the left or the right?

Do they drag a right or left leg or foot?

Do they let a right or left arm hang when they walk?

Is their SPEECH SLURRED or FACE DROOPY? Things to look for or ask: Does one side of the mouth droop when they smile? Do both eyes close when they blink? Can they stick their tongue out straight? Can they say “______________”? Do they sound like they have something in their mouth when they speak? Do their words make sense?

Things to look for or ask:

Does one side of the mouth droop when they smile?

Do both eyes close when they blink?

Can they stick their tongue out straight?

Can they say “______________”?

Do they sound like they have something in their mouth when they speak?

Do their words make sense?

Is one side WEAK or NUMB ? Things to look for or ask: Ask the person to raise both their arms up together in front of them. Does one arm begin to fall down? Ask the person to squeeze your fingers with each hand. Is one hand weaker than the other? Ask the person to try to hold something like a pen, cup, spoon or fork. Can they do it without any difficulty? Can the person feel you lightly touch them on both arms? Ask them if the feeling is the same on each.

Things to look for or ask:

Ask the person to raise both their arms up together in front of them. Does one arm begin to fall down?

Ask the person to squeeze your fingers with each hand. Is one hand weaker than the other?

Ask the person to try to hold something like a pen, cup, spoon or fork. Can they do it without any difficulty?

Can the person feel you lightly touch them on both arms? Ask them if the feeling is the same on each.

Is their VISION all or partly lost? Things to look for or ask: Ask the person whether they can see. Do you look clear to them? Do you look blurred? Do they see more than one of you? Ask the person whether they normally wear glasses or contact lenses. Ask the person to describe any changes in vision. When they look straight ahead, can they see a little to both sides and up and down?

Things to look for or ask:

Ask the person whether they can see. Do you look clear to them? Do you look blurred? Do they see more than one of you?

Ask the person whether they normally wear glasses or contact lenses.

Ask the person to describe any changes in vision.

When they look straight ahead, can they see a little to both sides and up and down?

Is their HEADACHE severe? Things to look for or ask: Do they have any pain anywhere? Do they have a headache? On a scale of 1-10, 10 being the worst, ask them to rate their headache. Do they normally have headaches? Is this headache any different from their usual headache? Does this feel like the worst headache of their life? Does light bother or hurt their eyes? Does a sound or loud noise make the headache worse? Is their pain different when they stand, sit or lie down?

Things to look for or ask:

Do they have any pain anywhere?

Do they have a headache? On a scale of 1-10, 10 being the worst, ask them to rate their headache.

Do they normally have headaches? Is this headache any different from their usual headache?

Does this feel like the worst headache of their life?

Does light bother or hurt their eyes?

Does a sound or loud noise make the headache worse?

Is their pain different when they stand, sit or lie down?

Immediate Actions to Take Remember what is happening or write it down if it does not slow down in getting emergency help Time is brain! Options: Call 911 Get to an Emergency Department

Remember what is happening or write it down if it does not slow down in getting emergency help

Time is brain!

Options:

Call 911

Get to an Emergency Department

Stroke Treatment: Thrombolytics Alteplase (tPA) = Clot buster

tPA Benefits Independent life vs. dependent Excellent recovery = 31% vs. 20% Death = 9% vs. 20% For every 100 patients treated with tPA: 32 benefited 3 were harmed

Independent life vs. dependent

Excellent recovery = 31% vs. 20%

Death = 9% vs. 20%

For every 100 patients treated with tPA:

32 benefited

3 were harmed

Organized Care Consistent, efficient use of proven medical treatment in an organized manner Care protocols Outcome measures

Consistent, efficient use of proven medical treatment in an organized manner

Care protocols

Outcome measures

Primary Stroke Centers: Proven Outcomes Rapid evaluation and treatment ie: thrombolytics Urgent referral for more advanced clot treatment Specialty units in the hospital with experienced staff Initial and ongoing reviews of care Certifying agency such as Joint Commission

Rapid evaluation and treatment

ie: thrombolytics

Urgent referral for more advanced clot treatment

Specialty units in the hospital with experienced staff

Initial and ongoing reviews of care

Certifying agency such as Joint Commission

Primary Stroke Centers: Proven Outcomes 19% decline in mortality 25% decline in death/institutional care 29% decline in death/dependency Increase in expediency of MD evaluation, CT, tPA administration *Reference: Cochrane Database, 2000

19% decline in mortality

25% decline in death/institutional care

29% decline in death/dependency

Increase in expediency of MD evaluation, CT, tPA administration

What Can You Do? Community and family outreach Reduce risk Recognize signs Respond quickly

Community and family outreach

Reduce risk

Recognize signs

Respond quickly

Questions? Resources available: Resurrection Health Care 1-877-RES-INFO (1-877-737-4636) www.reshealth.org Your Resurrection Health Care Hospital’s Stroke Care Coordinator American Heart/Stroke Association 1-888-4-STROKE www.strokeassociation.org National Stroke Association 1-800-STROKES www.stroke.org American Physical Therapy Association 1-800-999-APTA (2782) www.apta.org American Occupational Therapy Association 301-652-2682 www.aota.org American Speech-Language-Hearing Association 301-296-5700 www.asha.org

Resources available:

Resurrection Health Care 1-877-RES-INFO (1-877-737-4636) www.reshealth.org

Your Resurrection Health Care Hospital’s Stroke Care Coordinator

American Heart/Stroke Association 1-888-4-STROKE

www.strokeassociation.org

National Stroke Association 1-800-STROKES

www.stroke.org

American Physical Therapy Association 1-800-999-APTA (2782)

www.apta.org

American Occupational Therapy Association 301-652-2682

www.aota.org

American Speech-Language-Hearing Association 301-296-5700

www.asha.org