Innovations in Stroke Care FB2023.pptx
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To think of stroke as a life or death situation is to over-simplify. The concept of “Time Is Brain” doesn’t refer to inanimate neurons that die as a stroke progresses. Each moment of delay in stroke care can destroy not only a patient’s ability to perform activities to get through the day can also lose cells that contain personality and memories. Even patients who survive may lose part of their life. As hospitals are developing new methods of treatment for stroke victims, what role is there for EMS? This program will examine new in-hospital treatments like site-specific thrombolytics, clot corkscrews, cranial hypothermia, and the critical role of EMS in each phase of Stroke Systems of Care. These systems rely on both ALS and BLS providers to not simply save patients’ lives. This lively, pertinent, and through-provoking lecture shows how the actions of EMS providers are critical to every step of saving stroke patients’ life’s. www.ROMDUCK.com
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Innovations in Stroke Care FB2023.pptx
- 5. Ischemic •87% of strokes •Embolic •Thrombotic Hemorrhagic •13% of strokes • 60% Intracerebral • 40% Subarachnoid
- 6. LVO • Major arteries • basilar artery • carotid terminus • middle cerebral artery • Loss of flow to significant portions of brain • More severe, affecting higher- order brain functions SVO • Deep brain vessels • Not primary blood to the brain • Less severe • Often enduring and debilitating consequences • cognitive and motor impairment • mood disturbances • functional decline
- 7. Aneurisms • Weak area of a blood vessel AV Malformations • Artery and vein grow together
- 8. Subarachnoid Hemorrhage • A blood vessel bursts near the surface of the brain Intracerebral • A blood vessel bursts, leaking blood into the brain tissue
- 9. Is caused by a clot, but blockage is temporary and usually causes no permanent damage Approximately 15% of all strokes occur after a TIA
- 12. CHART omplaint
- 13. Time last seen…
- 14. CHART istory
- 16. –Hypoglycemia • ABGT / Better w/Glucose –Tumor • Slow & progressive onset –Abscess • Slow & progressive onset –Seizure • Staring, Aura or shaking –OD / ETOH • Acute Hx. –Migraine • Past Hx. • Photosensitivity –Head Injury • Recent Trauma –Subdural • Previous Trauma –Bell’s Palsy • Upper & Lower Face • Past Hx.
- 17. CHART ssessment
- 18. Altered Mental Status Focal Deficits Vital Signs including glucose Physical exam
- 23. ①Identify non-obvious strokes ②Assess and quantify presentation ③Triage to most appropriate destination ④Standardize reporting & stroke team activation ⑤Facilitate patient hand-off and continuum of care
- 24. Newborn Children Young Adults http://www.flickr.com/photos/7553606 0@N07/7160997963/
- 28. Bridgeport Hospital | Greenwich Hospital | Lawrence + Memorial Hospital | Westerly Hospital | Yale New Haven Hospital YaleNewHavenHospital Advanced Comprehensive Stroke Center Case Date 6/7/2021 Referring Hospital Care Yale New Haven Hospital Care Hospital Course and Discharge Case Imaging Arrival to YNHH: 6/7/2021 Neurosurgery Attending: Dr. Diluna & Dr. Matouk Imaging Mode: CTH BP on arrival: 110/50 SBP Goal: < 140 Neurosurgery Recommendations: - Admit to PICU, q1h neuro checks - Neuro ICU consult, Dr. Beekman aware - MRI/MRA brain now - SBP <140, goal eunatremic - Will discuss DSA tomorrow, potential embolization - Will discuss potential resection at later date - Loaded w/ keppra 500BID at OSH, no additional AEDs per neurology In YNHH ED: P 134, SpO2 99% RA, RR 21, BP 110/50; Exam notable for L facial droop, LUE paresis; Evaluated by neurosurgery and neurology and sent for MRI/MRV prior to PICU admission Hospital Course: Admitted to PICU with stable left sided neurological deficits, hemodynamically stable and on RA. She went for angiography with IR on 6/8 which showed multiple AVM in clusters, no acute intervention performed in preparation for IR/neurosurgery procedure on 6/11. She underwent Onyx embolization of AVM via R callosomarginal feeding artery by Dr. Matouk on 6/11/21. No residual AVM remained on post-procedure runs. She was maintained on a heparin infusion postoperatively 6/11-6/12. Post-operatively, her blood pressures were maintained with SBP <120 for the first few days afterwards. Nicardipine drip in place 6/12-6/15 to maintain these pressures. SBP restrictions loosened to SBP <140 and she received PRN hydralazine intermittently for some hypertension on 6/14 and 6/15, which improved after a few days. She received dexamethasone after her procedure, which was weaned to q24 by the time of transfer from the PICU. Her neurological exam remained stable throughout her stay in PICU and she was able to tolerate a full diet by the time of transfer to the floor. She underwent MRI brain and repeat DSA on 6/18/21, which showed no evidence of residual AVM. At this time, THE PATIENT is tolerating a diet, her pain and nausea is well controlled, and she is otherwise stable so she is cleared for discharge with the medications, issues to be addressed at follow up, and follow-up appointments listed below. She was discharged to acute rehab on 6/23/21 Patient Name: YNHH MRN: Date of Birth: Transfer Date: Referring Hospital: Danbury Hospital Medical History and Initial Presentation: The patient is a 14 yo girl with no significant PMH who is admitted with one day of acute onset difficulty swallowing, speaking, and L sided neuro deficits. She was eating lunch at school when she suddenly developed a choking sensation. She also reported feeling unable to breathe easily or speak. She had left sided weakness and was unable to stand. Denied any LOC, shaking, headache at that time. She was sent to Danbury Hospital by the school nurse. At Danbury Hospital, she had a CT head which revealed 2x4 cm R frontal IPH. She was treated with Keppra 500 mg prior to being transported to YNHH by helicopter. Thank you for your referral! Form completed by: Ranisha Parker, MSN, RN, SCRN Document completion date: 6/24/2021 Door In Time: 12:35 Door Out Time: 14:20 Total Time: 1:45
- 29. CHART ed Flags
- 34. CHART reatment
- 38. Thrombolytics
- 42. Innovations in Stroke Care
- 44. What is a stroke? 1.Complaints? 1.History? 1.Assessment? 1.Red flags? 1.Treatment? 1.Future care? 1.What is the role of EMS? 1.What is the benefit? 1.What is one take-away? http://www.flickr.com/photos/49656291@N00/3573339704/