Time is of the essence in acute medical cases, such as heart attack and stroke.
When neurologists speak of a stroke, you might hear “time is brain.” Delays can mean loss of brain function that may not be recovered.
“When a stroke victim hesitates coming to the hospital, they lose crucial treatment time,” explained Penny Clifton, a registered nurse and stroke program coordinator for St. Vincent Healthcare in Billings, Montana.
And when time is of the essence, a skilled, attuned team is crucial to delivering rapid patient care.
“The care team acts immediately so the patient gets the right assessment by the right person and the right imaging,” explained Clifton.
What type of stroke is it?
Determining the type of stroke the patient is having is important because treatment differs.
- The majority of strokes are ischemic strokes, which happen when a clot blocks blood from reaching the brain.
- Hemorrhagic strokes occur when blood bleeds from an artery into the brain.
- Transient ischemic attacks, commonly called TIAs or mini-strokes, last only a few minutes but are often a warning sign of a future stroke.
“Patients suffering from ischemic stroke can be successfully treated with a clot-busting drug — but only if they get the drug within four hours of initial symptoms,” said Dr. Ira Chang, a neurologist with Blue Sky Neurology, affiliated with the SCL Health Colorado Region.
If the patient has a large clot that the drug won’t dissolve, doctors may perform a thrombectomy, a procedure that removes the clot out of the artery, Dr. Chang explained. Thrombectomy procedures are performed at Lutheran Medical Center and St. Mary’s Medical Center in Colorado, and St. Vincent Healthcare in Montana.
Blood thinners may also be used to stop the clot from growing and allow the body time to break up a clot.
“Only about 15% of strokes are hemorrhagic, brought on by high blood pressure, an aneurysm or an underlying vascular abnormality,” said Dr. Chang.
Stroke education is key
Part of Clifton’s job is educating the public about stroke.
“Stroke is a challenge,” she said. “The American public is very good at recognizing chest pain related to a heart attack. They’re all over 911 with that. Stroke, not so much.”
Stroke symptoms include sudden numbness, sudden confusion, sudden trouble seeing, sudden trouble walking and maintaining balance, and sudden severe headache. If you think someone is having a stroke, act F.A.S.T. and do this test:
- Face: Ask them to smile. Does one side of their face droop?
- Arms: Ask them to raise both arms. Does one arm drift down?
- Speech: Ask them to repeat a simple phrase. Is their speech slurred or odd?
- Time: If you see any of these signs, call 911 immediately.
“When you begin your care with the paramedics or ambulance service, they notify us when they’re on their way and it allows us to get a head start for you — so we’re ready when you arrive,” Clifton pointed out. “We will have the neurologist standing by in the emergency department and have the CAT scan table available. It’s like a relay race to ensure a rapid response."
There are two levels of certification that recognize hospitals providing the highest level of care for acute stroke. Patients who receive treatment at certified hospitals have a higher incidence of survival and recovery.
- Comprehensive Stroke Centers offer the most complex stroke care, including clot retrieval.
- Lutheran Medical Center
- St. Mary's Medical Center
- Primary Stroke Centers provide resources and processes to care for acute stroke.
- Good Samaritan Medical Center
- Saint Joseph Hospital
- Platte Valley Medical Center
- St. Vincent Healthcare*
*Began their clot retrieval program in 2021 and are working towards certification as thrombectomy-capable Primary Stroke Center