Coordinated Stroke Care Saves Woman's Life

One Woman's Story

Last October, a 67-year-old woman arrived at work for what she thought would be a typical day. That day turned out to be anything but typical when she suffered a life-threatening stroke.

“ I wasn't feeling well when I got to work,” recalls Mrs. Beverly Hatcher (not the patient's real name). “I sat at my desk and tried to get myself together. Pretty soon, I wasn’t able to get up or to answer when people spoke to me.” Fortunately, Mrs. Hatcher’s co-workers realized that she was in serious trouble and immediately called an ambulance. Paramedics recognized the signs of a stroke, or an interruption of blood flow to the brain, and brought Mrs. Hatcher to Capital Health System (CHS). At the hospital, a carefully coordinated stroke team that is available 24 hours a day, seven days a week to evaluate and treat critically ill patients immediately assessed her.

“When Mrs. Hatcher arrived in our emergency department she was in very serious trouble,” recalls LouAnn McGinty, RN, MSN, Neuroscience Nurse Coordinator. “She had Cheyne-Stokes respirations, an alternating pattern of deep and shallow breathing seen in critically ill people. She was unable to speak properly and her entire right side was paralyzed with a left-sided facial droop. We rushed Mrs. Hatcher to CT scan. The study confirmed that she was having a stroke and was a candidate for t-PA-a new, clot–busting drug that can actually restore blood flow to the brain. We were able to administer the drug within one hour of his arrival at the hospital.”

The next day, Mrs. Hatcher was out of bed. The grip strength in her right hand was nearly equal to that of her unaffected left hand. Her speech had cleared and she was completely mobile with few remaining problems.

Stroke is the nation's third-leading cause of death and number-one cause of disability. As recently as the mid-1990s though, stroke was not considered an emergency. The reason? Physicians could do nothing to help the victim or decrease the resulting impairment. When t-PA gained FDA approval in 1996, that situation changed dramatically. Today, there is unprecedented urgency to treat stroke, because t-PA can only be effectively and safely administered within the first three hours of the onset of symptoms. As in Mr. Hatcher's case, it's critically important that the ill person or those around him recognize the severity of the situation and get help immediately. Unfortunately though, a recent National Institutes of Health (NIH) study revealed that up to 75 percent of the population cannot name a symptom of stroke, such as a sudden change in vision, one-sided numbness or paralysis or an inability to speak or understand speech. The same study found that the average stroke patient waits 6.6 hours before seeking emergency care, missing the opportunity to benefit from t-PA.

Receiving state-of-the-art stroke care also depends upon getting to the right facility. Some hospitals are not prepared to mobilize the expertise, equipment and resources necessary to deliver this specialized care. “Any hospital can administer t-PA, but studies show that hospitals with an established team approach provide patients with the best outcome,” says Ms. McGinty. “Because time is of the essence in delivering optimal stroke treatment, the NIH has established time guidelines for evaluation and treatment. Our hospital has succeeded in beating these deadlines over and over again. We have the staff and procedures in place. Each member of our stroke team has a specialized role to perform, from Emergency Department physicians and nurses, to neurologists to lab and imaging personnel. We even have a speech pathologist who evaluates all stroke patients to rule out a swallowing disorder before they are fed,” says McGinty. “ Assessing swallowing problems dramatically reduces the incidence of life-threatening aspiration pneumonia in stroke patients.”

For Mrs. Hatcher, the benefits of a coordinated emergency response team for stroke care at a local hospital are crystal clear: “The staff at Capital Health System saved my life.”

_{This article was contributed by LouAnn McGinty, RN, MSN, Neuroscience Nurse Coordinator
at Capital Health System, Trenton, NJ}

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