GPH awarded for stroke care, education efforts

Every 40 seconds, someone in the U.S. has a stroke, and every four minutes, someone dies of stroke, according to the American Heart Association/American Stroke Association.

Stroke is the fifth leading cause of death in the U.S., accounting for about one in 20 deaths. It is also a leading cause of serious long-term disability.

For stroke patients, getting the proper care quickly is vital to survival. Great Plains Health was recently recognized for its efforts in treating stroke patients. GPH is one of two hospitals in Nebraska that earned the American Heart Association/American Stroke Association’s Get With The Guidelines Stroke Gold Plus achievement award. The North Platte hospital also received the AHA/ASA’s Target: Stroke Elite Plus Honor Roll Award.

At 3 p.m. on Tuesday, a representative from the associations will be at the Great Plains Health Education Center to present staff members with the award. The hospital will also be recognizing local first responders for their work to ensure that stroke patients get the care that they need.

“It’s a collective effort,” said Dr. Anil Kumar, a neurologist at Great Plains Health. “Different teams are working to save the brain.”

Most of the time, stroke patients are taken to the emergency room by crews from North Platte Fire and Rescue or fire departments from smaller communities who have requested a tiered response from North Platte, according to Fire Chief Dennis Thompson.

A stroke patient’s care usually starts with a 911 call. Thompson emphasized that people should be familiar with stroke symptoms and should call 911 immediately if someone appears to be having a stroke.

“Do not wait to see if signs and symptoms pass,” Thompson said. “Time is critical. The longer a stroke goes untreated, the greater the risk of debilitating damage to the brain.”

Other conditions have symptoms similar to a stroke, said Robin Dimmit, an emergency room technician at Great Plains Health and a paramedic with the Stapleton Volunteer Fire Department.

“Sometimes it’s a diabetic emergency,” Dimmit said, adding that alcohol-related problems also can cause strokelike symptoms.

Regardless, she said, it’s always better to be safe than sorry.

Once an ambulance arrives, the patient is loaded up and given oxygen. An IV is started and vitals are monitored as the patient is rushed to the emergency department. Paramedics assess the patient so that their findings can be used by ER staff to determine how the patient’s condition is progressing.

The crew also calls a stroke code into the ER, which activates a team of staff members including a pharmacist, laboratory technician and radiologist who wait to meet the ambulance.

“When we arrive in the Emergency Department with a stroke patient, we stop only long enough to weigh the patient while they are on our cot and then take them directly to the Radiology Department for a CT (scan),” Thompson said.

While the patient is having the CT, the cot is taken back to the scale so it can be weighed separately. This allows ER staff to determine the patient’s weight and a pharmacist to figure the dose of a drug called tissue plasminogen activator, or tPA.

“It’s a clot buster,” said Tonya Hinrichs, a pharmacist at Great Plains Health. “It will actually break up the clot in the brain that is causing the stroke.”

While tPA can be very effective, it can’t be used on many patients. Hinrichs explained that some patients may take medications that could cause an adverse reaction to tPA and could even result in death.

The time frame to use tPA is also limited, which is one of the reasons it’s so important to go to the hospital as soon as possible. Unfortunately, many people opt to wait to get treatment, said Chastity Orr, stroke program coordinator at Great Plains Health.

Farmers and ranchers can be particularly bad about trying to “rub dirt on it,” Orr said. They often think they’ll feel better if they lie down for a while, but doing so allows more irreparable damage to the brain to occur.

“In 1 to 2 seconds, a person can lose 32,000 brain cells depending on the location of their stroke,” Orr said. “That’s their mobility, their ability to talk, to eat, to recognize a family member, their behavior — everything that makes them able to function in their daily lives.”

Hinrichs said that when patients are brought in for a stroke, it’s important for someone to come with them or to be available to provide important information to the medical team, including the patient’s “last known normal.” It’s important for the staff to know when the patient was last seen acting normally so they can determine whether tPA can be administered.

“We’ve had patients come in alone,” Hinrichs said, explaining that this can be problematic because stroke patients sometimes cannot communicate.

This is because some strokes occur in the part of the brain that controls language, Kumar said. Sometimes patients suddenly can’t understand what people are saying to them; other times they can decode what they are hearing but can’t speak coherently.

Depending on the severity and location of the stroke, various forms of rehabilitation may take place to help patients get back to normal. Some experience a full recovery, while others are left permanently disabled.

Several risk factors can increase someone’s chance of having a stroke, including high blood pressure, high cholesterol, being overweight, diabetes and family history.

Training to maintain an active lifestyle, balance diet and taking precautions such as getting a stent placed if a patient is at risk for a stroke could save a person’s life later, Kumar said.

Stroke care “isn’t just treatment, it’s prevention,” Kumar said.

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