I had the privilege of caring for a patient recently who presented to the Emergency Department (ED) from home by 911 after his family found him acutely confused. The patient is a 42-year-old man with a medical history of hypertension and diabetes who does not take his medications and smokes daily. Emergency Medical Services calls into the hospital to alert us of an incoming patient, stating the chief complaint, vital signs, exam and intervention that they performed. I could tell by their voices that this patient was very sick and needed emergent treatment. The medics performed a quick bedside exam called a FAST for possible stroke, looking for:
• Face – drooping
• Arms – weak
• Speech – slurred
• Time – onset of symptoms
The patient’s FAST was abnormal and his vital signs revealed a very high blood pressure and a rapid heart rate. The transport time was three minutes, allowing me to prep the resuscitation room with all necessary equipment and prepare for any life-saving procedural treatment that may be necessary. I informed the nurses and we all went into action. The nurses have a critical role in patient care in the ED and we all work as one fine-tuned orchestrated team, together with our therapists and technicians. The patient arrived at the ED unable to speak or move his entire right side. He had last been well three hours prior. In acute ischemic strokes for patients between 18-80 years of age, we have 4.5 hours to determine if the patient meets criteria for TPA, a life-saving, clot buster medication. I performed an NIH scale, which is a detailed rapid neurologic exam. His score was 16, confirming a large stroke. With a stroke, time equals brain. Earlier treatment leads to better outcomes. Careful patient selection is made because complications can occur. After consultation with neurology through our tele-stroke network with OSU and family consent, Gary was given TPA and flown to OSU for further care.
In talking with the family, I learned that the day prior, the patient had a 15-minute episode of slurred speech and transient weakness in his right side. Because it went away he did not seek care. This was a mini-stroke or what we call TIA (transient ischemic attack). This is a warning sign of an impending stroke. Approximately 11 percent of patients with a TIA have a stroke within 90 days and of those, 50 percent of those occur within 48 hours. We take these symptoms very seriously in the emergency department. Teaching the community about symptoms of stroke and the need for rapid evaluation is vital to improved patient outcomes.
Our patient survived and was able to return to Urbana Hospital in a “swing bed” program to undergo rehabilitation. Stroke is the fifth cause of death in the USA and 80 percent of strokes are preventable. There are seven simple things that you can do to reduce your risk of stroke. Keep your blood pressure controlled, eat healthy, get physically active, lose excess weight, lower cholesterol, reduce sugar and don’t smoke. See your family physician for preventive health screening. If you or your loved one show signs of stroke as noted in the FAST outline – droopy face, arm weakness and slurred speech, get to a hospital right away.
Dr. Paul A. Willette is a residency trained, board certified emergency medicine specialist with 27 years of experience. He is a clinical professor at Ohio University and works for US-Acute Care Solutions at Mercy Health.