Stroke Awareness - Snoqualmie Valley Hospit ... Stroke Awareness . What is a stroke? Stroke can...

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Transcript of Stroke Awareness - Snoqualmie Valley Hospit ... Stroke Awareness . What is a stroke? Stroke can...

  • Presented by: Duane Anderson, MD

    Snoqualmie Valley Hospital

    Emergency Department Medical Director

    Stroke Awareness

  • What is a stroke?

    Stroke can happen to anyone.

    Stroke is the fourth leading cause of death among Americans, and about 800,000 people in the U.S. have a stroke each year, according to the Centers for Disease Control and Prevention.

    http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj5_Lfx9tfMAhVMx2MKHeyuDOkQjRwIBw&url=http://www.medscape.com/viewarticle/847708&psig=AFQjCNHhJH0VDp-eWUBUWtH9Cd-cgFaszw&ust=1463258920492936

  • Posterior Brain

    Circulation

    • Vertebral • Anterior Spinal • Posterior Spinal • Posterior Inferior

    Cerebellar

    • Basilar • Anterior Inferior

    Cerebellar • Superior Cerebellar

    • Posterior Cerebral

  • Hemorrhagic and

    Ischemic Stroke

    https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiDotLW-9fMAhVT32MKHaOsB-AQjRwIBw&url=https://whatsupatupstate.wordpress.com/2014/05/09/stroke-survivor-was-a-patient-after-52-years-of-public-service/&psig=AFQjCNFxvqu2CtjXKOJnjjSmNIBpucbhdA&ust=1463260196144595

  • Hemorrhagic Stroke

    Some strokes are due to a rupture of a blood vessel in the brain’s circulation, this is hemorrhagic.

    http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj7r-mq_tfMAhUY3WMKHTPODDAQjRwIBw&url=http://medmovie.com/topic/ahaw_0088a/&psig=AFQjCNHSzZ-9TlfW6Hs-mSi2C-yex_2LmQ&ust=1463260976957711

  • Ischemic Stroke

    Most strokes are from a narrowing of arteries that give the brain less or no blood flow thus having brain cell damage or death. This is ischemic stroke.

    http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=&url=http://dailyhealthpost.com/this-is-what-brain-stroke-survivor-looks-like/&psig=AFQjCNHhJH0VDp-eWUBUWtH9Cd-cgFaszw&ust=1463258920492936

  • Stroke Symptoms

    http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjB4dqWgdjMAhVO0GMKHefLAX4QjRwIBw&url=http://www.stroke.org/stroke-resources/resource-library/symptoms-poster&bvm=bv.122129774,d.cGc&psig=AFQjCNFiG0q3zZP8pRn6tMH5rfb2BwpuWA&ust=1463261788741902

  • Spot a Stroke: Act FAST

    ACE: Ask the person to smile. Is one side drooping? Do they have

    vision problems? F

    A

    S

    T

    RMS: Ask the person to raise both arms. Does one arm drift downward?

    PEECH: As the person to repeat a phrase. Is speech slurred or garbled?

    IME: If the person shows any of these signs, call 911 immediately.

  • Stroke Risk Factors

    • High Blood Pressure

    • Heart Disease

    • High Cholesterol

    • Diabetes

    • Obesity

    • Smoking

    • Current history of blood clots

    • Over 40 years of age

  • Stroke is an emergency

    What do you do if you or someone you are with is having symptoms?

    •Call 911 •Go to the nearest Emergency Room

  • ER treatments

    What can be done for patients having stroke symptoms?

    • Emergency treatment of blood pressure to lower it

    • Emergency assessment and stabilization

    • Emergent diagnostic studies Head CT

    • Emergent collaboration with a Neurologist

    • Possibly a brain cell saving medication to dissolve the clot

    • Possibly an intervention by a Neurologist to remove the clot

  • Imaging – CT Scan

    What we see on a Head CT during stroke

  • Clot-busting drug

    tPA / Alteplase • Converts a clot to

    free flowing blood

    • Can be used in approximately 30% of patients with stroke symptoms

    • Can be used if the symptoms are less than 3 hours old.

    http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj-ypeejdjMAhUY3WMKHTPODDAQjRwIBw&url=http://www.vitaminsestore.com/stroke-causes-symptoms-risk-factors-and-treatments/&bvm=bv.122129774,d.cGc&psig=AFQjCNGqgzBtL4zd2s5vqM380V1K3Y-Thw&ust=1463264855199905

  • Symptoms After Stroke

    What causes some people to have different symptoms than others after stroke?

     Paralysis or loss of muscle

    movement

     Difficulty talking or swallowing

     Emotional problems

     Pain

     Memory loss or thinking

    difficulties

     Changes in behavior and

    self-care ability

    These symptoms include:

  • Functional areas of

    the brain

    This illustration shows the brain’s functional areas. After a stroke, deficits in function depend on which cerebral artery is affected.

    http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiwwYTP0d_MAhUQx2MKHfSlBEMQjRwIBw&url=http://www.highlands.edu/academics/divisions/scipe/biology/faculty/harnden/2121/notes/cns.htm&bvm=bv.122129774,d.cGc&psig=AFQjCNGpX_b9yvOFbCMXOkSZyfS2XhGqJg&ust=1463523839913381

  • Motor and Auditory

    Cortex

    • Movement loss

    • Tremors

    • Difficulty swallowing

    • Difficulty smiling

    • Attention deficit

    • Memory loss

    • Language problems

    https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjyv4nD0N_MAhUQ2GMKHfKwA5kQjRwIBw&url=https://www.studyblue.com/notes/note/n/nervous-system/deck/16139957&psig=AFQjCNHEtd_luuq_iXW-zuVWfjJEArE5eQ&ust=1463523229286250

  • Sensory and

    Visual Cortex

    Occipital-Parietal

    • Vision loss

    • Confusion

    • Weak limbs

    • Dizzy

    http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjoxKDXzt_MAhVC6mMKHWk4DYkQjRwIBw&url=http://multiple-sclerosis-research.blogspot.com/2015/01/education-whats-mri.html&bvm=bv.122129774,d.cGc&psig=AFQjCNEBQAyLYiMh1AuW7ockuFB-CLpp9Q&ust=1463523114313174

  • Stroke Tests

    What tests are done to determine a patient’s cause of stroke?

    • Carotid Artery blockage or stenosis: Doppler

    • Lipid Blood test

    • Echocardiogram: To look for clots or valve problems that might pre-dispose

    • Cardiac monitor- no atrial fibrillation

    • CT of abdomen and pelvis: for adenopathy or obvious source of malignancy.

  • Stroke Care

    Discharge Success

    • There are now more patients going directly home from the hospital

    • Fewer days spent in a Nursing Home

    • Neurology maintains an optimistic outcome for the patient

    • There are Experts in post stroke rehab such as SVH

  • SVH is a Level III Stroke

    Center of Care

    • Washington State DOH Designation

    • Established Protocols and meet performance requirements such as:

    • Emergent Head CT

    • tPA medication

    • Trained staff

    • Collaboration with Overlake Hospital Medical Center Level II for immediate Neurology Consult and transfer

  • Stroke Prevention

    • Blood Pressure Control

    • Cholesterol and Lipid Control

    • Keep Diabetes in Control

    • Diet Control

    • Take medications prescribed for Atrial Fibrillation control

    • Exercise regularly

    http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjhise61N_MAhUM92MKHaLYDhwQjRwIBw&url=http://blog.mountainview-hospital.com/blog/2011/december/managing-stroke-risk-factors.aspx&bvm=bv.122129774,d.cGc&psig=AFQjCNH2Eil9Xju8z87just6lfKOHvsBOA&ust=1463524679163523

  • Questions?