April 21, 2014
Specialist prescribes clotbuster and saves millions of brain cells
Neurologist Victor Zach, MD, demonstrates the telerobot he used to coordinate the stroke alert for patient Frank Fest. The telerobot spans the miles between patient and specialist.
Frank Fest, 82, noticed "things weren't right" as he prepared to compete in the National Championship of Cowboy Action Shooting at the Ben Avery Shooting Facility. A friend drove him to the nearby Sonoran Health and Emergency Center off Interstate 17 near Carefree Highway.
Emergency physician Amy Axberg, MD, observed that he had a facial droop, was losing control of his right side, and was having trouble speaking. She raised a stroke alert.
That's when the on-call stroke team at John C. Lincoln's award-winning Stroke Center went into action.
Victor Zach, MD, a board-certified vascular neurologist and neuro-intensivist, read the blood tests and X-rays and used an InTouch Health telerobot to evaluate Frank within minutes of his arrival at the Sonoran Center. The only robot approved by the FDA, it won Best in Show at the Consumer Electronics Show in 2013.
Dr. Zach coordinated the stroke alert via the robot, allowing Frank to receive the clot-busting drug Alteplase, a tissue plasminogen activator (tPA). It restored blood flow to his brain within 42 minutes of arrival.
Diagnosing Stroke F.A.S.T.
Use the acronym F.A.S.T. to remember the warning signs of a stroke:
Face: Ask the person to smile. Does one side of the face droop?
Arms: Ask the person to raise both arms. Does one arm drift downward?
Speech: Ask the person to repeat a simple phrase. Is his/her speech slurred or strange?
Time: If you observe any of these signs, call 9-1-1 immediately.
Frank then was transferred to the neuro-ICU at John C. Lincoln North Mountain Hospital. "I was in such good shape that I left the ICU the next day, Thursday," he said later. "On Friday, I was on the airplane going home to California. Nobody believes that I could have done that." The retired aeronautic engineer and former marathon runner lives near San Diego.
Tiny Percentage Receive tPA
The most common kind of stroke – ischemic – can be treated with tPA. Only 1 to 2 percent of eligible patients, out of 750,000 patients annually, receive it. That's due to the less than three-hour window of opportunity to administer tPA and the lack of specialists who can quickly prescribe the drug, Dr. Zach said.
A hemorrhagic stroke is caused by a blood vessel that breaks and bleeds into the brain and has a higher mortality rate.
Both kinds of stroke are the leading cause of adult disability. John C. Lincoln Hospitals are certified as Primary Stroke Centers by DNV Healthcare, showing they demonstrate better outcomes in stroke care. The Sonoran Center falls under the umbrella of John C. Lincoln Deer Valley Hospital's certification.
While at the Sonoran Center, Frank remembers "a doctor on the TV screen talking." Within an hour after the medication, the Sonoran staff noticed that Frank's speech and weakness improved.
"The next day, he didn't feel quite like himself, but it was a minor thing, and his facial droop had straightened," said Dr. Zach, one of the state's few neuro-intensivists. Admission to a neurological/neurosurgical ICU led by a neuro-intensivist has been associated with improved stroke outcomes, lower mortality rates and a shorter length of stay.
Two Million Cells a Minute
Easy access to the Sonoran Center I-17 also helped Frank. During a stroke, every minute costs about 2 million brain cells.
Victor Zach, MD, visits with Frank Fest in the neuro-ICU at John C. Lincoln North Mountain Hospital.
"We have billions of brain cells, but to lose 2 million a minute is a huge amount of cells," Dr. Zach said. "These are valuable memories and functions that will not be recovered quickly or, for a lot of people, at all. If he had to drive down to Deer Valley or North Mountain Hospital, that would have taken another 40 million to 90 million neurons, and the deficits would not be gone today."
Although he doesn't feel 100 percent normal yet, Frank said a couple friends who have had strokes, "are not in very good shape because it was too long before they got the tPA." He's also glad he was in Phoenix. "It would have taken longer to get the clotbuster at home because of time/distance to the hospital."
Learn more about stroke care at JCL.com/neuro.
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