Download presentation
Presentation is loading. Please wait.
Published byAmice Priscilla Lane Modified over 7 years ago
1
Melissa Duchene, rn-stroke program administrator
Trends in stroke care Melissa Duchene, rn-stroke program administrator Jan baker-apn-bc
2
statistics 5th leading cause of death in the united states
80% of strokes can be prevented About 795,000 people have a stroke every year Every 40 seconds someone in the us is having a stroke 37% of all Americans can not accurately identify even one warning sign of a stroke Stroke is the leading cause of serious long term disability with total cost estimated at over 34 billion Stroke kills almost 130,000 Americans every year ( 1out of 20 deaths) Source: American Heart association: heart disease and stroke statistics-2015 update
3
Two types of stroke Ischemic (Blockage) 87%
Caused by a blockage in the blood vessels to The brain
4
Ischemic strokes: Thrombus: a blood clot forms at a fatty deposit Source: American Heart association Embolus: a traveling particle, usually a blood clot, that gets stuck in a blood vessel.
5
Two types of strokes cont.
Hemorrhagic (Bleeding) 13% Caused by a burst or leaking blood vessels in the brain
6
Hemorrhagic stroke: Aneurysms: ballooning of a weakened spot of a blood vessel Arteriovenous malformations: a cluster of abnormal blood vessels ( avms)
7
Two types of hemorrhagic strokes
Intraparenchymal (within the brain tissue, also know as intracerebral) Hemorrhage: A vessel bursts and leaks blood into the tissue of the brain Subarachnoid Hemorrhage: this occurs when a vessel near the surface of the brain bursts and leaks blood into the outside portion of the brain, between the skull and the brain
8
tia transient ischemic attack
Blood flow to arteries is briefly blocked symptoms are temporary A Tia is a Warning that a stroke may happen You are 9.5 times more likely to have a stroke if you have had a tia A tia is a medical emergency Patients that have had a tia fail to report them to healthcare providers Approximately 200,000 to 500,000 tia’s are reported in the us EVERY YEAR
9
Why is the Ems role so important ?
TREATMENT STARTS RIGHT AWAY Rapid transport to nearest stroke center PRE-NOTIFICATION TO THE HOSPITAL PATIENT ARRIVES TO ED faster FOR QUICKER TREATMENT TRIAGE TO STROKE CENTERS FOR APPROPRIATE TREATMENT Ems can bypass hospital without stroke resources Obtain blood glucose level Establish a last known well time/symptom onset –very important Source :genentech stroke4ems
10
Three types of stroke hospitals
1-Stroke ready 2-Primary stroke center 3-Comprehensive stroke center Source: the joint commission; facts about joint commission stroke certification
11
1-Stroke ready Provide timely stroke care but can not meet all the needs to be certified( drip & ship) have 24/7 access to stroke expertise (in person or telemedicine) Have transfer agreements with other facilities established Collect and submit data Have stroke protocols Qualified medical staff that are trained in stroke care Diagnostic imaging/laboratory testing capabilities
12
2-primary stroke center
stabilize and treat acute stroke patient use standardized methods of delivering care Administer IV thrombolytics (tpa) if needed demonstrate applications of and compliance with clinical practice guidelines Stroke data and process improvements Neurosurgical expertise available protocols
13
3-comprehensive stroke center
Significant resources in infrastructure, staff and training to provide state- of- the -art care complex stroke patients coils and stents to the brain and specialized staff available advanced intervention capabilities; such as coiling, surgical clipping and iv tpa continuous research plan Source: the joint commission.org 2016
14
Treatment for stroke patients
15
Stroke treatments IV tPA IA (intra-arterial) tpa Thrombectomy:
penumbra-suction like device solitaire-stent retriever
16
Iv tpa (alteplase) Tissue plasminogen activator
Gold standard for treatment Weight based medication Works by dissolving the clot in return improving blood flow Given with onset of symptoms of 0-3hours ( may give up to 4.5 hours in some cases) Is currently the only thrombolytic
17
Intra –arterial tpa This is given is smaller doses
Patients that do not qualify for iv tpa Given in cath lab or ir suite Accessed through the groin similar to cardiac catheterization Given up to 6 hours of symptom onset
18
endovascular procedures
Mechanical thrombectomy – trained physicians remove the blood clot by deploying a stent retriever device to the area of blockage in the brain. The physicians thread the device through an artery in your groin with a catheter, the stent opens up and grabs the clot. The clot retrieving stent is then removed. They can also use a suction device.
19
endovascular procedures
Solitaire: stent retrieval device used to remove clot Penumbra- Suction like device used to remove clot.
20
telemedicine This is primarily used in rural hospitals where they have limited neuro expertise available Use smart phones, computers, ipads and digital video to connect to physicians Uses teleconferencing to connect stroke patients with neurologists that are off site. Allowing them to examine and interpret brain scan results, there by helping to make treatment decisions
22
Risk factors Modifiable:
High Blood pressure Diabetes Smoking/alcohol usage Sedentary lifestyle Coronary artery disease Atrial fibrillation
23
Risk factor cont… Non-modifiable:
Age Gender Family history Previous stroke or tia race
24
Care expectations Hga1c level 48 hour telemetry monitoring
Lipid profile Tee Carotids Follow up ct/cta/mri/mra Npo until dysphagia screen Physical/occupational therapy consult Stroke education Hga1c level 48 hour telemetry monitoring
26
references www.heart.org/idc/groups/heartpublic/@wcm/@fda/documents/
(2016)
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.