Fast Action Saves Lives
New Stroke Center Streamlines Treatment for Stroke Patients

Each year approximately 700,000 people suffer a stroke in the United States andmore than 163,000 die, making stroke the third leading cause of death.* For those who survive, stroke is a leading cause of long-term disability.

There's reason for hope, however. When recognized and treated quickly, the damage from a stroke can be greatly

reduced – even eliminated in some cases. But the window

of opportunity for treatment of the most common type of

stroke is small – just three hours from the onset of symptoms – making it vitally important that people learn to recognize the symptoms and call 911 if they suspect a stroke.

For those who suffer disabilities from a stroke, rehabilitation can help them regain the skills they need to live full and independent lives.

Understanding strokes
Strokes are often known as "brain attacks." There are two main types. The most common, accounting for more than 85 percent of all strokes, is an ischemic (is-KEY-mick) stroke, caused by a blockage of the blood supply to the brain due to a clogged artery. The second type, a hemorrhagic stroke, occurs when a blood vessel breaks and bleeds into the brain.

In both kinds, the brain is deprived of the blood and oxygen it needs, and nerve cells in the affected area die within minutes. That's where the similarities end, however; treatments differ greatly depending on the type of attack.

Each year, about 50,000 people also experience "mini-strokes" called transient ischemic attacks (TIAs) that appear like a stroke, but resolve on their own within minutes or an hour. A TIA is considered a warning that the person is at risk for a more serious and debilitating stroke. People with any stroke symptoms should call 911.

New Stroke Center
New at Holland Hospital this year is the establishment of a Stroke Center, which signifies that the hospital has developed and follows clearly defined protocols for consistent and efficient treatment of stroke patients. Research shows that hospitals with stroke centers have improved treatment, better patient outcomes and reduced care costs.

"We've streamlined the procedure so that all the pieces are in place ahead of time," states neurologist Paul Ariagno, MD. "When a stroke patient is brought in, there’s no second guessing and no delay in treatment."

Even before a stroke patient arrives in the Emergency Department (ED), the "stroke team" is in motion. Alerted by paramedics that a possible stroke patient is on the way, the ED issues a "Code Z – Stroke" over the hospital paging system to immediately assemble the team, which consists of an emergency physician, RNs, and imaging, radiology and lab specialists. A neurologist is also notified.

Upon arrival in the ED, the patient is evaluated using the National Institutes of Health Stroke Scale, which tests for neurological deficits that signify a stroke (this test is then repeated throughout the patient's hospital stay). Joe Bonello, RN, clinical manager of the ED, explains what happens next.

"The initial focus for a stroke patient is to get a head CT scan to determine which type of stroke we're dealing with," says Bonello. "It's critically important to know because the treatment for an ischemic stroke is to give a thrombolytic (a medication that dissolves blood clots) within three hours of the onset of symptoms."

If the CT scan shows that there is no intracranial bleeding – ruling out a hemorrhagic stroke – and the patient is not at risk of bleeding, the thrombolytic t-PA (for tissue plasminogen activator) is administered. It dissolves the clot and restores blood flow to the brain. In the rare case of a hemorrhagic stroke, a Holland Hospital neurosurgeon is alerted.

A nationwide clinical trial sponsored by the National Institute of Neurological Disorders and Stroke found that ischemic stroke patients treated with a t-PA within the three-hour therapeutic window were 33 percent more likely to have minimal or no disability after three months. Unfortunately, many patients eligible for t-PA do not receive it due to patients' delay in getting to the hospital (due to lack of knowledge of stroke symptoms), and failure of hospitals to rapidly evaluate stroke patients.

To ensure that stroke patients at Holland Hospital are treated quickly and efficiently, ED and Radiology staff have teamed up to meet the national goal of completing the diagnostic CT within 20 minutes of a patient's arrival, notes Bonello.

In 2005, Holland Hospital treated 146 stroke patients; that number is projected to rise by 5 percent each year as the population ages. Typically, patients are admitted to the hospital for several days for monitoring and assessment based on their medical history.

"Every case is different, and we tailor the care to the patient," explains Dr. Ariagno.

If rehabilitation is needed, they may be referred to Holland Hospital's Neuro Rehab program (Click here to learn more).

"Miracle" Recovery

Brad Horton in downtown Holland, near where he was driving when he suffered a stroke.

For Brad Horton, a training manager for Haworth Inc., the brain attack came out of the blue last November. Horton was driving in downtown Holland with several coworkers when he was suddenly "blasted" by an intense headache and his vision began to fragment, forcing him to pull over and let one of his coworkers drive. "It was like someone put a kaleidoscope in front of my eyes," recalls the Holland resident. Only 48 years old and in good health, it didn’t occur to him that he was experiencing classic symptoms of a stroke. Within minutes, he passed out. Fortunately, his coworkers took fast action that likely saved his life: they called 911. Horton was taken by ambulance to Holland Hospital. After an immediate evaluation and CT scan of his brain, he was diagnosed with an ischemic stroke and treated with the clot-buster t-PA. He awoke in the Intensive Care Unit that evening and left the hospital three days later, with no lasting effects. He credits his current health to "a series of miracles" – including the skilled care of hospital staff.

Home>