Time is Critically Important
2019-03-04
A family member noticed, and called 9-1-1 for the ambulance. “When the ambulance arrived, I was able to walk right in, and lay myself down onto the stretcher,” he explains. On his way to the Winchester District and Memorial Hospital (WDMH) is when things got worse and it wasn’t long after his arrival at WDMH that Mr. McMillan was en route again to Cornwall Community Hospital (CCH), one of 3 designated Telestroke sites in the Champlain Local Health Integration Network (LHIN).
A stroke causes brain cells to die due to lack of oxygen, when a clot stops blood and oxygen from flowing to the brain or when the artery to the brain bursts open. When a patient arrives at CCH and is suspected of having a stroke like Mr. McMillan, the assessing Emergency Department physician and Nurse, determine the need to page “Acute Stroke” overhead. Rosa Awad Maglieri, Clinical Nurse Educator in the Emergency Department says, “time is brain.” This popular stroke slogan emphasizes that time is critically important when treating stroke and the longer a patient goes without intervention; the more brain cells are damaged or die.
Paging “Acute Stroke” overhead triggers staff in CT to finish with their current patient and allow the stroke patient to jump the queue of other CT patients. The Paramedics bring the patient to the CT department and offload him directly onto the CT scanner table, in order to save time. This overhead page also prompts the laboratory staff to report to the Emergency Department to retrieve blood from the stroke patient, as quickly as possible.
Meanwhile, the Ontario Telehealth Network (OTN) is set up for a consultation with a neurologist (a doctor who specializes in stroke). Once the patient returns to the Emergency Department, CT images are uploaded to enable viewing from anywhere in the province. “As an Emergency Department nurse we witness the detrimental physical and cognitive effects a stroke can have on a patient when not treated in a timely manner. It brings us great satisfaction to deliver the appropriate timely treatment impacting the patient’s recovery and in fact, his quality of life," expresses Chase Horvath the nurse in the Emergency Department on the day Mr. McMillan came in.
In Mr. McMillan’s case, both the Emergency Department physician, and the neurologist via OTN saw the clot in the CT images and discussed his eligibility for the “clot busting” medication, as well as Endovascular Therapy; the procedure to remove the clot. The physician consulted with a neurosurgeon at the Ottawa Hospital at the Civic Campus and after receiving the clot dissolving medication, Mr. McMillan was transferred out for the emergency procedure. The best timeframe for the clot removal procedure to occur is within 6 hours from the onset of stroke symptoms.
“I don’t remember anything until I woke up in Ottawa, after all the procedures were over” says Phillip. He was transferred back to Cornwall and discharged home a week later, with no physical or cognitive problems. Mr. McMillan has also been able to return to work.
“We’ve come such a long way in the treatment of stroke, and cases like these are great to hear about,” says Heather Arthur, VP of Patient Services and Chief Nursing Officer. Remember the acronym FAST (
Face drooping,
Arms able to lift only one,
Speech slurred or jumbled,
Time to call 9-1-1) to recognize the symptoms of stroke.