Celeste Rhys, nurse manager, Emergency Department at McKee Medical Center
family at ease.” Typically the nurse stays in the room to assist the remote physician with further assessment of the patient. Using this technology, the stroke neurologist can zoom the camera in or out to see patient reactions and can interact with the patient through the audio channel. “It’s like having that doctor in the room,” says Rhys. At both McKee and NCMC, all emergency department personnel understand that whenever a patient presents with stroke-like symptoms, time is of the essence. Dr. Ledges says, “Most stroke patients are transported to emergency rooms by ambulance. If a stroke is suspected, paramedics will issue a stroke alert.” The alert is made based on specific assessments performed en route, such as difficulty speaking, facial droop and arm or leg weakness on one side. Also, paramedics and triage staff at emergency rooms must try to determine the time of symptom onset. There is a critical window of 4.5 hours where thrombolytic therapy can significantly reduce the effects of blood clots. However, giving thrombolytics beyond that time frame can result in more harm because as brain tissue dies the likelihood for bleeding increases. “It’s a moving target. We have to know when symptoms first started,” explains Dr. Ledges. Hence, the need for speed. “If the patient is seen within the 4.5 hour window, the sooner you give the drug, the better the outcome. Every effort is made to expedite
patients in this situation. At hour one you can have a better outcome than at hour four. However if you don’t know when symptoms started, you can’t give the medicine.” Consequently, a stroke alert by paramedics or any hospital staff triggers a cascade of immediate responses. Doctors and nurses at the emergency service stand by to meet the ambulance, the imaging facility is cleared to receive the patient, and the Telestroke robot is at hand. The patient is taken immediately for a CT scan, an imaging test in which the brain is X-rayed from different angles. “CT scans are a primary method of determining whether a stroke is ischemic or hemorrhagic,” states the Internet Stroke Center website. Dr. Ledges continues, “If a CT scan doesn’t show bleeding, we immediately activate the Telestroke service; the nurse rolls in the Telestroke camera (robot) and a neurologist from Swedish Medical Center in Denver will be on hand to conduct an examination remotely.” The remote neurologist also reviews the CT scan and confirms the results. In the rare instance of a hemorrhagic stroke, the patient may be recommended for immediate air transport to Swedish. Rhys notes, “Brain bleeds require highly specialized neurosurgical techniques, many of which can be performed at Swedish. Again, time is an essential factor. And if transfer is required it must be done before too much of the brain tissue is damaged. The sooner they can get it diagnosed, and if need be, the sooner we get them shipped, that’s time in their favor.” More commonly, the stroke patient is admitted to the intensive care unit, and, if thrombolytics are indicated, local physicians administer them and the patient will be cared for by the neurologist in their own community. Banner Health has neurologists on staff at both hospitals to provide continuing care for the patients in the hospital and after they are discharged. Dr. Ledges concludes, “The big advantage of Telestroke is having two physicians in different specialties (ER and neurology) evaluating the patient in real time, weighing in on the decision to include or exclude for thrombolytics… coming together to determine the best care for this person.” For Celeste Rhys, enthusiasm for the Telestroke program is more than professional; it’s personal. Her mother suffered a stroke seven years ago. Rhys says, “I truly believe that had this technology been available, she would still be with us. That’s why it’s so dear to me. I’m not bitter, I’m just excited that we’re going to be able to give this to other people so that they don’t have to go through what my family went through.”
Elissa J. Tivona is a writer and international educator living in Fort Collins. She resides as the Peace Correspondent at www.thepeacecorrespondent.com
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Lydia’s STYLE Magazine