April 24, 2015
MEDICAL UNIVERSITY of SOUTH CAROLINA
Vol. 33, No. 34
How to travel 161 miles in only six minutes By Mikie Hayes Public Relations
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or a man seemingly suffering a stroke, a community hospital situated in a town of only 6,701 residents would hardly seem like the epicenter of good stroke care. So when he is rushed to a small community hospital, with no neurologist on staff, 161 miles from the state’s premier stroke center at MUSC, it’s conceivable that his family might worry. But what they don’t know is that a specialized stroke care doctor will indeed be in the room with their loved one — in the room, that is, via an over–sized computer screen. Thanks to MUSC’s Tele Stroke network, his care will be overseen by a brain attack specialist. The ambulance arrives at the hospital. The 47–year–old patient is registered in the system. Three minutes later, at 1:29 p.m., MUSC is paged, doctors alerted. At 1:32 John Krainin, M.D., an MUSC Tele Stroke physician, logs into the network. He’s now on the case. “Six minutes,” said Christine Holmstedt, D.O., medical director of MUSC’s Clinical Stroke Services, who also received the stroke alert page and is watching the entire scene play out via her computer in the Clinical Science Building. “Try getting a specialist into the ED in six minutes. No way. That is one of the things that makes this program so remarkable.” A stroke, or “brain attack,” is caused either by a blood clot that cuts off the brain’s supply of blood and oxygen, which is referred to as an ischemic stroke, or by bleeding in the brain, which is called a hemorrhagic stroke.
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Tissue Plasminogen Activator (tPA), an intravenous clot-busting medicine, is the only FDA–approved acute stroke medication and considered standard of care for the treatment of acute ischemic stroke, but it has to be administered within a three-hour window of time from onset of stroke and only under very specific criteria. Holmstedt explained that tPA can dissolve a blood clot in the brain, “But,” she said, “it must be given very quickly – the quicker the medication is given, the better the outcome for patients. One uncommon complication is bleeding which is why some physicians are anxious to administer it without a neurologist, and why there is a very precise set of guidelines to ensure we are using it appropriately and as safely as possible.” With the camera focused on the patient, Krainin is able to perform a stroke scale and neurologic evaluation, review the CT scan and discuss treatment recommendations with the patient, patient’s family and ED physician in the community hospital. Holmstedt, too, is looking at the scan in her office. She says to colleague Ellen Debenham, R.N., program manager of the MUSC Tele Stroke and Tele Neurology programs, “He’s having a stroke. The left side of his face is drooping; see how the mustache is lower on the left side. He’s not moving his left arm or leg, but he’s pulling up his socks with his right hand.” After completing his neurologic evaluation and reviewing the CT scan, Krainin discusses his
Student Leadership MUSC students honored for extraordinary service.
photo and graphics provided
Dr. Christine Holmstedt sits in the parking lot of Orangeburg Regional Medical Center where she’s about to enter the hospital to conduct a telestroke training when she responds to a consult for a stroke patient coming into Toumey Medical Center in Sumter. MUSC’s Tele Stroke Network includes 18 sites across the Palmetto State which provides access to stroke experts at MUSC. The program, created in 2008, has conducted just over 5,700 stroke consults since that time.
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See Tele sTroke on page 3
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Gun Violence
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Town Hall Meetings
Students discuss gun violence as a global health issue in competition.
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Meet Cienna
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Student Professionalism