In theory, the staff at any hospital emergency room should be able to care for a patient who is having a stroke. In reality, the stroke team at Upstate University Hospital has the most experience and most advanced equipment for treating patients in the Central New York region with any type of stroke.
The stroke team — an emergency physician, a neurologist, a stroke coordinator and emergency nurses — assembles as soon as paramedics alert the emergency department they believe their patient has had a stroke. In addition, the nursing supervisor is alerted, along with the pharmacy, laboratory and radiology departments.
The goal is not only to save a life, but also to save brain cells.
Patients who arrive by ambulance often have one IV in place for medication, so nurses insert a second so blood can be drawn.
One of the first tests measures blood sugar, since symptoms of hypoglycemia can mimic those of stroke. A doctor will conduct a neurological exam that tests different areas of the brain (consciousness, speech and language, memory, eye movement, reflexes, sensation and walking and balance). An magnetic resonance imaging scan can reveal narrowing or blockages of blood vessels in the brain. Other tests may be used to measure blood flow and detect clots.
A medical history is crucial: Has the patient had surgery recently? Taken blood thinners? Had elevated blood pressure or intestinal bleeding?
Interventions for ischemic strokes may include the use of tissue plasminogen Activator, which must be administered within three hours of the onset of a stroke. In some cases, concentrated doses of tpA can be placed at the site of the stroke within the brain. Upstate also offers a clot-retrieval procedure in which an interventional neuroradiologist threads a stent to the clot within the brain, then captures the clot for removal from the body. Both procedures are time-sensitive and may not be options for patients who have been slow to seek care — or who did not seek care at Upstate.
A smaller percentage of strokes are the hemorrhagic kind. Depending on the location and severity of the aneurysm, surgeons at Upstate may be able to place a clip at the base of the aneurysm so blood cannot escape. Or, they may elect to treat the aneurysm from inside the blood vessel, by placing platinum micro-coils that act as a barrier to blood flow.
Some patients undergo a cooling process during treatment of their brain injuries. In some patients, staff monitor the oxygen level of brain tissue.
As their conditions improve, patients may be transferred to other units, including one with 35 beds devoted to patients with neurological problems. Nurses and therapists who specialize in stroke care are stationed on these floors.
Stroke Inpatient Care
Upstate features the region’s only specialized neuroscience and rehabilitative floors. Within 24 hours of a stroke patient’s admission to the hospital, physical, occupational and speech therapists and a psychiatrist evaluate to determine the needs of the patient. Rehabilitative therapy begins almost immediately, depending on the severity of the stroke. Upstate has an inpatient rehabilitation unit, where patients may be moved when they are able to handle three hours per day of therapy.
People who have had ischemic strokes stay an average of seven days, while those who have had hemorrhagic strokes stay an average of 20 days.
The stroke team at Upstate trains the next generation of doctors in stroke care, and is involved in research that may advance stroke treatment or help prevent stroke.
Read the stories of some Central New York stroke survivors:
Do you have a stroke risk factor?
Listen to an interview about emergency stroke care on HealthLink on Air