Patients who are wheeled into Upstate University Hospital’s emergency department suffering from stroke are likely to receive acute treatment and rehabilitative care under the same roof, followed by the same ensemble of providers.
The hospital, the first designated stroke center in Central New York, features the region’s only specialized neuroscience and rehabilitation floors, with three levels of specialized nursing care. The neurologists, neurosurgeons and emergency physicians train students and conduct research that improves our understanding of how the brain works and how best to treat stroke. But they are always on call to care for patients with stroke.
Since becoming a stroke center, Upstate has also taken care of hundreds of complicated stroke patients who were too sick to be cared for at other hospitals in Central New York.
The hospital’s stroke team works together to determine what treatment is best for each individual patient.
When paramedics report a possible stroke patient, the team is summoned to the emergency department. This includes an emergency physician, a neurologist, a stroke coordinator and emergency department nurses. In addition, the nursing supervisor alerts the pharmacy, laboratory and radiology departments.
In the ED
Blood tests are done as soon as the patient arrives, and a doctor conducts a neurological exam. A variety of imaging tests may be used in the diagnosis, along with blood flow measurements and tests to detect clots. The staff also assembles a medical history.
Ischemic strokes — those caused by clots — may be treated with an intravenous clot-busting medication, but sometimes, the blood clot is too big or the patient can not be given the medication because of other medical concerns. Fortunately, Upstate has specialists such as Amar Swarnkar, MD who can take the clot out using special catheters inserted in the patient’s groin.
The treatment of a hemorrhagic stroke — caused by a bleed — depends on its location and severity. Sometimes it is managed with medications to carefully control blood pressure, says Gene Latorre, MD. Other times, surgery is indicated. Surgeons may place clips at the base of the aneurysm, or they may place platinum micro-coils inside the vessel to act as a mechanical barrier to blood flow.
Hypothermia is employed in the treatment of some patients. Others may undergo brain tissue oxygen monitoring.
In the ICU
Upstate has a 14-bed neuroscience intensive care unit, plus 35 additional beds devoted to patients with neurological problems on other units. Patients are transferred as their conditions improve, but nurses with special training in the care of neurological patients continue to monitor and implement the plan or care for each patient.
Physical, occupational and speech therapists and a psychiatrist evaluate each stroke patient within 24 hours of admission, and rehabilitative therapy begins almost immediately.
Upstate offers an inpatient rehabilitative unit, where patients may be moved once they are able to handle three hours per day of therapy.
Rehabilitative counselors offer support for patients in returning to work or school.
The outcome of acute stroke care is tightly connected to how quickly appropriate emergency treatment is initiated, and the quality of the overall management provided. At Upstate, it is not unusual for patients with severe stroke to go home after three days, with minimal or no evidence of lasting stroke effects.