Quick decisive action in the hours right after there are signs of a stroke is critical to a patient’s long-term recovery.
When my stroke happened on Oct. 4, 2024, the call to 911 was made immediately and an ambulance got me to the emergency room (ER) at The Queen’s Medical Center-Punchbowl within an hour of making the call.
There are a lot of steps to treating a stroke patient in a short period of time. Here’s what to expect.
First things first
Calling 911 immediately at the first signs of a stroke improves chances for a better outcome, says Angel Echols, APRN, ER neurovascular nurse, who was my stroke nurse practitioner when I arrived at Queen’s.
Angel Echols, APRN
Arrival and diagnosis
The scene can look chaotic in the first 10 minutes of reaching the ER. “You’ve got ER nurses who are getting your vital signs, getting blood, getting labs, getting a weight,” Echols says.
She explains that there are six or seven people on average involved in the acute phase in the first 10 minutes, including an ER nurse or two, an ER tech, an ER physician, a neurologist, a stroke nurse practitioner, and eventually the surgeon. “They all help to determine what kind of work they’re going to do,” she says. “The neurologist and the stroke nurse practitioner are examining you and trying to figure out a couple things, like, does this look like a stroke? There are plenty of things that mimic a stroke.”
Within the first 10 to 15 minutes, the patient goes directly into a computed tomography (CT) or CAT scan.
“A CAT scan will show us if there’s some early ischemic changes, or early stroke and other things we’re looking for, like bleeding,” Echols says. “Bleeding would be a contraindication for giving the clot busting medicine, Tenecteplase.”
A CT scanner is used in those chaotic first minutes.
Making the treatment decision
For me, they saw some early ischemic changes, but no bleeding. “So, we went ahead and gave that Tenecteplase in the CT scanner while you were still on the table,” Echols says. “The next set of images is actually a CT angiogram, which is done with contrast, and that’s looking at the blood vessels, not just the brain tissue, to see if there’s a large vessel occlusion, meaning a big blood vessel that’s blocked off, that needs to be opened up or revascularized in order to prevent permanent damage.”
In my case, there was a large vessel occlusion, and it was determined that I was a good candidate for thrombectomy, which is a surgical procedure used to remove a blood clot, a thrombus, from an artery or vein.
Luckily, I was in a good time window. “There was a minimal occlusion, meaning it wasn’t too far downstream for them to go in to remove the blockage, and there wasn’t a large area of stroke already,” says Echols.
Post-treatment monitoring
Once the treatment is complete, the patient typically heads to the intensive care unit or ICU with frequent monitoring of vital signs (blood pressure, heart rate, respiratory rate) and neuro checks.
“An assessment is done every 15 minutes for the first hour,” Echols says. “They’ll continue to monitor consistently with neuro checks and testing strength to make sure none of your stroke symptoms are worse.”
Family support
Family members or emergency contacts listed in the medical records can provide important information that helps in the treatment, such as when the patient was last known to be in normal health.
“My ideal scenario is talking to the family even before the patient gets to the emergency room,” says Echols. “I can also set the expectation of what we’re going to do and what my suspicions are before the procedure.”
It helps when family members are there at the hospital, she says. “Often, the patient cannot speak for themselves, whether their speech is so slurred or they have severe communication issues, so family is very important.”
After the procedure is complete, the family is notified and given an update on how the procedure went. Once the patient is stabilized in the ICU, the family is welcome to visit, Echols says. “There are plenty of studies that have shown that stroke patients benefit from having families at bedside.”
I remember only a little bit of those chaotic hours after arriving at Queen’s. Reading through my medical report now makes me even more appreciative of all of Angel and the ER staff who brought me through it. And my wife’s quick call to 911 to put everything in motion.
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