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Pilot TeleStroke program starts at Community Hospital
McCook, Nebraska -- A pilot TeleStroke program between Community Hospital and Great Plains Regional Medical Center in North Platte may have a positive impact on the outcome of stroke patients in the McCook area.
Telestroke is the use of telemedicine specifically for stroke care. The new trial program allows Dr. Jose Cardenas, a neurologist from North Platte to actually see and converse with a patient having a stroke in McCook using telemedicine, while the doctor is in North Platte. Viewing the patient is a benefit over a simple telephone consult. Using a remotely controlled camera, he can also collaborate with the emergency room physician and staff at Community Hospital, and discuss test results such as the patient's EKG, chest X-ray, lab tests, CT scan or MRI. The CT images may also be sent via the network connection and viewed by the neurologist to assist in treatment decision making.
"This is a very exciting project that has the potential for a very positive impact on the outcome of stroke patients in the McCook area, said GPRMC Stroke Coordinator Barbara Petersen. She added that if the trial project goes well with Community Hospital, the first critical access hospital to work with GPRMC, they want to expand the project to incorporate other rural hospitals. "At this time the consultation is limited to certain times and days of the week due to the fact the equipment is only available in Dr. Cardenas' office," Petersen said. "We hope to open up availability as technology allows and additional neurologists become available." The 2009 American Stroke Association (ASA) recommendations on telemedicine, support the use of telestroke as a means of providing stroke care in rural, remote, or underserved areas.
Community Hospital family medicine physicians, physician assistants and ER staff recently tested the telemedicine equipment which was installed the hospital's emergency room in February. During the test, they were in contact with Dr. Cardenas in North Platte.
"The anticipated benefit of TeleStroke is to assist ER physicians and providers to have an increased comfort level of evaluating and treating acute ischemic stroke patients and administering tPA, a blood clot dissolving drug, when indicated," Petersen said. "Similar projects have been conducted to provide neurology services for acute stroke via telemedicine in Arizona and Pennsylvania."
According to the National Stroke Association, there are approximately 750,000 ischemic strokes annually in the United States. One out of 15 deaths in the United States are due to stroke. Stroke is now the leading cause of long-term disability in the Unites States. At an annual cost of $58 billion dollars each year, stroke healthcare costs have become substantial.
Petersen explained that the challenge with stroke treatment is that it is extremely time sensitive. Two million brain cells die every minute during stroke, increasing risk of permanent brain damage, disability or death. Recognizing symptoms and acting fast to get medical attention can save a life and limit disabilities.
"IV tPA is the only FDA approved acute ischemic stroke thrombolytic agent. tPA is given to help dissolve the clot and restore blood flow to the brain tissue," she explained. She also said that if given promptly, IV tPA can help resolve or improve stroke symptoms. It is currently approved for acute ischemic strokes within the first three hours of stroke symptom onset. "There are protocols and criteria to treat acute ischemic stroke up to 4.5 hours with IV tPA as well, but this is not yet FDA approved," she added. "There are strict administration criteria for IV tPA administration as there is a risk of bleeding with its usage. This criteria causes many ER physicians and providers reluctance to take on the burden of treating patients with IV tPA without a consultation by a neurologist," Petersen said.
"We are very excited about adding TeleStroke services at Community Hospital and the additional support from Dr. Cardenas, said Darcie Johnson, R.N., BSN, Community Hospital Emergency Room Coordinator. She added though, "not everyone who has a stroke is eligible to receive tPA. Sometimes the risk of bleeding and complications outweigh the benefits of the drug," she said. "Only a medical provider can determine if a person who is having a stroke should receive tPA."
Jose Cardenas, M.D., neurologist and vascular neurologist, is board certified with the American Board of Psychiatry and Neurology. He is associated with Neurology Associates of Great Plains in North Platte. Dr. Cardenas specializes in treating headaches, strokes, Parkinson's disease and multiple sclerosis. He also sees patients at Community Hospital's Medical Specialists Center as a visiting specialist once a month.
ADDITIONAL STROKE INFORMATION
Public Stroke Prevention Guidelines
1. Know your blood pressure. If it is elevated, work with your doctor to keep it under control. High blood pressure is a leading cause of stroke. Have your blood pressure checked at least once each year--more often if you have a history of high blood pressure.
2. Find out if you have atrial fibrillation (AF). If you have AF, work with your doctor to manage it. Atrial fibrillation can cause blood to collect in the chambers of your heart. This blood can form clots and cause a stroke. Your doctor can detect AF by carefully checking your pulse.
3. If you smoke, stop. Smoking doubles the risk for stroke. If you stop smoking today, your risk for stroke will begin to decrease.
4. If you drink alcohol, do so in moderation. Drinking a glass of wine or beer or one drink each day may lower your risk for stroke (provided that there is no other medical reason you should avoid alcohol). Remember that alcohol is a drug - it can interact with other drugs you are taking, and alcohol is harmful if taken in large doses. If you don't drink, don't start.
5. Know your cholesterol number. If it is high, work with your doctor to control it. Lowering your cholesterol may reduce your stroke risk. High cholesterol can also indirectly increase stroke risk by putting you at greater risk of heart disease - an important stroke risk factor. Often times, high cholesterol can be controlled with diet and exercise; some individuals may require medication.
6. Control your diabetes. If you are diabetic, follow your doctor's recommendations carefully because diabetes puts you at an increased risk for stroke. Your doctor can prescribe a nutrition program, lifestyle changes and medicine that can help control your diabetes.
7. Include exercise in the activities you enjoy in your daily routine. A brisk walk, swim or other exercise activity for as little as 30 minutes a day can improve your health in many ways, and may reduce your risk for stroke.
8. Enjoy a lower sodium (salt), lower fat diet. By cutting down on sodium and fat in your diet, you may be able to lower your blood pressure and, most importantly, lower your risk for stroke.
9. Ask your doctor if you have circulation problems. If so, work with your doctor to control them. Fatty deposits can block arteries that carry blood from your heart to your brain. Sickle cell disease, severe anemia, or other diseases can cause stroke if left untreated.
10. If you have any stroke symptoms, seek immediate medical attention.