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Every second counts for Cedars-Sinai stroke team
Every second a person has stroke symptoms, brain cells die. As seconds tick away, permanent cognitive and physical abilities are lost and the risk of death looms. As a result, members of Cedars-Sinai's stroke team are always operating with a sense of controlled urgency.
"Once stroke patients arrive at Cedars-Sinai, our job is to evaluate them as quickly as possible," said Laurie Paletz, RN, stroke team coordinator. "Timing is critical. Diagnosis is crucial. And, we have to be right."
Cedars-Sinai is one of 23 designated stroke centers in California and its stroke team is comprised of four nurses, seven physicians and other caregivers. Earlier this year, the medical center's Stroke Program earned the Get With the Guidelines Gold Plus Award – the highest honor given by the American Heart Association/American Stroke Association.
When a suspected stroke patient arrives in the Emergency Department, a "Code Brain" is called. At least one member of the stroke team responds, Paletz said. A neurologist, also part of the stroke team, is then called.
The team's responsibility is to quickly diagnose and determine qualifications for treatment, said Nicole Wolber, RN, a stroke team member. While a CT scan quickens stroke evaluation, determining the correct treatment may prove difficult, she said.
Many patients qualify for tissue plasminogen activator, or t-PA, which is known as a clot-busting drug. The drug is given two ways – intravenously or directly into the brain through a catheter running from the femoral artery. Its effectiveness, however, is based on when the patient receives it. The closer to within three hours of the patient's initial symptoms that the drug is given, the better the patient's outcome, Wolber said.
"If a patient has had a stroke, it is important they get t-PA as soon as they get here," Wolber said. "But, at the same time, we have to go through every scenario before we give this drug because it is potent. ... If the patient doesn't qualify for t-PA, or a determination on when stroke symptoms first occurred isn't sufficient, we will help streamline them for another treatment."
While a patient undergo CT scans – a component of the assessment process, there's a small window during which the stroke team questions family and friends about the patient's health. If a patient arrives alone, is unresponsive, or if paramedics can't provide information, the team reverts to a group of white-coat detectives.
"It takes more than just asking a patient, ‘When did your symptoms first start,'" said Nili Steiner, RN, a team member. "Patients aren't always reliable. They may be incapacitated or frightened. They also may have had symptoms earlier but didn't notice them."
Sometimes, Paletz said, the team has to get creative.
"We had a patient tell us the last thing they remembered doing before becoming symptomatic was watching Jeopardy," she said. "We had to go back and look at what time Jeopardy was on, which was somewhat easy. When they are watching CNN, or some other 24-hour network, we're out of luck."
Once patients are treated, they are moved into Cedars-Sinai's 20-bed Neurology Intensive Care Unit, which is staffed by the stroke team, neurologists, neuro-intensivists and other highly trained nurses.
Patients remain here until they're ready for rehabilitation. Rehabilitation occurs at Cedars-Sinai or another facility, Steiner said. But, she said, the stroke team is always in contact with the patient and their family.
In addition to their work at Cedars-Sinai, the stroke team is proactive in educating the public about stroke, especially in high-risk neighborhoods, said Betty Robertson, RN, another member of the team. The group also meets weekly with the Emergency Department and EMS staff to revisit coordination of care for stroke patient.