Time is of the essence when someone is experiencing a stroke. That’s why the emergency room team at Our Lady of the Lake – the region’s only Comprehensive Stroke Center of Excellence – is prepared to immediately begin assessing and treating possible stroke patients, even before they arrive at the hospital.
“If someone is coming in by ambulance, we are usually aware that it could be a stroke. The paramedics will either call in a patient report to let us know that is what they suspect, or they tell us their symptoms and we believe it sounds like a stroke,” said Dr. Michael Truax, an emergency department physician at Our Lady of the Lake. “In those situations, we activate our stroke plan and wait for the patient. We meet them once the ambulance arrives and start a neurological exam and stroke workup the second they come through the doors.”
In other cases, patients arrive by private vehicle or may even be at Our Lady of the Lake for other health concerns.
“We definitely have stroke patients come in the front door and say they are concerned about their symptoms,” Dr. Truax said. “Other times, they are here for a completely different reason and we receive an alert that they are exhibiting stroke symptoms. You really never know how or when a stroke patient will arrive, so we are always on the lookout and ready to activate our plan at a moment’s notice.”
Understanding Stroke Levels: Timing Matters
Dr. Truax said a key aspect of that plan is determining whether a stroke patient should be classified as Level One or Level Two. The distinction is based largely on how long it has been between the time the person first exhibited symptoms and the time they arrived at the emergency room. Level One stroke patients have begun having symptoms within four-and-a-half hours prior to arrival and may be eligible to receive powerful blood thinners. By contrast, Level Two patients have had symptoms for more than four-and-a-half hours.
“The Level Two patients may still be eligible for a thrombectomy,” Dr. Truax said. “Our interventional radiologists will perform imaging, and can remove a blood clot if they see one in the blood vessels of the brain.”
Dr. Truax said the goal at Our Lady of the Lake is to provide blood thinners to Level One stroke patients within 30 minutes of their arrival and to perform a thrombectomy within 60 minutes if a patient is at a Level Two.
“We are typically able to meet those goals because we have a well-oiled operation. Everything is very nuanced and everyone understands their role,” he said. “It’s become almost second nature to a lot of us who work in the emergency room.”
Training for Excellence in Stroke Treatment
The logistics of the emergency department at Our Lady of the Lake also have been designed to facilitate rapid stroke treatment. A stroke landing zone has been created where the entire care team meets before or as soon as a patient arrives. Dr. Truax said this space allows doctors, nurses, pharmacists and others to work together, communicate clearly and provide immediate treatment.
“We can do our stroke exam within the first 30 seconds and determine their stroke score and what kind of stroke it is,” he said. “The CT scan is located right behind our doors, so we can bring them there right away for more imaging. It’s all very streamlined.”
In addition, numerous Our Lady of the Lake clinicians and staff participate in annual training sessions to review the latest developments in stroke care, assess their skills and address any areas where there can be improvement.
“We take a lot of pride in being a Comprehensive Stroke Center, so we have really worked hard to refine our processes and shave off as much time as possible when it comes to patient care,” Dr. Truax said.
That training also includes knowing how to conduct proper assessments to determine whether someone has actually had a stroke. Dr. Truax said it is not uncommon for a person to suspect a stroke, only for tests to determine that they have experienced a different type of medical episode, such as a seizure or low blood sugar levels.
“Sometimes, a person will have a seizure and then have weakness on one side of their body as their brain is recovering. If no one saw the seizure happen and the patient doesn’t remember it, it can easily mimic the symptoms of a stroke,” he said. “In addition, we always check the sugar on every stroke patient because if we see a low number, we want to fix that first and see if things improve. You always want to do a complete workup and be very thorough so that you are giving the proper diagnosis and treatment.”
Know the Symptoms, Act Fast
Ultimately, Dr. Truax said he wants people to come to Our Lady of the Lake if they have any type of stroke symptoms, which often include balance problems, eyesight changes, facial drooping, arm weakness or speech difficulty. The sooner someone receives treatment and has normal blood flow restored to the brain, the better their chances are of making a strong recovery.
“Time is brain tissue in a stroke situation,” he said. “I want you to come see me because I want to take care of you as quickly as I can. It breaks my heart where I hear stories of people who started having symptoms two days prior and thought they would get better. We are waiting for you here and are ready to put you on the right treatment path.”
Our Lady of the Lake treats approximately 2,000 stroke patients each year. It is the only local hospital to be designated as a Comprehensive Stroke Center. The hospital’s average monthly “door to needle” clot-busting treatment time is under 30 minutes, among the fastest times in Louisiana. Our Lady of the Lake also has a 20-bed neurocritical unit to specifically care for stroke patients.
