Transcript KNOW STROKE - Appalachian Stroke Network

KNOW
STROKE
Community
Outreach &
Education
• Martha Power FNP-C
• Tanya Smith FNP-BC
• Angela J. Schaffer RN
Be Stroke Smart
Reduce: stroke risk
Recognize: stroke symptoms
Respond: at the first sign of stroke,
Call 911 immediately!
Why people don’t
respond to stroke symptoms
• Don’t recognize
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symptoms
Denial
Think nothing can be
done
Worry about cost
Think symptoms will go
away
Fear or don’t trust
hospitals
Perceptions of Stroke
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Myths
Stroke is not
preventable
Stroke cannot be
treated
Stroke only strikes the
elderly
Stroke happens in the
heart
Stroke recovery ends
after 6 months
Reality
• Up to 80% percent of
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strokes are preventable
Stroke requires
emergency treatment
Anyone can have a
stroke
Stroke is a “Brain Attack”
Stroke recovery can last
a lifetime
Stroke Facts
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A leading cause of death in the United States
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795,000 Americans suffer strokes each year
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134,000 deaths each year
-From 1996 to 2006 stroke deaths fell by 18.4%
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6,400,000 stroke survivors
Stroke Facts
• A leading cause of adult disability
• Up to 80% of all strokes are preventable
through risk factor management
• On average, someone suffers a stroke
every 40 seconds in America
The Cost of Stroke
• The estimated direct
and indirect cost of
stroke was 73.7 billion
in 2010
• The mean lifetime cost
of ischemic stroke per
person is about
$140,048 in America
Types of Stroke
• T.I.A.
• Ischemic
• Hemorrhagic
Transient
Ischemic Attacks
• Warning Strokes or “mini
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strokes”
Blood clot, vasospasm,
etc.
Occurs for a short time
Symptoms resolve in 1-24
hours
Indicates possible major
stroke in the future
1 in 9 will have stroke
within 3 months
Ischemic Stroke
Caused by a
blocked blood
vessel in the
brain
8 out of 10
Strokes are
ischemic
Risk Factors
for Ischemic Stroke
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Hypertension
Diabetes
Heart Disease
Smoking
High Cholesterol
Atrial Fibrilation
History of previous
stroke
Age
Obesity
Poor Diet
Lack of exercise
Ischemic
Stroke Symptoms
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CALL 911!
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Facial Droop
Slurred Speech, dysarthria
Difficulty swallowing, dysphagia
Expressive or receptive aphasia
Gaze preference
Weakness, numbness, loss of
sensation
Symptoms on one side of the face
or body
Visual changes or loss of part or
all of vision
Confusion
Reduced or loss of consciousness
Vertigo, dizziness, ataxia
Nystagmus (wiggling eyes)
t-PA, the
“Clot Buster”
• t-PA is recommended for
treatment of ischemic stroke in
selected patients
• However, t-PA is only
administered to less than 3%
of ischemic stroke patients
• Delay in seeking medical care
contributes significantly to
underutilization of t-PA for
stroke.
• Extending time window for tPA administration beyond the
current recommended 3 hrs
might be beneficial.
t-PA
Recommendations
• t-PA should be administered to eligible patients within 3.0-4.5 hours
after stroke
• Eligibility criteria in this time period are similar to those for persons
treated at earlier time periods with the following additional exclusion
criteria:
– Age > 80 years; Oral anticoagulant use with INR ≤ 1.7*; baseline NIH
Stroke Scale score > 25; a history of stroke and diabetes (*For the 3.0
– 4.5 hr window all pts receiving oral anticoagulant are excluded
whatever their INR).
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7/7/2015© 2009, American Heart Association. All rights reserved.
Information from the Expansion of the Time Window for Treatment of Acute
Ischemic Stroke with IV TPA – Science Advisory
Merci Clot
Retrieval Device
Meri Clot Removal Video 1:10
http://youtu.be/MGX7deuFkhc
Penumbra Device and Restored
Cerebral Circulation
Penumbra Clot Retrival Video 1:45
http://youtu.be/lyfzNgrVOOk
Solitaire
Revascularization Device
Solitaire Revascularization Device Video 1:43
http://youtu.be/0DQPD5TTS5Y
The Latest in
Neurointerventional
Radiology
Brain Attack!
• Stroke is a “Brain
Attack.”
• Stroke happens in the
brain not the heart
• Stroke is an
emergency. Call 911
for emergency
treatment.
Carotid Artery Stent
Carotidendarterectomy
Case Study
• A 59 year old male working at his
desk.
• He sends a coworker an email that
does not make sense.
• He is confused, has a left facial
droop,
and his left arm and leg are weak.
• He is on Coumadin for an irregular
heart rhythm. He has no other
medical history.
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He says, “I am not going to
the hospital, because they
can’t do anything for me.”
What do you do?
Case Study Continued…
• You call 911 and your coworker is rushed to a Primary Stroke
Center Emergency Department
• The Stroke Team meets him at the door, and after imaging,
diagnose him with an acute R MCA stroke with a large penumbra.
Case Study Continued…
• He takes Coumadin for Atrial
Fibrilation, but a blood test and
the fact that he arrived so soon
after onset of his symptoms,
meets criteria for him to receive
tPA, the “clot busting”
medication for stroke.
• His stroke symptoms
completely resolve with the
tPA.
• When he returns to work without
any neurological deficits, he
Thanks You for calling an
ambulance and getting him
medical treatment so quickly!
Hemorrhagic Stroke
Caused by a
ruptured
blood vessel
in the brain
Risk Factors
for Hemorrhagic Stroke
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Hypertension
Bleeding disorders
Aneurysm rupture
Vascular malformation
Excessive alcohol use
Cocaine use
Hemorrhagic Stroke
Symptoms
• Focal neurological
deficits
• Headache, “worst
headache ever”
• Neck pain
• Light intolerance
• Nausea, vomiting
• Decreased level of
consciousness
Two Categories of
Hemorrhagic Stroke
• ICH: bleeding into brain tissue
as a result of bleeding or
rupture of a small, deep
cortical artery that is damaged
by chronic hypertension
• SAH: subarachnoid
hemorrhage is the result of
bleeding into the subarachnoid
space, most often in relation to
ruptured aneurysm or AVM
Aneurysm Clipping
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Neurosurgery
Incision and
removal of skull
bone
Surgical clip
prevents blood
from entering
aneurysm
Coiling Procedure
for Aneurysm
• Performed by Neurointerventional
Radiologist
• Catheter guided to aneurysm site
• Coil is packed into aneurysm
• Blood no longer enters site
• Associated with improved
outcomes
Stroke Recovery
• 10% of stroke survivors recover almost completely
• 25% recover with minor impairments
• 40% experience moderate to severe impairments
requiring special care
• 10% require care within either a skilled-care or other
long-term care facility
• 15% die shortly after the stroke
Lifestyle Changes for
Survivors and Caregivers
• Daily living skills
• Dressing and
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grooming
Diet, nutrition and
eating difficulties
Skin care problems
Pain
Sexuality/Intimacy
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Behavior
Depression & Anger
Emotional Liability
One-sided Neglect
Memory Loss
Communication
Problems
An
Example
of Leftsided
Neglect
Types of
Stroke Rehabilitation
• Physical Therapy (PT)
– Walking, range of
movement
• Occupational Therapy (OT)
– Taking care of one’s self
• Speech Language Therapy
– Communication skills,
swallowing, cognition
• Recreational Therapy
– Cooking, gardening
Well Known
Stroke Survivors
• President Gerald Ford
• Mary Kay Ash
• Teddy Bruschi
• Charles Schultz
• Sharon Stone
• Harry Caray
• Della Reese
• Charles Dickens
• Kirk Douglas
• Ed Koch
• Roy Horn
• of Siegfried & Roy
• Ted Williams
How to Lower
Your Risk for Stroke
• Stop smoking
• Maintain blood pressure below
140/80
• Keep cholesterol in acceptable
range
• Manage blood sugar if diabetic
• Regular Exercise
“Everything
in moderation”
• Low fat, low salt diet
• Moderate alcohol use
Primary
Stroke Care
• A Dedicated Stroke Team
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Coordinates Stroke Care
Neurology and Neurosurgery
Services 24/7
Cutting Edge Imaging (CT,MRI,
etc.) 24/7
Advanced Vascular Procedures
performed by Neurointerventional
Radiologists on call 24/7
Specialty Stroke Trained Nursing
Care
Physical Therapy, Occupational
Therapy, and Speech Therapy
Follow Up Care managed by
Neurology Service
Support Group, Education,
Research, and Community
Outreach
Healthcare Team
Current
Research Trials
• SHINE
• POINT
• CLEAR-ER
• STROKE
BIOMARKERS
• PEDIATRIC
STROKE
Stroke
Support Groups
Meeting for
Education,
Community,
and Healing.
Women & Stroke
AHA/ASA Campaign to
increase awareness of
cardio- and neurovascular
disease in Women ~
Appalachian Stroke Network
A Regional Cooperative
of Healthcare Providers
coming together to
improve Stroke Care
Throughout Appalachia
ACT FAST
Call 911
KNOW
STROKE