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Presentation on theme: "KNOW STROKE."— Presentation transcript:


2 Community Outreach & Education
Martha Power FNP-C Tanya Smith FNP-BC Angela J. Schaffer RN

3 Be Stroke Smart Reduce: stroke risk Recognize: stroke symptoms
Respond: at the first sign of stroke, Call 911 immediately!

4 Why people don’t respond to stroke symptoms
Don’t recognize symptoms Denial Think nothing can be done Worry about cost Think symptoms will go away Fear or don’t trust hospitals

5 Perceptions of Stroke Myths Reality 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 strokes are preventable Stroke requires emergency treatment Anyone can have a stroke Stroke is a “Brain Attack” Stroke recovery can last a lifetime

6 Stroke Facts A leading cause of death in the United States
795,000 Americans suffer strokes each year 134,000 deaths each year -From 1996 to 2006 stroke deaths fell by 18.4% 6,400,000 stroke survivors

7 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

8 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

9 Types of Stroke T.I.A. Ischemic Hemorrhagic

10 Transient Ischemic Attacks
Warning Strokes or “mini 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

11 Ischemic Stroke Caused by a blocked blood vessel in the brain
8 out of 10 Strokes are ischemic

12 Risk Factors for Ischemic Stroke
Hypertension Diabetes Heart Disease Smoking High Cholesterol Atrial Fibrilation History of previous stroke Age Obesity Poor Diet Lack of exercise

13 Ischemic Stroke Symptoms
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) CALL 911!


15 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 t-PA administration beyond the current recommended 3 hrs might be beneficial.

16 t-PA Recommendations t-PA should be administered to eligible patients within 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). 3/25/2017© 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

17 Merci Clot Retrieval Device
Meri Clot Removal Video 1:10

18 Penumbra Device and Restored Cerebral Circulation
Penumbra Clot Retrival Video 1:45

19 Solitaire Revascularization Device
Solitaire Revascularization Device Video 1:43 The Latest in Neurointerventional Radiology

20 Brain Attack! Stroke is a “Brain Attack.”
Stroke happens in the brain not the heart Stroke is an emergency. Call 911 for emergency treatment. The term “Brain Attack” is the most descriptive and realistic description of a stroke. It also provides a powerful call to action. A brain attack should warrant the same degree of emergency care as a heart attack. After all, your brain is your mind and your body’s most vital and delicate organ. Immediate response is crucial because every minute matters – from the time symptoms first become noticeable to the time treatment is received, more brain cells die. In other words TIME IS BRAIN. The best thing to do is to call 911 for immediate assistance. Treatment is available and some options are most effective if administered within the first three hours after experiencing symptoms. Your chances of walking out of the hospital with little to no disability are greatly improved if you receive appropriate treatments early. Unfortunately, it takes the average American 12 to 24 hours to get to the hospital after experiencing the first stroke symptom. This is why it’s important that everyone learns how to RECOGNIZE stroke symptoms and how to RESPOND. References: National Stroke Association. The Complete Guide to Stroke At: Lichtman JH, Watanbe E, et al. Hospital Arrival Time and Intravenous t-PA Use in US Academic Medical Centers, 2001–2004. Stroke. 2009;40:00-00. 20

21 Carotid Artery Stent Carotidendarterectomy

22 Case Study What do you do? A 59 year old male working at his desk.
He sends a coworker an 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. He says, “I am not going to the hospital, because they can’t do anything for me.” What do you do?

23 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.

24 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!

25 Hemorrhagic Stroke Caused by a ruptured blood vessel in the brain

26 Risk Factors for Hemorrhagic Stroke
Hypertension Bleeding disorders Aneurysm rupture Vascular malformation Excessive alcohol use Cocaine use

27 Hemorrhagic Stroke Symptoms
Focal neurological deficits Headache, “worst headache ever” Neck pain Light intolerance Nausea, vomiting Decreased level of consciousness

28 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

29 Aneurysm Clipping Performed by Neurosurgery
Incision and removal of skull bone Surgical clip prevents blood from entering aneurysm

30 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

31 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

32 Lifestyle Changes for Survivors and Caregivers
Daily living skills Dressing and grooming Diet, nutrition and eating difficulties Skin care problems Pain Sexuality/Intimacy Behavior Depression & Anger Emotional Liability One-sided Neglect Memory Loss Communication Problems

33 An Example of Left-sided

34 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

35 Well Known Stroke Survivors
President Gerald Ford Teddy Bruschi Sharon Stone Della Reese Kirk Douglas Roy Horn of Siegfried & Roy Mary Kay Ash Charles Schultz Harry Caray Charles Dickens Ed Koch Ted Williams

36 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 Low fat, low salt diet Moderate alcohol use “Everything in moderation”

37 Primary Stroke Care Healthcare Team
A Dedicated Stroke Team 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

38 Current Research Trials

39 Stroke Support Groups Meeting for Education, Community, and Healing.

40 Women & Stroke AHA/ASA Campaign to
increase awareness of cardio- and neurovascular disease in Women ~

41 Appalachian Stroke Network
A Regional Cooperative of Healthcare Providers coming together to improve Stroke Care Throughout Appalachia

42 ACT FAST Call 911


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