FAST Stroke Care

GWTG-2013-stroke-clipped

East Jefferson General Hospital has long been recognized for its personalized and comprehensive approach to treating stroke patients. In fact, CareChex, the leading hospital review service, has ranked EJGH in the top 10% of all hospitals in the United States for stroke care. East Jefferson General Hospital was also recently awarded its third consecutive American Heart Association Gold PLUS Performance Achievement Award and the Target Stroke Elite PLUS for Stroke Care.

Perhaps nothing speaks to the quality of care we provide stroke patients more than the recent designation we received from the Joint Commission, an independent, not-for-profit organization that is the nation's oldest and largest standards-setting and accrediting body in health care, certifying EJGH as an Advanced Primary Care Stroke Center. This designation means a great deal to us, but here is what it means to those we care for:

  • Certification signifies we have implemented the stringent, national guidelines needed to achieve high level stroke care and outcomes Join Commission's Disease-Specific Care Certification Program is designed to evaluate clinical programs across the continuum of care.
  • Designation shows an organized approach to performance measurement and improvement activities.
  • What all this means to you, the community we serve is that today we stand as a stroke treatment facility that can stand alongside the finest in the nation. But more importantly, it means we are actively dedicated to improving our processes to ensure we stay at the forefront of stroke care.

What is a stroke?

A stroke occurs when blood supply to the brain is impeded or reduced, often caused by blockage in a blood vessel. Because blood is responsible for carrying oxygen to the brain, any interruption in that process can cause damage to the brain very quickly. Then, the part of the body connected to the damaged brain area will no longer be able to function properly.

Because brain damage can happen so quickly during a stroke, prompt action is vital. Administering treatment at the onset of symptoms can help to minimize brain damage and promote recovery.

What are the symptoms of stroke?

Symptoms of a stroke happen quickly. If any of the following symptoms suddenly occur, seek medical attention immediately. A stroke may cause:

  • Loss of sensation, weakness or paralysis in your face, arm, or leg, particularly on one side of your body.
  • Trouble seeing in one or both eyes.
  • Difficulty speaking, slurring or trouble comprehending what others are saying.
  • Trouble with walking or balance.
  • A sudden, severe headache that is different from past headaches.
  • If you have any of these symptoms, call 911 right away. Even symptoms that appear and then seem to go away could be sign that a stroke is impending. From the onset of symptoms, you have three hours to receive treatment for maximum recovery. Do not wait to see if symptoms subside.

How is a stroke diagnosed?

To find out what kind of stroke it is, the doctor will do a type of X-ray called a CT scan of the brain, which can show if there is bleeding. The doctor may order other tests to find the location of the clot or bleeding, check for the amount of brain damage, and check for other conditions that can cause symptoms similar to a stroke.

What factors may increase the risk for stroke?

  • High blood pressure
  • High cholesterol
  • Smoking
  • Being overweight or obese
  • Diabetes
  • Sleep Apnea
  • Cardiovascular disease
  • Heavy alcohol consumption or binge drinking
  • Illicit drug use
  • Personal or Family history of stroke or heart attack
  • Being over the age of 55

Concussions

Concussions are essentially blows to the head that can occur in sports and in daily life. The major causes of concussions outside of the playing field are car accidents, falls, and cases of assault.

The American Academy of Neurology Grades concussions on the following scale:

American Academy of Neurology Grading Scale

Grade 1 (mild) Transient confusion

No loss of consciousness

Symptoms and status abnormalities resolve in less than 15 minutes

Grade 2 (moderate) Transient confusion

No loss of consciousness

Symptoms and status abnormalities last greater than 15 minutes

Grade 3 (severe) Any loss of consciousness

If you think you may have a concussion, avoid sleeping for a few hours after the trauma has occurred. If you are asleep, you or a family member may not be able to monitor worsening symptoms. If you experience extreme sleepiness, it may be a sign of a more significant problem, and you should contact a physician or visit the emergency department. Once you have fallen asleep, ask someone to check on you hourly for the first 24 hours.

Some common and immediate symptoms include dizziness, headaches, nausea or vomiting, memory loss on events before or after the trauma, and an unresponsive state. The days and weeks following the impact can cause an individual to have chronic headaches, fatigue, emotional or personality changes, trouble sleeping, depression and an inability to concentrate.

If you suspect you have a Grade 3 or, in some cases, a Grade 2 concussion, you should arrange to be transported to the emergency room for diagnostic testing. 

Headaches

The most common headache types are tension and migraines. Although sinus headaches are a common complaint, they are actually much less common than people think. Most headaches are tension headaches.

Tension Headaches

Tension headaches are far and away the most common. Typical tension headaches originate at the back of the head and are felt on both sides. The pain is often described as a vise-like pressure, like a band around the head. They can be disruptive, but are not usually incapacitating. To say that a tension headache is purely the result of muscular tension would be to oversimplify a complicated physiological response to stress. However, treatment does not have to be complicated. Counseling, exercise, getting adequate sleep and a healthy diet with plenty of water can all help to curb tension headaches. There are also some muscle relaxers, anti-anxiety medications and anti-inflammatory medications that can be very effective when taken properly. Usually, if the stress can be eliminated or abated, the headaches will too.

Rebound Headaches

Chronic self-medicating can actually bring on headache symptoms. When a patient forms a pattern of taking headache medicine more than twice a week or in larger than prescribed doses, they may experience what is known as a rebound headache. The overuse of over-the-counter or prescription medications can begin to have the opposite effect for which it is intended, and the medication actually perpetuates headaches instead of relieving them. This type of headache is referred to as rebound because the pain subsides briefly after taking the medicine and then returns, creating a cycle of chronic headaches. Rebound headaches can be difficult to treat because the patient may have to suffer through a few headaches without medication in order for the rebound effect to subside.

Migraine Headaches

Compared with tension headaches, migraines can be much more severe. Pain tends to be located on one side of the head and is usually described as throbbing or even stabbing. During a migraine, which can last anywhere from a couple of hours to a couple of days, sufferers may experience extreme sensitivity to light and sound, dizziness, nausea and vomiting.

Although it is a less common symptom, some migraineurs (people who experience migraine headaches) notice an aura at the onset of the headache. Auras are often visual disturbances like blurred vision, blind spots, flashing lights or even loss of vision on one side. These usually indicate a migraine is imminent and fade away as the pain of the headache sets in.

The cause of migraines is thought to be quite complex, involving vascular restriction as well as chemical interactions in the brain, possibly linked to serotonin. As of yet, there is no hard and fast explanation as to why some people suffer from them at some times and others do not or why more women between the ages of 15-40 experience migraines than any other demographic. One theory suggests, according to the National Headache Foundation, "migraines arise from an inflammatory process resulting from an interaction between the trigeminal nerve and the blood vessels surrounding the brain."

Although there is no silver bullet answer for migraines, there are medications that can prevent them from occurring as frequently and other medications that can offer immediate relief. There are two types of medications commonly prescribed, sometimes in combination: preventive and abortive. Abortive medications are taken to stop the pain of a migraine as it occurs. For mild migraines, your doctor may suggest an abortive, over-the counter drug such as Tylenol, Advil or Aleve. For severe migraines, prescription abortive medications called triptans are migraine specific and can be dramatically effective. Imitrex is the prototype for triptans but other commonly prescribed medications include Maxalt and Frova.

Preventive medications are generally prescribed for someone who suffers from migraines in excess of two or three times a month. Some of the first line therapies for preventive care include Topomax, Depakote and Inderal.

Sinus Headaches

In the relatively rare instances that a sinus headache occurs, the pain is located in the face, around the eyes, nose and cheeks and is usually the result of congestion or a sinus infection. If you are not suffering from other symptoms associated with allergies or a cold, then it is more likely that you are experiencing a tension headache or possibly a migraine.

When the symptoms of a stroke hit, you are in the race of your life. You call 9-1-1 and EJGH EMS begins addressing your stroke immediately and before you arrive at the Emergency Department. That rapid response, along with proven therapies later, can significantly reduce the short and long-term effects of your stroke.

A stroke doesn’t discriminate, so it's important to know your risks. If you have any history or hypertension or other warning signs, talk to your EJGH physician about reducing your risks. And if you do develop any FAST symptoms don’t hesitate to call 9-1-1 right away. Each minute matters.

EJGH has not only earned the American Heart/Stroke Association’s highest honor, “Gold Plus” now for the fifth consecutive year, we are also certified with LERN (Louisiana Emergency Response Network). At EJGH, our stroke program acts FAST. We immediately work to get your symptoms under control and limit the short and long-term damage done by your stroke. We have seen the difference minutes can make. If you believe you may be suffering a stroke, act FAST. Call 9-1-1 and put the region’s best stroke team to work for you.