Stroke care: It’s about time

Stroke patients at Peconic Bay Medical Center will now benefit from the latest technology, thanks to the emergency room’s brand-new 64-slice CT scanner, shown off here by Arthur Crowe, administrative director for radiology, and Mary Jo Stark, director of nursing emergency medical services.

They call it Stroke Awareness Month, but it’s not just about new knowledge doctors and nurses have about how to diagnose and treat patients at Peconic Bay Medical Center’s certified stroke center.

It’s more an effort to raise the awareness of patients and their families, according to Dr. Brian McMahon, PBMC’s director of emergency medicine. While people are becoming more knowledgeable about the signs of a stroke, they’re inclined to ignore the body’s small hints that they could be heading toward a full stroke, the doctor said.

“Speak up when you have symptoms,” Dr. McMahon advises. The symptoms can include:

* An inability to perform certain tasks that you previously could tackle.

* An inability to easily manipulate your fingers, even though your arm movements are still normal.

* An inability to describe things.

* Loss of balance or vision.

Mostly, it’s important for patients and their relatives to know what is normal and so establish a baseline from which to judge. A deviation from what’s normal could be a sign that something’s amiss and you need to consult a doctor, Dr. McMahon said.

Even in a society of baby boomers who shun aging, there’s too much of a tendency to accept symptoms as typical results of advanced age, he said. Don’t accept that your independent status and quality of life have to be compromised as you age, he advised. It’s also crucial to find out what’s causing the difficulty and how that might be addressed.

Physicians count on information from family members who can tell how a loved one’s behavior may be outside the ordinary.

Advances in stroke diagnosis and treatment enable many patients to recover totally or to greatly diminish lasting effects, the doctor said. That means getting a patient to the ER rapidly when signs of a stroke appear.

Among those signs are:

* A sudden numbness or weakness in face or an arm or leg.

* Eyes rolling from side to side.

* An inability to repeat simple words or to smile or stick out the tongue.

* A sudden and severe headache.

* Dizziness and a loss of balance.

Call for an ambulance because EMTs can treat patients en route to the hospital, Dr. McMahon said. A spouse, friend or neighbor can’t help beyond providing transportation. While PBMC is a certified stroke center, if your nearest hospital is Eastern Long Island, go there, he said. Like PBMC, Southampton Hospital is also a state-designated stroke center.

Medical personnel can assess symptoms and provide immediate help to stabilize a patient’s condition and determine whether the symptoms are caused by a stroke or a heart attack, blood sugar fluctuations or some other problem. If it is a stroke, a patient can be transported quickly to PBMC or Stony Brook University Hospital, Dr. McMahon said.

The staff at PBMC has had many hours of training in assessing and treating stroke victims. The approximately 100 people who share responsibilities in the stroke center completed even more training, according to Mary Jo Stark, nurse manager for emergency services.

“Truly, it makes a difference in the care of every single stroke patient,” she said. A heightened sense of awareness and knowledge enables team members to respond rapidly and effectively, she said.

She, too, sounded the alarm for people to heed any early warning signs. Even if symptoms seem to resolve themselves, get to a doctor, Ms. Stark said.

“At the end of the day, it’s about prevention,” she said.

In the emergency room, a possible stoke victim will be treated by a team responsible for rapidly assessing the condition, assuring that vital signs are stabilized and that the person is able to breathe. A neurologist will order a CT scan and then work with the radiologist to identify what part of the brain is affected and whether it might be a hemorrhagic or ischemic stroke. That difference is vital because the treatments for each are diametrically different, Dr. McMahon said.

An ischemic stroke is caused by a blood clot and can be broken up by drugs to restore blood flow and reduce, and perhaps eliminate, the chance of permanent brain damage, Dr. McMahon said.

The less common hemorrhagic stroke causes bleeding and may result from an aneurysm. Treatment of a hemorrhagic stroke requires stopping the bleeding and determining what’s causing it.

When it’s called for, stroke patients can be quickly transported to Stony Brook for more advanced interventions, Dr. McMahon said. For example, Stony Brook has a device enabling physicians to thread a wire into the brain and “vacuum” out a clot, he said.

In the case of an aneurysm, a catheter with coils that stimulate clotting can be threaded to the source of the bleeding, the doctor added.

While the process might seem dramatic to patients and their families, the procedures have “almost become routine” to the stoke response team, said Dr. McMahon.

Even with the best equipment and medications, time is of the essence, he said.

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