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MMCN stroke patients to be connected to neurologists

A new technology available at Marshall Medical Centers places a neurologist at the bedside of a stroke victim during the critical early stage when immediate treatment can minimize the long-term effects of a stroke and prevent death.

The North Alabama Neurostroke Network connects 10 hospitals - including Marshall Medical Center North in Scant City and Marshall Medical Center South in Albertville - using video-capable computers to communicate with neurologists in Huntsville to treat a stroke victim.

“I personally believe this represents a significant clinical improvement opportunity,” said Gary Gore, CEO of Marshall Medical Centers. “Teleneurology is being used in many hospitals across the country, even in larger facilities, to deal with the lack of emergency neurology coverage in many communities.”

The network kicks in when a patient suspected of having had a stroke arrives at the hospital and a staff member initiates a “stroke alert.”

The patient’s vital information - including a CT image - is forwarded to the network’s transfer center, which transmits it to a neurologist. While the doctor reviews the case, a nurse conducts a stroke scale test on the patient.

The patient’s ability to answer questions and perform activities is scored by the nurse during the 10-minute assessment.

That information is relayed to the neurologist, who then performs a remote assessment of the patient in the exam room with a nurse assisting. The neurologist, who is on a computer screen, can see the patient and ask questions.

“It’s the same as having a neurologist walk in the door,” Gore said. “He just can’t touch the patient.”

Dr. Amit Arora, a Huntsville Hospital neurologist and director of the stroke network, trained emergency nurses and physicians at Marshall Medical Centers to use the technology. He praised the high-tech camera on the telestroke cart, which is rolled to the foot of the patient’s bed for the assessment.

“We can actually zoom in on the patient and examine their pupil with this powerful camera,” he said.

After the exam, the neurologist determines whether the patient receives the lifesaving tissue plasminogen activator. Only a short window exists when the medication must be administered to reduce damage from a stroke.

The majority of stroke victims don’t get to the hospital in time for tPA treatment. That’s why it is so important to identify a stroke immediately.

Arora said patients in the network who receive tPA will be transferred to Huntsville Hospital where any remaining parts of the clot will be removed mechanically in a specially-equipped cath lab.

It is extremely important to have the network in place in the South, which Arora called the “stroke belt” of the nation.

“We’re also the area of sweet tea consumption,” he said. “We’re high risk. We’re the buckle of the stroke belt.”

An 11-state region in the southeastern United States is called the stroke belt for its high incidence of stroke. It includes Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Virginia.

A stroke occurs when a vessel in the brain is blocked by a blood clot or rupture.

A stroke caused by a clot is called an ischemic stroke; about 85 percent of all strokes in the United States are ischemic. The only FDA-approved treatment for ischemic strokes is tPA given through an IV in the arm.

The medication works by dissolving the clot and improving blood flow to the part of the brain being deprived of blood flow. If administered within three hours (and up to four-and-a-half hours in certain eligible patients), tPA may improve the chances of recovering from a stroke.

Gore praised the collaboration between hospitals to share precious resources in an effort to save lives and reduce the damaging effect of strokes.

“I think having a neurologist available will be helpful,” he said. “Telestroke technology allows a faster assessment from a neurologist than if he were down the hall in surgery. We’re enhancing our services. It’s a way to better coordinate our services to help a stroke patient.”

The head of the emergency department at Marshall South agreed.

“The availability of a neurologist to the emergency department 24 hours a day will further enhance the specialty services available to patients in our community,” said ER director Renee Jordan.

Rose Myers is a former journalist now working in marketing for Marshall Medical Centers.

Source: The Arab Tribune

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