Strokes are a disease that can be fatal or life-altering and are, unfortunately, very common. It is the fifth leading cause of death in the United States and the leading cause of disability. Fortunately, UT Health East Texas EMS|AIR1 has a robust team of caregivers who are trained in treating stroke patients. Dr. Yagnesh Desai, Medical Director for UT Health East Texas EMS|AIR1, oversees these teams and shares how they handle these critical patients every day.
Every 40 seconds someone in the United States has a stroke. There are many individuals in East Texas who either have had a stroke or are at risk for having one. “We see stroke patients very frequently,” says Dr. Desai. “It's a disease process we see a lot of here in East Texas, much like cardiac disease. Anyone who has a history of high blood pressure or diabetes, if they've had any kind of heart disease – they are at risk for having a stroke. Unfortunately, we have a lot of all of that in East Texas.” The caregivers who respond to these calls are the emergency medical services crews.
When 911 is called and an ambulance shows up at the door, these crews are trained to identify stroke victims and get them to the best care as quickly as possible. “Stroke training is a part of normal EMS training,” says Dr. Desai. “As medical director, one of my responsibilities is educating crews on topics that we see all the time and possibly tricky situations. Coming up, I’m giving a talk that goes over multiple scenarios with a patient who is having a stroke. It’s always good to refresh our education.” There is a need for constant learning, as stroke care can involve a complex protocol.
Dr. Desai breaks down how an EMS crew would handle the call for a possible stroke.
“After a patient has called 911 we show up in an ambulance, or even one of the helicopters if they live in a very remote area. Our crew's first job is to determine if this person is having a stroke. The way they do that is by performing a physical exam. If the patient has obvious paralysis on one side of their body, they have a facial droop, their mouth is dropping, or their speech is very slurred, there is a good chance this person has indeed had a stroke.
“They will start an IV line and then they are going to check blood glucose. Sometimes if the patient is a diabetic and their sugar has gotten really low, they can present symptoms that would resemble a stroke. Then they start transport to the nearest hospital. Once they get to the hospital, the first thing they want to do is get a CT scan of the brain to identify which kind of stroke the patient is having.”
There are two major kinds of stroke: a hemorrhagic stroke and an ischemic stroke.
A hemorrhagic stroke is when an individual who has long-standing high blood pressure has small arteries in their brain burst over years of weakening from high blood pressure. Bleeding accumulates in the brain and compresses the brain tissue.
An ischemic stroke is the more common kind of stroke, accounting for 87 percent of all strokes, that occurs when a blood clot blocks a blood vessel in the brain, preventing blood flow. When the brain doesn't get blood flow, stroke symptoms occur.
At the hospital, a scan of the brain is performed to identify which type of stroke the patient is having. Determining this will then let the physicians choose the best treatment. “The majority of patients are given a medication called TPA. TPA is a medication (thrombolytic) and what is does is dissolve that blood clot and reestablish blood flow to the brain,” says Dr. Desai. “The sooner the stroke symptoms are recognized, the sooner they are taken to a hospital that provides TPA treatment, the better the chances of recovery and having a good outcome.”
However, there are limits on when a patient can receive TPA and which patients can qualify. “TPA is effective within the first three hours of starting stroke symptoms. We can sometimes extend that timeframe up to four and a half hours, but it doesn’t apply to everybody because it takes out people who have diabetes or people past a certain age group and certain risk factors that make it dangerous to give them this medication.” TPA can work to resolve a brain clot in many patients, but those who don’t qualify for this treatment have another option. “At UT Health Tyler we also do neurointerventional stroke treatment,” says Dr. Desai. “Patients that are past the treatment window of receiving TPA can be seen by interventionalists here.”
If the CT scan reveals that the clot is located in one of the larger blood vessels, the interventional neuroradiologists can introduce a wire into a blood vessel until it reaches the clot. They will then remove the clot to restore blood flow to the brain. These professionals are specially trained to treat stroke patients and perform these procedures as an alternative to traditional surgery. “That's something that can be done up to 24 hours after the start of the stroke,” shares Dr. Desai. “That's one of the unique technologies we have in Tyler and we're seeing some really good results from it.”
Strokes are a serious disease, but education on the signs and treatments can make it less frightening and even save someone’s life. In being both an emergency room physician as well as the Medical Director for UT Health East Texas EMS|AIR1, Dr. Desai knows how vital it is for people to learn about strokes. “It's incredibly important if you think, if you suspect or if you even imagine that you might be having a stroke to get evaluated immediately at your closest emergency room or by a physician. The general population might have the idea that a stroke is only when you're paralyzed on one side and your face looks funny and you can’t talk, but there are so many different presentations of a stroke. If you feel that something is not right, if you see a family member or friend and they are not on their normal, functioning level, get them checked out. There are strokes that cause the full paralysis on one side of your body, but there are strokes in which a person can only have some numbness in one of their arms. Or they may just notice everything is spinning around and they can’t walk straight.
“It's important that folks get evaluated if they feel that they might be having a stroke. It's incredibly important because we are in the age now where something can be done for strokes. Now we have TPA medications, neurointerventional treatments. Things that are giving patients with these devastating strokes a second chance of life. There is a window of opportunity to get help. Don't miss the opportunity to get help.”
To learn more about the stroke care throughout UT Health East Texas, please visit https://uthealtheasttexas.com/services/neurology/ut-health-east-texas-stroke-centers