Fast Action for Stroke
Thanks to rapid treatment to restore blood flow in her brain, a woman regains health.
More than 3 Million Americans today are living with the crippling effects of stroke—the No. 1 cause of disability in the United States.
Thanks to the prompt care provided by the Stroke Team in Monmouth Medical Center’s Emergency Department, 50-year-old Debra Kruchinsky is not counted among that number. She recently was discharged from Monmouth with only minor lingering effects of the stroke she suffered at work on July 10.
“The first thing I said to my kids when they arrived at the hospital was ‘It was amazing’,” says the mother of three and grandmother of three, who drove herself to Monmouth after developing a severe headache and numbness in her face and arm.
While at work as a medical transcriptionist in Eatontown, she notes that she had a “headache in an unusual place” as well as numbness on the left side of her face and her left arm.
“i took a sip of very hot coffee, thinking the caffeine would help my headache, and i burned my tongue but couldn’t feel anything on the left side of my tongue—that’s when I knew something was seriously wrong,” she says.
When she arrived at Monmouth’s Emergency Department, she was brought into an examining room within five minutes and was seen by a doctor, who within two minutes called a Code Stroke. At Monmouth, the Acute Stroke Team—comprising a neurologist, a specially trained registered nurse and an internal medicine resident physician—is available to respond to a Code Stroke 24 hours a day, seven days a week.
“Once she called the code, the ER doctor told me to take a deep breath, because things were going to happen very quickly,” Kruchinsky said. “Within seconds, there were 10 people in the room, and I had a doctor at my head, and nurses starting IVs in each arm.”
After she underwent a CT (computed tomography) scan to rule out a hemorrhagic stroke (bleeding in the brain), it was determined that she was a candidate for thrombolytic treatment, which is approved for the immediate treatment of stroke. In 1996, Monmouth became the first hospital in Monmouth and ocean counties to put in place guidelines for the use of thrombolytic treatment to treat stroke patients.
“Most strokes are caused when blood clots
move to a blood vessel in the brain and block blood flow to that area, and for such strokes the blood- clot thinning medicine of thrombolytics can beused to help dissolve the clot quickly,” explains Stroke Cen- ter medical director Martin Herman, M.D., chief of neurology at Monmouth Medical Center and the physician who treated Kruchinsky. “Giving thrombolytics within three hours of the first stroke symptoms can help limit stroke damage and disability. In occasional, highly selected cases the window can be extended to four-and-a-half hours, but it is always crucial to seek emergency care as soon as possible when experiencing symptoms of a stroke.”
Kruchinsky says that Dr. Herman carefully explained that the most commonly used drug for thrombolytic therapy is tissue plasminogen activator (TPA), and that the key to the safe and effective use of TPA therapy is completing the stroke evaluation and beginning treatment within three hours of the onset of symptoms.
“Dr. Herman was excellent, and went over everything with me, and we decided together that this was the best course to take,” she said. “We began the treatment right away, and I had a wonderful nurse who didn’t leave my side for the hour it took to administer the TPA.”
Upon completion of the TPA administration, she was transferred to the intensive care unit. She says that by the next day, she noticed a marked improvement in her numbness.
“I will do physical therapy to address the weakness in my left hand and my balance, which is a little off, but I have no issues with speech or vision or any other major neurological complications,” she said.
Monmouth’s Stroke Center, a division of the hospital’s Neurosciences Institute, provides a full continuum of care to stroke patients, following the “best practice” standards established by the Brain Attack Coalition and the American Stroke Association, says Stroke Center coordinator Florence Armour.
“We have a great program, thanks to the dedicated staff who continue to work on making it so successful, plus we have the data to show how good it really is,” says Armour, who adds that Monmouth is part of the national database, through the American Stroke Association, that provides Web-based data collection tools that allow it to benchmark outcomes against similar designated stroke centers.
As a part of its mission, The Stroke Center also is committed to educating the community that stroke is an emergency that requires an immediate trip to the hospital.
“Patients like Mrs. Kruchinsky who are lucky enough to be evaluated within the three-hour window and to have no contraindications to TPA treatment have a 30 percent greater chance of recovery with either no deficit or minimal deficit as compared to those who do not receive this treatment,” Armour says. “And while we are aware that many stroke patients are not eligible for treatment with TPA— including those who have suffered a hemorrhagic stroke, had a previous stroke, recent or active bleeding, uncon- trolled high blood pressure or blood clotting problems—we know that stroke victims who are ineligible for this therapy can increase their chances of survival and decrease the degree of disability by getting to an emergency room quickly.”
Know the signs of stroke
With the treatments available today for stroke, time can make a life-or-death difference. So if you think you or a companion may be having a stroke, call 911 promptly.
Here are the warning signs:
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sudden numbness or weakness of the face, arm or leg, especially on one side of the body
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sudden confusion or trouble speaking or understanding
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sudden trouble seeing in one or both eyes
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sudden trouble walking, dizziness or loss of balance or coordination
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sudden, severe headache with no known cause
