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QHC provides clot-busting drug for stroke patients

People suffering a stroke in the Quinte area now have faster access to the clot-busting drug Tissue Plasminogen Activator (tPA) to try to reduce and reverse the effects of the stroke. Previously, patients were automatically re-routed to Kingston to receive this treatment.

tPA is suitable for people who have suffered an ischemic stroke within the past four and a half hours. An ischemic stroke is the kind of stroke caused by a clot blocking a blood vessel to the brain.

“For ischemic stroke, the key is getting the clot-busting drug into the patient as soon as possible,” said Dr. Andrew Samis, the doctor in charge of the Quinte Health Care Intensive Care Unit (ICU).  “Literally every minute counts, with the best results being achieved when the tPA can be infused within the first hour after the onset of symptoms. Obviously the change to treating at QHC Belleville General rather than directing patients to Kingston saves an hour in transportation alone. This minimum one hour saving will allow a number of people who suffer a stroke in the Quinte region to be eligible for the clot busting drug who would otherwise have been excluded based on time.”

QHC has developed a comprehensive process called “Code Stroke” to ensure that stroke patients are identified, screened and given a CatScan as quickly as possible and then receive tPA if appropriate. Even saving five minutes in the work-up can be important to the patient’s outcome.

“The goal of this treatment is to try and reverse the effects of the stroke before they become permanent,” said Caryn Langstaff, District Stroke Co-ordinator, QHC. “Not every kind of stroke is caused by blood clots blocking a blood vessel in the brain, but for those that are, the early delivery of tPA can limit or even reverse the damage of the stroke in some people.”

One of the limitations to delivering tPA at QHC in the past was the absence of a stroke neurologist on staff. This is where the process turned to a high tech solution – Telestroke. Telestroke is a provincial initiative in which the doctor and the patient will be linked to a stroke neurologist somewhere else in the province via an audio-video link.  The neurologist will be on a large TV screen at the foot of the patient’s bed in the Quinte Health Care ICU and be able to see the patient and the diagnostic information in order to assist the QHC physician in the decision to give tPA.

“This is a very exciting time in health care with the benefits of our new ICU and the technological benefits afforded via the Telestroke initiative,” said Ms. Langstaff. “The delivery of tPA via Telestroke at Quinte Health Care will have tremendous benefit for the residents of this community.”

What is a Stroke?
Stroke is a sudden injury to part of the brain caused by an interruption in its blood supply. It occurs when a blood vessel supplying oxygen and nutrients to a part of the brain either becomes occluded or blocked (ischemic stroke) or ruptures (hemorrhagic stroke).

What is tPA?
tPA is a medication that is given intravenously at the time of an acute stroke. tPA breaks up the blood clot to allow the blood supply to return to that part of the brain.  Not every patient who has a stroke can receive tPA. For tPA to work, it can only be given within the first 4.5 hours of the stroke, and only in the cases of ischemic stroke. There are numerous factors to determine whether tPA is the appropriate treatment for a patient.

For patients meeting the criteria for tPA, there is great potential for improved outcomes. Generally, eligible patients receiving tPA have a 30% greater likelihood of returning to normal or near normal function within three months following a stroke. tPA must be given within 4.5 hours of onset of stroke to have this benefit.

What is Telestroke?
Telestroke is a provincial initiative linking community and remote hospitals with the expertise of a Stroke Neurologist 24/7 via clinical videoconference technology.  This initiative provides access to critical neurology services, which may not otherwise be accessible. A Telestroke consultation involves a Neurologist from another part of the province viewing a patient assessment, their CT scan, blood work and other diagnostic information, and consulting with a QHC ICU Physician using special videoconferencing equipment (two-way television).

Did you know?
* More than 50,000 strokes occur in Canada each year, equivalent to one stroke every 10 minutes.
* Stroke is the third leading cause of death in Canada.  Each year, more than 14,000 Canadians die from stroke.
* About 300,000 Canadians are living with the effects of stroke.

While it is difficult to predict who might suffer a stroke, there are several factors that will increase the likelihood of suffering a stroke. Controllable factors include such things as obesity, physical inactivity, high blood pressure, high cholesterol, diabetes, smoking, and excessive alcohol consumption.

By adopting and maintaining a healthy active lifestyle, one can significantly reduce the controllable risk factors for stroke. Additionally, by raising awareness and increasing knowledge of the signs, symptoms, and potential ways to limit the risk of suffering a stroke, we can significantly reduce the number of deaths and lasting disabilities caused by stroke every year.

“Time is Brain”
More than 32,000 neurons may die in each second of an acute stroke.  In other words, the longer one waits, the greater likelihood of brain tissue death and potential impairment. Brain tissue dies within minutes, and time-sensitive treatments, like the clot-busting medication tPA, only work if administered within the first few hours after the stroke onset.

Stroke is a medical emergency.   If you SUDDENLY experience any of the following signs and symptoms Call 911.

*       Weakness. Sudden loss of strength or sudden numbness in the face, arm or leg, even if temporary.
*       Trouble speaking. Sudden difficulty speaking or understanding or sudden confusion, even if temporary.
*      Vision problems. Sudden trouble with vision, even if temporary.
*       Headache. Sudden, severe and unusual headache.
*       Dizziness. Sudden loss of balance, especially with any of the above signs.

QHC District Stroke Centre
Quinte Health Care is a designated District Stroke Centre under the Ontario Stroke System.  Its mandate is to provide organized stroke prevention and care to people residing in Hastings and Prince Edward Counties, facilitating best practice in stroke care across the continuum of care.  As of December 3, 2010, Quinte Health Care, through the Provincial Telestroke Initiative, is now delivering the time-sensitive, clot-busting drug Tissue Plasminogen Activator (tPA) for patients experiencing ischemic stroke, who meet very specific medical criteria.

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  1. Don Wakefield says:

    Can the drug be administered a PECMH using telestroke or must the patient go to Belleville General?

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