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Stroke Symptoms
A stroke is an attack on the brain that can be devastating if not addressed immediately. Sara Durham, Stroke Coordinator, discusses the importance of knowing stroke symptoms.
Featuring:
Sara Durham, RN, BSN
Sara Durham, RN, BSN a nurse for 14 years with a background in the OR, SICU, and MICU has been the Sepsis and Stroke Coordinator here at Putnam Community Medical Center for just at two years. Her current role entails provider, staff, and community education regarding stroke and sepsis. She concurrently reviews and helps manage all of the stroke and sepsis patients to ensure her facility meets all guidelines mandated for the care of these patients. Transcription:
Prakash Chandran (Host): A stroke is something we are all aware of. It’s a brain attack that can happen to anyone at anytime and occurs when blood flow to an area of the brain is cutoff. But what are the warning signs you need to know about when having a stroke? We’re going to talk about it today with Sara Durham, a Registered Nurse at Putnam Community Medical Center. This is Helmet of Health, a podcast from Putnam Community Medical Center. I’m Prakash Chandran. So, first of all Sara, I know I gave a brief summary, but let’s start with learning a little bit more about what a stroke is.
Sara Durham, RN, BSN (Guest): There are actually two types of stroke. You have a hemorrhagic stroke which is a bleed into your brain, and you have an ischemic stroke which accounts for about 87% of strokes out there that are occurring and that means that you have a blockage, usually a blood clot that blocks the flow of blood to your brain.
Host: Okay, it’s good to know that there are two different types of strokes. I didn’t know that. And do they represent themselves the same way?
Sara: Typically, yes but like I said, most of the time there are several different symptoms and we’ll get into that in a few minutes. Some are very apparent, some are not. But 80% of strokes are the ischemic strokes which are treatable with medications if it’s within a certain timeframe and or surgery.
Host: Okay, I understand. Before we get to the specific symptoms of these strokes, I want to understand why time is so much of the essence. I’ve heard this before, but I always hear like with a stroke, time is the most important thing. So, maybe just talk at a high level about that first.
Sara: Yes, that’s a great question. As far as the time goes, we have a clot busting drug that we can give. Most people know it as TPA, it’s called alteplase. We have a timeframe of three to four and a half hour window. We just started stretching it out to the four and a half hour window and not all patients can have it. So, we typically say if your symptoms started within three hours, we are going to try to get that medication in there. The reason for that is, the longer that you wait, the longer that the stoke goes on; the more risk for bleeding that you have into the area of the brain where the stroke is if we give you that medication. So, after a certain amount of time, we can’t do that and then your other option could possibly be what we call a mechanical thrombectomy where you would go to a comprehensive center and they actually go in and retrieve the clot manually.
Host: Okay so let’s dive right into it. Maybe talk a little bit about the specific signs and symptoms of a stroke.
Sara: The best way to remember is the pneumonic BE FAST. So, first of all, the B stands for balance which is sudden loss of balance which could present as just something as simple as being dizzy. The E stands for eyes which is sudden loss of vision. Sometimes it’s in one eye, sometimes in both. It doesn’t mean that you’ve completely lost vision, it could just be a little blurred. The F stands for face and that’s just stating does the face look uneven. Most of the time, when patients present with these symptoms; one side of their face will be drooped or even maybe their eye or their cheek. You can ask them to smile and you can really see that facial droop going on there. The A stands for arms. So, does one arm drift down? If somebody can’t hold both of their arms out or say they are holding a cup of coffee or something and all of the sudden they drop it and their arm isn’t working anymore. That’s a definite sign.
The S stands for speech. So, does their speech sound strange? Usually it will sound a little slurry, sometimes not. And with some people, it’s difficult to tell because maybe their speech is already slurred, or they don’t have their dentures in what have you. But you can ask them to repeat a phrase and that’s always a great way to judge that. And finally, the T stands for time. So, everybody needs to remember that times is brain. The sooner that you can call 9-1-1, do not try to drive someone to the hospital. Call 9-1-1, get EMS involved and then they will make the decision and they can alert the facility which is what we do here. They will alert us when they are on their way with a possible stroke patient and we are all ready to do what we need to do because we understand that time is so important, that three hour window that we talked about before.
Host: So, its BE FAST and what’s interesting is, I’ve heard of FAST plenty of times, but this is the first time I’m hearing about the B-E part of that which I think is really important. So, you said it’s balance and eyes. Is that correct?
Sara: Yes and that is something that especially the balance part. People get these symptoms and they think well of course dizziness can be attributed to something else going on with you. Maybe your blood sugar is low which is one of the first things that we check whenever we have a patient coming in with these stroke symptoms. But I have had patients that were having a stroke, their only presenting symptom was mild dizziness and that was it.
Host: Wow. Okay. And I wanted to get a clarification on something because you said the best thing that someone can do if they notice their friend or a loved one experiencing some of these symptoms is to call 9-1-1 and not to drive them to the hospital. But if it’s such a time sensitive disease, why shouldn’t someone be on their way to their closest emergency room and call 9-1-1 at the same time?
Sara: Generally, calling 9-1-1 is going to get you there faster and you are going to have someone – a medical professional who can look at your symptoms and see what’s going on. The important thing is to know when did these start. If it’s a loved one, you really want to remember that, okay we were driving down the road and then all of the sudden his speech got slurred or altered mental status or something like that. Remember that time if you are the one who is taking the loved one or friend or even if you just witness it in public. But most of the time, by calling 9-1-1, it’s like I said, you are going to get seen by a medical professional quicker and they can alert us when you are on your way in and we will be there and ready with medication if it’s appropriate or ready to transfer you to a comprehensive center if you are outside of the window and you need to have that surgical procedure done that I was talking about.
Host: I’m really glad that you made that clarification and I think just overall, because it’s such – it can be a really scary scenario to be involved in. You are not going to remember all the steps needed to potentially save this person so it’s much better to call 9-1-1. They are going to know exactly what to do. All right Sara, we really appreciate your time today and I think we’ve all learned that pneumonic phrase BE FAST. That’s Sara Durham, a Registered Nurse at Putnam Community Medical Center. Thanks for checking out this episode of Helmet of Health. Head to www.pcmcfl.com to get connected with a provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and looking forward to our next conversation.
Prakash Chandran (Host): A stroke is something we are all aware of. It’s a brain attack that can happen to anyone at anytime and occurs when blood flow to an area of the brain is cutoff. But what are the warning signs you need to know about when having a stroke? We’re going to talk about it today with Sara Durham, a Registered Nurse at Putnam Community Medical Center. This is Helmet of Health, a podcast from Putnam Community Medical Center. I’m Prakash Chandran. So, first of all Sara, I know I gave a brief summary, but let’s start with learning a little bit more about what a stroke is.
Sara Durham, RN, BSN (Guest): There are actually two types of stroke. You have a hemorrhagic stroke which is a bleed into your brain, and you have an ischemic stroke which accounts for about 87% of strokes out there that are occurring and that means that you have a blockage, usually a blood clot that blocks the flow of blood to your brain.
Host: Okay, it’s good to know that there are two different types of strokes. I didn’t know that. And do they represent themselves the same way?
Sara: Typically, yes but like I said, most of the time there are several different symptoms and we’ll get into that in a few minutes. Some are very apparent, some are not. But 80% of strokes are the ischemic strokes which are treatable with medications if it’s within a certain timeframe and or surgery.
Host: Okay, I understand. Before we get to the specific symptoms of these strokes, I want to understand why time is so much of the essence. I’ve heard this before, but I always hear like with a stroke, time is the most important thing. So, maybe just talk at a high level about that first.
Sara: Yes, that’s a great question. As far as the time goes, we have a clot busting drug that we can give. Most people know it as TPA, it’s called alteplase. We have a timeframe of three to four and a half hour window. We just started stretching it out to the four and a half hour window and not all patients can have it. So, we typically say if your symptoms started within three hours, we are going to try to get that medication in there. The reason for that is, the longer that you wait, the longer that the stoke goes on; the more risk for bleeding that you have into the area of the brain where the stroke is if we give you that medication. So, after a certain amount of time, we can’t do that and then your other option could possibly be what we call a mechanical thrombectomy where you would go to a comprehensive center and they actually go in and retrieve the clot manually.
Host: Okay so let’s dive right into it. Maybe talk a little bit about the specific signs and symptoms of a stroke.
Sara: The best way to remember is the pneumonic BE FAST. So, first of all, the B stands for balance which is sudden loss of balance which could present as just something as simple as being dizzy. The E stands for eyes which is sudden loss of vision. Sometimes it’s in one eye, sometimes in both. It doesn’t mean that you’ve completely lost vision, it could just be a little blurred. The F stands for face and that’s just stating does the face look uneven. Most of the time, when patients present with these symptoms; one side of their face will be drooped or even maybe their eye or their cheek. You can ask them to smile and you can really see that facial droop going on there. The A stands for arms. So, does one arm drift down? If somebody can’t hold both of their arms out or say they are holding a cup of coffee or something and all of the sudden they drop it and their arm isn’t working anymore. That’s a definite sign.
The S stands for speech. So, does their speech sound strange? Usually it will sound a little slurry, sometimes not. And with some people, it’s difficult to tell because maybe their speech is already slurred, or they don’t have their dentures in what have you. But you can ask them to repeat a phrase and that’s always a great way to judge that. And finally, the T stands for time. So, everybody needs to remember that times is brain. The sooner that you can call 9-1-1, do not try to drive someone to the hospital. Call 9-1-1, get EMS involved and then they will make the decision and they can alert the facility which is what we do here. They will alert us when they are on their way with a possible stroke patient and we are all ready to do what we need to do because we understand that time is so important, that three hour window that we talked about before.
Host: So, its BE FAST and what’s interesting is, I’ve heard of FAST plenty of times, but this is the first time I’m hearing about the B-E part of that which I think is really important. So, you said it’s balance and eyes. Is that correct?
Sara: Yes and that is something that especially the balance part. People get these symptoms and they think well of course dizziness can be attributed to something else going on with you. Maybe your blood sugar is low which is one of the first things that we check whenever we have a patient coming in with these stroke symptoms. But I have had patients that were having a stroke, their only presenting symptom was mild dizziness and that was it.
Host: Wow. Okay. And I wanted to get a clarification on something because you said the best thing that someone can do if they notice their friend or a loved one experiencing some of these symptoms is to call 9-1-1 and not to drive them to the hospital. But if it’s such a time sensitive disease, why shouldn’t someone be on their way to their closest emergency room and call 9-1-1 at the same time?
Sara: Generally, calling 9-1-1 is going to get you there faster and you are going to have someone – a medical professional who can look at your symptoms and see what’s going on. The important thing is to know when did these start. If it’s a loved one, you really want to remember that, okay we were driving down the road and then all of the sudden his speech got slurred or altered mental status or something like that. Remember that time if you are the one who is taking the loved one or friend or even if you just witness it in public. But most of the time, by calling 9-1-1, it’s like I said, you are going to get seen by a medical professional quicker and they can alert us when you are on your way in and we will be there and ready with medication if it’s appropriate or ready to transfer you to a comprehensive center if you are outside of the window and you need to have that surgical procedure done that I was talking about.
Host: I’m really glad that you made that clarification and I think just overall, because it’s such – it can be a really scary scenario to be involved in. You are not going to remember all the steps needed to potentially save this person so it’s much better to call 9-1-1. They are going to know exactly what to do. All right Sara, we really appreciate your time today and I think we’ve all learned that pneumonic phrase BE FAST. That’s Sara Durham, a Registered Nurse at Putnam Community Medical Center. Thanks for checking out this episode of Helmet of Health. Head to www.pcmcfl.com to get connected with a provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and looking forward to our next conversation.