Prakash Chandran: When it comes to strokes, the onset, entry and outcome can be extremely quick. So identifying a stroke as fast as possible is a key factor to the successful treatment of a patient. Here to talk to us about fast stroke identification, intervention, and the neurological perspective is Kristi Ermigarat, Clinical Stroke Coordinator at Tenet Health Central Coast.

This is Healthy conversations, the podcast from Tenet Health Central Coast. My name is Prakash Chandran. So Kristi, it's great to have you here today. I'd love to just get started with the basics. What exactly is a stroke and why is it such a time-sensitive disease?

Kristi Ermigarat, BSN, RN: Of course. So a stroke is a vascular issue that happens within the brain. And there's a couple of different types. There is a clot type that we call ischemic and then there's also a bleeding type that we call hemorrhagic. And so both of these types of stroke actually limit blood flow to the brain and prevents our brain cells from getting oxygen as well as the nutrient that can actually cause cell damage and even cell death if too much time has gone by. And so strokes are most definitely a time-sensitive health emergency and especially because there are 2 million brain cells that die every minute if the stroke goes untreated. So we always encourage our community to call 911 immediately. Don't delay. Don't wait for the symptoms to get better. Don't go lay down and take a nap. Patients who seek immediate care actually do better in the long run and actually have less of a disability following a stroke.

Prakash Chandran: So one of the things that you mentioned is that if someone were experiencing symptoms, that they should call 911 immediately. So what are the symptoms that people should look out for?

Kristi Ermigarat, BSN, RN: So patients who have either types of these strokes certainly can have a specific type of symptoms. So for example, with our clot types or the ischemic type of strokes patients can have, weakness or numbness, usually in one side of the body or the other, they can have leg or arm weakness, they can have speech trouble. And then with the bleeding or hemorrhagic type of stroke, patients can have what we call the worst headache of their life or a sudden severe onset of a headache with no other explanation. These patients can also experience such things like nausea, vomiting, seizures and even a sudden loss of consciousness.

Prakash Chandran: Now, you know, you mentioned some of the symptoms and I've definitely heard about an acronym or a mnemonic to help people remember the signs of a stroke called FAST as a way to recognize things. What exactly does that stand for?

Kristi Ermigarat, BSN, RN: So FAST, yes, it's an acronym that we utilize to identify some stroke symptoms. And so F stands for face or facial weakness. And what we're looking for is a droop or weakness in one side of the face, how you can assess for that is you can ask your friend or family member to smile and you might see one side of their smile droop more than the other. And then A stands for arms or legs. And so that's what we're looking for, that weakness in either the arms of the legs or even both. And how you can assess for this, is you can have somebody hold their arms out. And sometimes one of the arms might drift quicker than the other or you can have weaker grips on one side of the other. And then S stands for speech. So with this, we're looking for a patient who has slurred speech, but they can also have difficulty speaking, difficulty finding their words or even difficulty understanding what's being said to them. And then T, like we already talked about, is time. Time is of utmost importance and the quicker you call 911, the better.

Prakash Chandran: Yeah, that makes a lot of sense and I appreciate the breakdown. But more recently, I've been hearing some hospitals use the acronym BE FAST. So B-E-F-A-S-T, instead of just FAST, can you break down what that means?

Kristi Ermigarat, BSN, RN: Of course. Yes, So BE actually allows healthcare professionals to determine if the stroke is occurring in either the front side of the brain or the back side of the brain. And so B stands for balance. And with this, we're looking for somebody who is either dizzy, off-balance, uncoordinated, walking issues. And then E, we're looking at vision or the eyes. So with this, we can have patients that have anything from blurred vision, they can have double vision or even they can have a loss of peripheral vision altogether.

Prakash Chandran: So with some of the symptoms that you have mentioned, what exactly do you recommend if you witness a friend or a loved one that is potentially showing these symptoms and having a stroke? What should they do?

Kristi Ermigarat, BSN, RN: So anybody that recognizes these types of symptoms in a friend or a family member should call 911 immediately. Do not try to drive them to the emergency department. So when you actually call 911, that's when your care starts. When the ambulance gets there and the fire department gets there, they're able to start your care as well as notify the receiving hospital that they're potentially bringing in a stroke patient. And in particular here at Sierra Vista, when we get those kinds of calls from an ambulance company, we are able to activate our stroke team. And this gives us time to align all of our resources, make sure we have everything ready to go to give our patients the best care possible.

Prakash Chandran: Now, one of the things that I've always been interested in finding out is if a person is able to self-identify whether or not they're having a stroke. Have you ever seen any instances of this?

Kristi Ermigarat, BSN, RN: We have certainly seen and experienced patients who are able to recognize these symptoms on their own. And again, with these types of symptoms, like you said, you can have a headache. You can maybe notice that you're having trouble speaking. So again, with these types of situations, we want our patients to immediately pick up the phone and dial 911. If you're not able to, finding somebody who can do that for you. Be creative. Flag down a neighbor, knock on somebody's door. But again, time is of the essence. Time is brain, as they say.

Prakash Chandran: Time is brain. That's the first time I've heard of that, but definitely something to remember. I want to talk about who strokes affect. I read a study recently that said it affected primarily elderly people and mostly men. Is that true?

Kristi Ermigarat, BSN, RN: That is actually false. So strokes actually affect women more often than men, mostly because women are having expected longer lifespans. And then also with the younger female population, they're at higher risk due to these things such as birth control and then also, with pregnancy, are at higher risk for strokes and blood clots. And then tagging onto that our younger population. This population, they don't typically go see their primary care doctor, so they can have undiagnosed health situations or health issues such as high blood pressure, high cholesterol, and even some venous malformations in their brain that can cause strokes.

Prakash Chandran: So Kristi, in general, are there things that we can do to lower the risk of us getting a stroke?

Kristi Ermigarat, BSN, RN: Of course, there are certainly ways that we can reduce our risk for stroke. And the golden rule is active lifestyle. So those are such things as eating a healthy well-balanced diet. This is going to help keep our blood pressure low. It's going to help reduce our cholesterol. Lowering our stress levels. Also, we want to encourage our patients and community to see their physicians regularly. Make sure you're taking all of your prescription medications as they're prescribed and do not stop those medications until you have a conversation with your physician. And then last but not least, avoiding illicit drugs and not smoking at all.

Prakash Chandran: So when it comes to treatment of a stroke, I've heard that both neurologists and neurosurgeons can play a role. Is this something that you can explain?

Kristi Ermigarat, BSN, RN: So when somebody comes into our hospital with a potential stroke, the neurologist is initially the first person that gets called and they are involved in determining what the best care is for our patients, regardless if it's bleeding into the brain or a clot type of a stroke. So if the patient does have some bleeding into the brain that requires surgery, that's when a neurosurgeon gets involved. So to simplify that, neurosurgeons are specifically for brain surgery, whereas neurologist do not perform surgery.

Prakash Chandran: So after that initial handoff, is there further communication between the neurologist and the neurosurgeon just to care for the patient and makes sure that there's the best possible outcome?

Kristi Ermigarat, BSN, RN: Most definitely. If the neurologist feels like a neurosurgeon needs to be brought on board, there is interdisciplinary work that goes on, and there's lots of communication between the various physician and specialties. And then as the care progresses throughout the hospital stay, both physicians will follow the patient to assure that they're receiving the most appropriate care and best practices.

Prakash Chandran: So I've heard a lot about Sierra Vista being kind of the place to go if you're having a stroke. Why exactly is this the case?

Kristi Ermigarat, BSN, RN: So I would definitely agree with that remark. I live here and I have friends and family that live here. I grew up here. And so, we here at Sierra Vista take great pride in the care that we provide for our stroke patients, as well as the rest of our community. So Sierra Vista has been providing stroke care for a very long time. We were the first hospital to be certified by what's called The Joint commission in 2011. And then, most recently in 2019, we were the first and only thrombectomy-capable center here in San Luis Obispo county. And so what this means is we are actually capable of going in and physically removing a clot from the brain, which is absolutely amazing to me. I have seen such incredible outcomes from this procedure. It's very exciting that it is an option for our community here in San Luis Obispo. And then on top of that, we also have a very experienced group of neurosurgeons. And not only do we have access to these neurosurgeons here in our county, we also have a very unique relationship with UCSF that allows us to transfer patients who need a higher level of care in a very rapid manner.

Prakash Chandran: Yeah, that sounds amazing, Kristi. Just before we close here today, is there anything else that you'd like to share with our audience regarding strokes?

Kristi Ermigarat, BSN, RN: Yeah, I would love to reiterate that time is brain, time is of the essence. Please, please, if you ever experience any of these symptoms that we've gone over or you recognize any of these symptoms in a friend or loved one, call 911, do not delay. Don't wait for the symptoms to resolve. Time is of the utmost importance for all of our stroke patients and can ultimately improve the outcome for our patients. So please call 911 and do not wait.

Prakash Chandran: Well, Kristi, thank you so much for your time. I think that message is loud and clear. Please don't wait. If you recognize any symptoms at all, the best thing to do is to call 911 because time is brain. So thank you so much for your time, Kristy.

Kristi Ermigarat, BSN, RN: Thank you so much.

Prakash Chandran: That was Kristi Ermigarat, Clinical Stroke Coordinator at Tenet Health Central Coast. Thanks for checking out this episode of Healthy Conversations. For a referral to a board-certified physician, please call the Sierra Vista Regional Medical Center and Twin Cities Community Hospital physician referral line at 866-966-3680. You can also visit tenethealthcentralcoast.com/about/podcasts to subscribe to our podcasts. 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. This has been Healthy Conversations, the podcast from Tenet Health Central Coast. Thanks so much and we'll talk next time.