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Stroke Emergencies
Dr. Alfred Sacchetti discusses the important risk factors we all should know about stroke, the acronym F.A.S.T for symptom recognition and what to do if you or someone you love seems to be experiencing a stroke.
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Learn more about Alfred Sacchetti, MD
Alfred Sacchetti, MD
Alfred D. Sacchetti, MD, FACEP is the Chief of Emergency Services at Our Lady of Lourdes Medical Center in Camden, NJ and Assistant Clinical Professor of Emergency Medicine at Thomas Jefferson University in Philadelphia, PA.Learn more about Alfred Sacchetti, MD
Transcription:
Stroke Emergencies
Melanie Cole (Host): We’re hearing more and more about stroke and how important it is for you to know the signs so that you know what to do if you suspect that you or a loved one is suffering a stroke. My guest today is Dr. Alfred Sacchetti. He’s the Chief of Emergency Medicine at Our Lady of Lourdes Medical Center. Dr. Sacchetti, as we’re hearing more and more about stroke in the media and famous people having stroke, tell us a little bit about what it is and how prevalent it is today.
Dr. Alfred Sacchetti (Guest): Well I think that the first thing is that you have to decide what are we going to call a stroke and the generally accepted definition of a stroke is a decrease in blood supply or an interruption in blood supply to a portion of the brain that prevents that portion of the brain from functioning. If the interruption is very brief, then you’ll usually get function back almost immediately. If it’s more prolonged, you’re going to lose some function and never get it back in that part of the brain, and along those same lines, that’s the distinction between what people would call a stroke – so if you cut off that blood supply and it’s more than a given period of time, then you’re going to wind up with a permanent deficit. So you’re going to have weakness in one arm or difficulty speaking, and that’s not going to come back and that’s technically a stroke, but if you only block it for a brief period of time, and this is what they call a mini stroke or a TIA, a transient ischemic attack is the official name for that, and those are a little bit more common than stroke, but they’re also a warning sign and most people who get a TIA are at very high risk of getting a stroke.
Host: Who is at risk for whether it’s a TIA or a full on stroke and tell us about the different types of strokes that are out there?
Dr. Sacchetti: Okay, there’s a couple different kinds of strokes. The most common kind of stroke overwhelmingly is what’s called an ischemic stroke and ischemic means we shut off the blood supply. So we blocked it with either a blood clot or somebody had some atherosclerotic plague that flicked off from a lesion in their neck and then it flipped up into their brain and blocked off the blood supply there. So there you’re just shutting off blood supplies. An ischemic stroke is the most common kind. The other type of stroke is what’s called a hemorrhagic stroke, and there what happens is a blood vessel breaks. You may have an aneurysm in the blood vessel which is an out pack and a little bubble that breaks and all of a sudden the blood flow to that part of the brain is cut off because it’s leaking out through this hole in the aneurysm or you may have the blood vessel itself break from longstanding high blood pressure, in which case the blood supply is not going to get out to the rest of the brain. In addition to the hemorrhagic stroke, once the blood starts leaking out around all the nerve cells, the blood itself is actually very irritating to kill the nerve cells itself. Blood only works well when it’s inside a blood vessel. When it gets out and right up against the neurons and nerve cells, it’s going to cause damage to them. So you’re going to wind up with a stroke because you’re going to lose blood supply to an area of the brain but in addition, the leaking blood is going to damage some of the brain cells there as well, and those are the two types of strokes that you can get. Far and away the most common though is going to be the ischemic stroke where you block the blood supply.
Host: One of the most important things, Dr. Sacchetti that we’re hearing about is being able to recognize those symptoms, because as you said, the longer it goes on time is brain, deficits could be you know life long, so we need to know those symptoms and they use an acronym FAST. Tell us about that and why that is so important that we understand what those monikers mean.
Dr. Sacchetti: Well I think the main thing you want to take away from recognizing a stroke and acronyms and stuff are nice, but I think the really main thing is something’s not right. Forget about looking for the specifics. What you’re really looking at is something’s not right with either myself or my mother or a loved one or a coworker, and that’s the number one giveaway. As soon as that happens, you want to be looking at how can I get them to medical help as quick as possible? The something not right might turn out to be something very simple, like they’re a diabetic who skipped a meal and their blood sugar’s low and that can be reversed, and that’s fine, but as soon as you suspect something’s not right, that’s the time to initiate the calls to 911 and to get the people moving towards the hospital. Now in terms of something specific to a stroke, it can be weakness in one side. You could have some weakness or numbness in an arm or a leg and it’s usually going to be both. It can be a difficult speaking. You’re talking to a colleague and all of a sudden they have trouble finding the words that they want to use. So they know what they want to say but they can’t say the words that they want to use or they start slurring their words or particularly in some of the older patients we’ll see what’s called a change in mental status. Where suddenly it’s usually an awake, alert person who’s completely functional and now they’re very confused and they’re very sleepy and you can’t wake them up. All of those things can be signs of a stroke. More importantly, even if it’s not a stroke that causing these problems, especially if there’s a change in their mental status, there’s something wrong and they need to get into hospital care, at least into a physician’s office to be seen and figure out what’s going on. If you suspect that it’s a stroke, like you said earlier, time is brain, and the most effective way to get them taken care of is to call 911 and the ambulance people, the emergency medical services people, will know how to get them to the proper hospital to get them taken care of.
Host: What does that mean proper hospital? What are EMS looking for when they’re getting you someplace that can handle a stroke?
Dr. Sacchetti: Well the reason the proper hospital makes a big difference is, you want to get to a hospital that 1) can do the CAT scan within 10 minutes of you arriving at the door. 2) If they find that you’re in a particular category of stroke, so say you’re in ischemic stroke and you’re in the window – there’s a window of time, four and a half hours from when the stroke starts until we can give you this medicine, you have to be in that window, if you’re at a proper hospital, a primary stroke center or comprehensive stroke center, they can give you a medicine which will help dissolve that clot and if you can dissolve that clot that’s blocking the blood flow to that area of the brain, restore that blood flow, then they’re going to have function back in those nerves. If you go one step further, in addition to primary stroke centers, there are what’s called comprehensive stroke centers, and those are the next level of care because in those centers, if you can’t get rid of the clot by dissolving it, they actually have neurosurgeons and neurologists, and radiologist who have special tools that they can actually go up through the blood vessel, grab the clot and pull it out and just perfuse the brain that way. So ideally you want to be taken to the closet center that can provide the most effective care. So if you call the EMS agency, if you call 911, they will know from where your location is, where the best place is to take you. So you really don’t want to get in the car and start driving because you may wind up going to the wrong facility. So they’ll know if you’re 10 minutes away from a primary stroke center, they’re going to get you there so you can get the clot dissolving medicine on board. If you’re even closer or better going to a comprehensive stroke center, they’re going to take you there because if they can’t dissolve the clot then they have the expertise at that center to be able to go up and extract the clot from the blocked blood vessel.
Host: What a great point, Dr. Sacchetti, is that some people think, oh I’ll just drive the person, but they might not really know where that comprehensive stroke center is or the primary stroke center, so that’s really, really important information. Then tell us what’s next?
Dr. Sacchetti: Let me give you an example, we are a comprehensive stroke center. A couple weeks ago we had a relatively young woman come in with a very dense stroke involving the left side of her body. It involved a portion of her brain such that she was completely weak on that left side. She couldn’t move her arm or leg at all and her face had a droop on that side, but it didn’t affect the area of her brain that controlled her speech, so she was actually able to speak to us and we were able to figure out exactly what time her symptoms started and she was well within the window. We gave her the medicine to dissolve the clot, but the medicine wasn’t working. The clot wasn’t dissolving. At the same time that we had made her, done her initial CAT scans, we were able to do the next level of CAT scans to look at where the clot was. The neurosurgeons came in and were able to go up and pull that clot out and she was able to walk out of the hospital completely neurologically intact two days later. So yes, it’s very, very dramatic. Had it not been for the fact that she was taken by the ambulance to a comprehensive stroke center, she probably would never have recovered that function on the left side of her body.
Host: That’s amazing, and that procedure that you’re talking about, the mechanical thrombectomy, that’s not available everywhere yes?
Dr. Sacchetti: No it’s not. It’s only at the comprehensive stroke centers.
Host: Tell us your best advice, as we wrap up this segment and it’s so interesting, Dr. Sacchetti, and you are really a great educator, you explain everything so well for us, tell the listeners what you’d like them to know about risk factor awareness and if it’s even possible to prevent a stroke, as I said, people are scared that this is something that’s just going to happen out of the blue and effect the rest of their lives, what would you like us to know?
Dr. Sacchetti: I think you hit the nail right on the head, it’s wonderful to treat a stroke, it’s way better to prevent it, and the things that prevent a stroke are the same things that prevent a heart attack and prevent a lot of problems. You want to control your blood pressure. So if you have high blood pressure and you’re on high blood pressure medicine, take it. I mean, we see so many people who feel that I don’t have any symptoms from my high blood pressure, it can’t be that bad and they don’t take their medicine and they’re the ones who come in with the strokes and even the heart attacks. If you have high cholesterol, if you have high lipids and your doctor puts you on medications for that, make sure you take those medicines. You’re not going to have a lot of symptoms from either of those things until it comes to the point where you clot off a blood vessel either in your heart or your brain or even your leg, and then you have all kinds of problems, and the final thing is smoking. For God’s sake if you don’t know that smoking’s bad for you in 2019, you had to have been living under a rock. It’s just an awful, awful problem and everything about smoking produces pathology in the body. From lung disease, to heart diseases to stroke. So you really want to – if you’re smoking, put the cigarette out, throw out the ash tray, throw out the matches and the lighter and be done with it. Because the problem is the following, even in the best of hands, the most sophisticated comprehensive stroke center in the world may not be able to reverse your stroke, and if you think it’s bad having a little bit of weakness, imagine what it’s going to be like spending the rest of your life in the nursing home because you can’t understand any language and you can’t move one side of your body at all. You’re going to miss your children growing up, your grandchildren growing up, all the best parts of your life are going to be gone, so for God’s sake, stop smoking.
Host: Wow, like I said, you’re a great educator and wonderful information and so informative about stroke, about those risk factors, about when you recognize that there’s something that’s just not right and why it’s important to seek out a comprehensive stroke center such as Lourdes Medical Center. Thank you so much Dr. Sacchetti for being with us today. This is Lourdes Health Talk, for more information, please visit lourdesnet.org, that’s lourdesnet.org. This is Melanie Cole, thanks for tuning in.
Stroke Emergencies
Melanie Cole (Host): We’re hearing more and more about stroke and how important it is for you to know the signs so that you know what to do if you suspect that you or a loved one is suffering a stroke. My guest today is Dr. Alfred Sacchetti. He’s the Chief of Emergency Medicine at Our Lady of Lourdes Medical Center. Dr. Sacchetti, as we’re hearing more and more about stroke in the media and famous people having stroke, tell us a little bit about what it is and how prevalent it is today.
Dr. Alfred Sacchetti (Guest): Well I think that the first thing is that you have to decide what are we going to call a stroke and the generally accepted definition of a stroke is a decrease in blood supply or an interruption in blood supply to a portion of the brain that prevents that portion of the brain from functioning. If the interruption is very brief, then you’ll usually get function back almost immediately. If it’s more prolonged, you’re going to lose some function and never get it back in that part of the brain, and along those same lines, that’s the distinction between what people would call a stroke – so if you cut off that blood supply and it’s more than a given period of time, then you’re going to wind up with a permanent deficit. So you’re going to have weakness in one arm or difficulty speaking, and that’s not going to come back and that’s technically a stroke, but if you only block it for a brief period of time, and this is what they call a mini stroke or a TIA, a transient ischemic attack is the official name for that, and those are a little bit more common than stroke, but they’re also a warning sign and most people who get a TIA are at very high risk of getting a stroke.
Host: Who is at risk for whether it’s a TIA or a full on stroke and tell us about the different types of strokes that are out there?
Dr. Sacchetti: Okay, there’s a couple different kinds of strokes. The most common kind of stroke overwhelmingly is what’s called an ischemic stroke and ischemic means we shut off the blood supply. So we blocked it with either a blood clot or somebody had some atherosclerotic plague that flicked off from a lesion in their neck and then it flipped up into their brain and blocked off the blood supply there. So there you’re just shutting off blood supplies. An ischemic stroke is the most common kind. The other type of stroke is what’s called a hemorrhagic stroke, and there what happens is a blood vessel breaks. You may have an aneurysm in the blood vessel which is an out pack and a little bubble that breaks and all of a sudden the blood flow to that part of the brain is cut off because it’s leaking out through this hole in the aneurysm or you may have the blood vessel itself break from longstanding high blood pressure, in which case the blood supply is not going to get out to the rest of the brain. In addition to the hemorrhagic stroke, once the blood starts leaking out around all the nerve cells, the blood itself is actually very irritating to kill the nerve cells itself. Blood only works well when it’s inside a blood vessel. When it gets out and right up against the neurons and nerve cells, it’s going to cause damage to them. So you’re going to wind up with a stroke because you’re going to lose blood supply to an area of the brain but in addition, the leaking blood is going to damage some of the brain cells there as well, and those are the two types of strokes that you can get. Far and away the most common though is going to be the ischemic stroke where you block the blood supply.
Host: One of the most important things, Dr. Sacchetti that we’re hearing about is being able to recognize those symptoms, because as you said, the longer it goes on time is brain, deficits could be you know life long, so we need to know those symptoms and they use an acronym FAST. Tell us about that and why that is so important that we understand what those monikers mean.
Dr. Sacchetti: Well I think the main thing you want to take away from recognizing a stroke and acronyms and stuff are nice, but I think the really main thing is something’s not right. Forget about looking for the specifics. What you’re really looking at is something’s not right with either myself or my mother or a loved one or a coworker, and that’s the number one giveaway. As soon as that happens, you want to be looking at how can I get them to medical help as quick as possible? The something not right might turn out to be something very simple, like they’re a diabetic who skipped a meal and their blood sugar’s low and that can be reversed, and that’s fine, but as soon as you suspect something’s not right, that’s the time to initiate the calls to 911 and to get the people moving towards the hospital. Now in terms of something specific to a stroke, it can be weakness in one side. You could have some weakness or numbness in an arm or a leg and it’s usually going to be both. It can be a difficult speaking. You’re talking to a colleague and all of a sudden they have trouble finding the words that they want to use. So they know what they want to say but they can’t say the words that they want to use or they start slurring their words or particularly in some of the older patients we’ll see what’s called a change in mental status. Where suddenly it’s usually an awake, alert person who’s completely functional and now they’re very confused and they’re very sleepy and you can’t wake them up. All of those things can be signs of a stroke. More importantly, even if it’s not a stroke that causing these problems, especially if there’s a change in their mental status, there’s something wrong and they need to get into hospital care, at least into a physician’s office to be seen and figure out what’s going on. If you suspect that it’s a stroke, like you said earlier, time is brain, and the most effective way to get them taken care of is to call 911 and the ambulance people, the emergency medical services people, will know how to get them to the proper hospital to get them taken care of.
Host: What does that mean proper hospital? What are EMS looking for when they’re getting you someplace that can handle a stroke?
Dr. Sacchetti: Well the reason the proper hospital makes a big difference is, you want to get to a hospital that 1) can do the CAT scan within 10 minutes of you arriving at the door. 2) If they find that you’re in a particular category of stroke, so say you’re in ischemic stroke and you’re in the window – there’s a window of time, four and a half hours from when the stroke starts until we can give you this medicine, you have to be in that window, if you’re at a proper hospital, a primary stroke center or comprehensive stroke center, they can give you a medicine which will help dissolve that clot and if you can dissolve that clot that’s blocking the blood flow to that area of the brain, restore that blood flow, then they’re going to have function back in those nerves. If you go one step further, in addition to primary stroke centers, there are what’s called comprehensive stroke centers, and those are the next level of care because in those centers, if you can’t get rid of the clot by dissolving it, they actually have neurosurgeons and neurologists, and radiologist who have special tools that they can actually go up through the blood vessel, grab the clot and pull it out and just perfuse the brain that way. So ideally you want to be taken to the closet center that can provide the most effective care. So if you call the EMS agency, if you call 911, they will know from where your location is, where the best place is to take you. So you really don’t want to get in the car and start driving because you may wind up going to the wrong facility. So they’ll know if you’re 10 minutes away from a primary stroke center, they’re going to get you there so you can get the clot dissolving medicine on board. If you’re even closer or better going to a comprehensive stroke center, they’re going to take you there because if they can’t dissolve the clot then they have the expertise at that center to be able to go up and extract the clot from the blocked blood vessel.
Host: What a great point, Dr. Sacchetti, is that some people think, oh I’ll just drive the person, but they might not really know where that comprehensive stroke center is or the primary stroke center, so that’s really, really important information. Then tell us what’s next?
Dr. Sacchetti: Let me give you an example, we are a comprehensive stroke center. A couple weeks ago we had a relatively young woman come in with a very dense stroke involving the left side of her body. It involved a portion of her brain such that she was completely weak on that left side. She couldn’t move her arm or leg at all and her face had a droop on that side, but it didn’t affect the area of her brain that controlled her speech, so she was actually able to speak to us and we were able to figure out exactly what time her symptoms started and she was well within the window. We gave her the medicine to dissolve the clot, but the medicine wasn’t working. The clot wasn’t dissolving. At the same time that we had made her, done her initial CAT scans, we were able to do the next level of CAT scans to look at where the clot was. The neurosurgeons came in and were able to go up and pull that clot out and she was able to walk out of the hospital completely neurologically intact two days later. So yes, it’s very, very dramatic. Had it not been for the fact that she was taken by the ambulance to a comprehensive stroke center, she probably would never have recovered that function on the left side of her body.
Host: That’s amazing, and that procedure that you’re talking about, the mechanical thrombectomy, that’s not available everywhere yes?
Dr. Sacchetti: No it’s not. It’s only at the comprehensive stroke centers.
Host: Tell us your best advice, as we wrap up this segment and it’s so interesting, Dr. Sacchetti, and you are really a great educator, you explain everything so well for us, tell the listeners what you’d like them to know about risk factor awareness and if it’s even possible to prevent a stroke, as I said, people are scared that this is something that’s just going to happen out of the blue and effect the rest of their lives, what would you like us to know?
Dr. Sacchetti: I think you hit the nail right on the head, it’s wonderful to treat a stroke, it’s way better to prevent it, and the things that prevent a stroke are the same things that prevent a heart attack and prevent a lot of problems. You want to control your blood pressure. So if you have high blood pressure and you’re on high blood pressure medicine, take it. I mean, we see so many people who feel that I don’t have any symptoms from my high blood pressure, it can’t be that bad and they don’t take their medicine and they’re the ones who come in with the strokes and even the heart attacks. If you have high cholesterol, if you have high lipids and your doctor puts you on medications for that, make sure you take those medicines. You’re not going to have a lot of symptoms from either of those things until it comes to the point where you clot off a blood vessel either in your heart or your brain or even your leg, and then you have all kinds of problems, and the final thing is smoking. For God’s sake if you don’t know that smoking’s bad for you in 2019, you had to have been living under a rock. It’s just an awful, awful problem and everything about smoking produces pathology in the body. From lung disease, to heart diseases to stroke. So you really want to – if you’re smoking, put the cigarette out, throw out the ash tray, throw out the matches and the lighter and be done with it. Because the problem is the following, even in the best of hands, the most sophisticated comprehensive stroke center in the world may not be able to reverse your stroke, and if you think it’s bad having a little bit of weakness, imagine what it’s going to be like spending the rest of your life in the nursing home because you can’t understand any language and you can’t move one side of your body at all. You’re going to miss your children growing up, your grandchildren growing up, all the best parts of your life are going to be gone, so for God’s sake, stop smoking.
Host: Wow, like I said, you’re a great educator and wonderful information and so informative about stroke, about those risk factors, about when you recognize that there’s something that’s just not right and why it’s important to seek out a comprehensive stroke center such as Lourdes Medical Center. Thank you so much Dr. Sacchetti for being with us today. This is Lourdes Health Talk, for more information, please visit lourdesnet.org, that’s lourdesnet.org. This is Melanie Cole, thanks for tuning in.