Critical question in stroke treatment: When?
Detective work, diagnostic skills establish timing
The narrow window for stroke intervention seems inordinately restrictive when you consider that precious time is spent by witnesses recognizing stroke symptoms, deciding what to do, and eventually transporting the patient to the emergency department (ED). The rest of the prescribed time can easily be spent in patient evaluation by ED nurse and physician, obtaining a brain scan, performing and checking essential lab tests, assembling the treatment team, and preparing the room where the clot-dissolving drug is administered.
Determining when an event occurred is one of the most difficult tasks in diagnosis. "We use tricks’ to pin down the focal time for patients," says Laura Sauerbeck, RN, the clinical research coordinator at The Greater Cincinnati-Northern Kentucky Stroke Research Center in Cincinnati. "We pick events from their environment to stimulate their memories. For example, we’ll ask, Was Wheel of Fortune on TV? Was Oprah on?’ Elderly people tend to have a set routine, and when they eat breakfast or when those shows are on TV can pinpoint an occurrence."
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