Joining forces to fight strokes

With a touch of a button, a University of Virginia Medical Center physician in Charlottesville is able to examine a stroke patient at Culpeper Regional Hospital.

Physicians and educators from both hospitals demonstrated an emergency scenario with a mock patient and new stroke alert and management system at the 70-bed facility on Thursday.

Using the Stroke Telemedicine and Tele-Education program, UVa stroke neurologist Dr. Andrew Southerland, was able to assess “stroke patient” Culpeper Mayor Chip Coleman, 62, inside exam room 6.

“This is really a cutting edge opportunity for us to interact with stroke patients in their local communities and to get to see them in a timely fashion,” Southerland said. “And before this technology was available, patients might not get to a facility where they were adequately treated. It’s also a neat opportunity to collaborate with physicians and nurses from the community.”

Transported by ambulance from a local coffee shop, Coleman came into the emergency room around 1:40 p.m. with right-side weakness, high blood pressure, numbness, facial drooping and trouble speaking.

Once admitted, CRH nurse Tom McElroy quickly evaluated Coleman’s condition, checking his arm and leg muscles, and looking for a symmetrical smile.

“I don’t want you to be scared, but I think you’re having a stroke,” informed McElroy. “There are things we can do here for you. I just want to tell you there will be a lot of things happening in a short period of time. I just want you to know you’re going to be in good hands, though.”

The physicians’ analysis

Soon after, CRH emergency department Dr. Michael Hehman arrived and continued the medical assessment.

“Follow the light with your eyes,” Hehman instructed Coleman. “Squeeze my hands, good. Put your legs up in the air.”

Immediately after the exam, Hehman ordered a CT scan of Coleman’s head and had it sent digitally to UVa.

During the mock medical checkup, UVa neurologist Nina Solenski, standing outside of the exam room, explained that the emergency department doctor was looking for specific stroke symptoms such as facial drooping, numbness on one side of the body and trouble speaking clearly.

“Once he’s convinced that this might be a stroke, he’ll alert the rest of the system,” she explained.

She also said that there are two kinds of strokes: ischemic strokes, which account for about 80 percent of all strokes and caused when a blood clot blocks a blood vessel in the brain; and a hemorrhagic stroke is caused by a blood vessel that breaks and bleeds into the brain.

“You can’t give a tissue plasminogen activator for the bleeding kind,” she said. “So it’s very critical a head scan is done rapidly.”

Meanwhile, CRH staff has connected with Dr. Southerland using the videoconference equipment. Using a webcam and monitor, Southerland appeared on the screen from his Charlottesville office to continue the assessment.

Controlling the webcam to zoom in and out, Southerland was able to examine Coleman’s face during the examination. He also used Coleman’s “mock wife” Andrea Lomboy, a stroke telemedicine and tele-education program coordinator at UVa, to help him conduct a stroke assessment scale where Southerland measured Coleman’s alertness, motor skills and basic language.

Even though Southerland was in Charlottesville at the time of Thursday’s examination, he was able to view Coleman’s head CT scan within a matter of minutes thanks to modern technology.

“By the time that I’ve been called, the images are already on our radiology system. We can pull them up simultaneously with the tele stroke interaction,” Southerland explained.

A typical stroke exam takes about 5 to 10 minutes, according to the medical experts. After all of the testing, Coleman was “diagnosed” with left hemispheric stroke.

Future technology

Following the demonstration, Southerland summed up the importance of the partnership between CRH and UVa., endorsing the new equipment.

“I think the technology will continue to evolve and improve,” he said. “It’s pretty seamless.”

Meanwhile, Dr. David Burt, an emergency department physician who works at CRH and UVa., explained to the captivated crowd observing from the hallway what was going on inside the exam room.

“If EMS has already called ahead to say ‘we may have a stroke patient,’” Burt said, “that will put the ER on high alert saying, ‘I may have six patients to see coming in on stretchers, but this may be one of those patients where a few minutes either way makes a big difference. So it’s that concept of critical actions that have to be done well not some of the time, but we really expect them to be done well all of the time.”

Burt said the primary focus of this new video conferencing machine is a collaborative effort between EMS, nursing staff, physicians and radiology.

“We are always testing the system so that every piece of it works because we expect that 24/7 if we want to get a stroke consult, it just has to work,” Burt said. “If my grandma had came in and she was having a stroke and the system didn’t work or a bulb was burned out, there’s simply no excuse for that.”

Following the demo, Coleman was back to his good-humored self, thanking the staff and crew, who are filming a stroke awareness video.

“Great group from EMS to nurses to docs,” Coleman said via email Thursday evening. “While [the] main purpose is to get [the] word out, I also had a great time interacting with everyone. Good experience. I hope people get information and learn how best to respond.”

Before the demonstration started in the emergency department, CRH President and CEO Lee Kirk greeted his staff and UVa employees in the hospital’s boardroom.

“Our partnership with the University of Virginia is about access to expertise, technology, [and] capital,” he said. “The end vision is clinical integration. One aspect of clinical integration is using evidence-based best practice clinical protocol and that’s what these programs are about here at Culpeper Regional Hospital. And a wonderful part of our partnership is to be able to offer these university level, world class clinical programs right here in Culpeper.”

Culpeper Regional Health System, CRH’s parent company, and UVAMC agreed to partner in January 2009 under the terms that UVa would invest $40 million in CRH over a three-year period, equating to a 49 percent investment in the Culpeper hospital. Meanwhile, CRH will remain an independent, non-profit entity with its own board of trustees.

Stroke symptoms

» sudden numbness or weakness of face, arm or leg, especially on one side of the body

» sudden confusion, trouble speaking or understanding

» sudden trouble seeing in one or both eyes

» sudden trouble walking, dizziness, loss of balance or coordination

» sudden severe headache with no known cause

Source: National Stroke Association website