Dr. David Cionni, emergency medicine physician at UCHealth Yampa Valley Medical Center, demonstrates the telestroke equipment with Dr. Sharon Poisson, on screen, a vascular neurologist at UCHealth Stroke and Brain Aneurysm Center in Denver. (Courtesy photo)
STEAMBOAT SPRINGS — Timing is crucial when it comes to diagnosing a stroke, as is the accuracy of the diagnosis.
A “stroke mimic” can present the same symptoms but be caused by seizures, infections, low blood sugar or migraine headaches.
Without a full-time neurologist at UCHealth Yampa Valley Medical Center in Steamboat Springs, the Emergency Department staff has the next best thing in their “telestroke” consult.
B – Balance Is the person suddenly having trouble with balance or coordination?
E – Eyesight Is the person experiencing suddenly blurred vision, double vision or a sudden loss of vision in one or both eyes?
F – Face drooping Does one side of the face droop or is it numb? Ask the person to smile.
A – Arm weakness Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
S – Speech difficulty Is speech slurred, are they unable to speak or are they hard to understand? Ask the person to repeat a simple sentence like, “The sky is blue.” Is the sentence repeated correctly?
T – Time to call 9-1-1 If the person shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get them to the hospital immediately.
Source: American Stroke Association
Within about six minutes of arrival — sometimes as little as two minutes — a vascular neurologist can be in the room with a patient via high definition monitor and new telestroke equipment.
“It’s been an incredible asset for the hospital and the valley,” said Dr. David Cionni.
Last week, Cionni, an emergency medicine physician, demonstrated the technology through a conversation with Dr. Sharon Poisson, a vascular neurologist at UCHealth Stroke and Brain Aneurysm Center on the Anschutz Medical Campus in Denver. Poisson is also co-director of the stroke program at UCHealth University of Colorado Hospital.
“Strokes are very time sensitive,” Cionni said.
And, they are the cause of the most long-term disabilities in the United States. More than 795,000 Americans each year suffer a stroke. It is the nation’s fifth-leading cause of death, with about 140,000 people dying each year from stroke.
The clot-dissolving tPA (Plasminogen Activator) medicine can “stop a stroke in its tracks,” Cionni said.
But, it must be administered within the first four and a half hours of a stroke.
If it is not a stroke, the tPA treatment can come with serious risks, including brain bleeding and death. It is a powerful and potentially life-saving medication, Cionni said, but it also has a downside.
“Having a specialist in the room to help with the accuracy and speed of the diagnosis is critical for the patient,” Cionni explained.
Having eyes on the patient helps tremendously, Poisson described onscreen from her office in Denver. It also helps with conversations with family, as they describe any symptoms they observed.
Being on the same page as the Emergency Department doctors in diagnosing a patient and determining treatment within minutes of the patients’ arrival gets the patient the right level of care as quickly as possible, according to Poisson.
If the patient is a candidate for the tPA medicine, the more quickly it is given, the more damage can be prevented, Poisson said, which means a quicker recovery with less disability.
“I always say time is brain — meaning literally more time passing means more brain cells die,” Poisson said.
Having the expertise of a specialist on hand also keeps more patients in the valley, said Cionni.
Of the approximately 20 patients the telestroke technology has been used with since it went online in November, the majority were able to stay in the Yampa Valley, and about half of those patients had not actually experienced a stroke.
One of the major goals is to limit transfers to Denver by transferring only those who have to be, Poisson said.
Poisson said, while they have tried Facetime calls in the past to consult on patients, it didn’t work well and doesn’t come close to comparing to the effectiveness of telestroke technology.
The telestroke equipment is secure and protects the patient’s privacy. There are no connectivity issues. It is also very high resolution, she said, which is crucial for seeing pupil and eye movement and subtle changes in a person’s facial movements or expressions.
Poisson controls the camera and can move it around the room to talk to different people, zoom in on the patient or monitor vital signs. She can also show the patient pictures and ask them to describe what they see in order to test their language abilities.
Getting the story firsthand from the family can give her vital information, she said.
Sometimes a stroke is very obvious, when a person is paralyzed and can’t speak at all. In a case like that, doctors would typically already have treatment underway, Poisson said.
But, often, the symptoms can be more subtle and require a much closer exam to determine whether the patient is a good candidate for treatment. If it is determined the patient needs to be transferred to Denver, Poisson can be on screen and helping throughout the entire process.
She works with 14 sites across the state, including a mobile unit. System-wide, UCHealth has 18 telestroke sites.
Having a neurologist in the room, Cionni said, gives the Emergency Department doctors more confidence in their diagnoses and a better determination on whether the patient needs to be flown to Denver.
Overall, there has been a decrease in strokes on the past several decades, Poisson said.
“But, there are some suggestions strokes are increasing in young adults, between the ages of 20 to 45,” she said. “And, no one is completely sure why.”
Last month, 52-year-old actor Luke Perry never regained consciousness after suffering a massive stroke, serving as a stark reminder that, while strokes are more common over the age of 65, they can happen at any age, Poisson said.
While not all strokes are preventable, 80 percent can be prevented. Lowering risk factors, said Cionni, includes management of blood glucose, cholesterol levels and blood pressure. Eating well, exercising, not smoking and maintaining a healthy weight also play a huge role.
As Cionni and Poisson wrapped up their demonstration, another doctor knocked on the door, seeking a “face-to-screen” consultation with Poisson for a patient in his care.