Stroke: What to Expect in the Emergency Room

Experiencing a stroke can be frightening. After all, stroke kills approximately 157,000 people per year and is the third most common cause of death in the United States. From the onset of stroke symptoms until ongoing stroke rehabilitation, the journey through recovery can be a long process. It may be helpful to know what you can expect if you or a loved one has a stroke.

If you are experiencing one or more of the following symptoms of stroke, you should call 911 immediately, even if the symptoms cease on their own.

• Sudden weakness, paralysis or numbness of the face, arm or leg, especially on one side of the body
• Sudden onset of double vision, dimness or loss of vision
• Sudden difficulty speaking or understanding language
• Sudden severe headache without apparent cause
• Unexplained dizziness, unsteadiness or loss of balance, especially in combination with other signs

All of these symptoms could be related to other conditions, so it is imperative that proper diagnosis and treatment is received. If it is a stroke, the best chance for recovery is to receive treatment within the first three hours since the onset of symptoms. This is key to preventing a serious disability or death caused by too little blood flow to the brain.

Emergency Department

When you are not sure if you are having a stroke, the safest thing to do is get to the emergency department. “Sometimes when people are panic stricken because they or someone they love is sick, they will try to drive to the hospital themselves,” says Fred G. Wenger, DO, medical director of the Emergency Department at The University of Tennessee Medical Center. “They think that they cannot wait for the ambulance, and that is a very bad strategy for people with stroke or chest pains. Their condition could get even worse.”

Paramedics and emergency medical technicians are trained to recognize stroke symptoms, can begin treatment upon arrival and can call ahead to the hospital and alert the emergency department that you are coming so they can prepare proper medical personnel and diagnostic equipment. They will ask critical questions such as the time the symptoms first started, which symptoms you have experienced and which medications you are taking. “The time that the patient was last seen without symptoms would be an important piece of information and would need to be told to the paramedics,” says Jennifer Henry, stroke coordinator at UT Medical Center.

Once you are on the way to the hospital in the ambulance, there are several things the emergency medical personnel will do. You can expect to receive the following.

• Placement on a monitor
• Placement on oxygen
• IV Line, if necessary
• Blood sugar assessment
• Vital Signs
• Asked a lot of questions

The goal is to get the person to the emergency department as quickly as possible and determine which type of stroke they are experiencing.

Care begins while you are being transported to the hospital. Once you arrive at the emergency department, you will be evaluated and treated by a stroke team, which includes an emergency physician, emergency nurse and either a neurologist or neurosurgeon. “Later, other members of the stroke team would get involved such as the rehabilitation professionals,” Henry adds. The Stroke Center at UT Medical Center has the critical elements to achieve long-term success and improve outcomes for patients. The quality care provided is effectively managed to meet the unique and specialized needs of stroke patients.

Patients will have a lot of people asking a lot of questions over and over again. “Patients can expect a lot of people paying a lot of attention to them in a hurry,” Wenger says. “They will be put on a monitor, assessed and asked the same questions repeatedly. We want to get everything absolutely right.”

Diagnosing a Stroke

Diagnosing a stroke is complicated but critical to determining which types of treatment a patient will receive. The doctor must determine if the stroke is ischemic or hemorrhagic. Ischemic strokes—those resulting from blood clots—are the most common type of stroke, affecting approximately 85 percent of all stroke victims, according to Wenger. A hemorrhagic stroke involves bleeding in the brain from the bursting of blood vessels and accounts for the other 15 percent.

Your stroke team will check for various neurologic, motor and sensory deficits. The exam may show changes in muscle weakness, decreased sensation, abnormal reflexes and changes in vision. Tests then will be performed to determine the exact type, location and cause of the stroke—as well as to rule out other conditions. Tests may include the following.

• CT Scan or MRI
• Electrocardiogram (ECG)
• Carotid Duplex
• Heart Monitor
• Cerebral Angiography
• Blood Work

When the results are in, your physicians will work with you to determine the best course of treatment, which may include medications, surgery and/or rehabilitation, depending on the type of stroke, its severity and its effects.

UT Medical Center’s Brain and Spine Institute features a Stroke Center dedicated to reducing the long-term impact of a stroke, offering rehabilitation for stroke victims and advanced technology. The center offers the latest imaging technology in order to provide minimally invasive treatment. In addition, the stroke center provides patients with rapid medical attention, a stroke coordinator and a team with stroke expertise as well as early identification of stroke rehabilitation needs. The center also focuses on public education, including stroke prevention and the detection of early warning signs of stroke.

If you think you are having a stroke, dial 911 immediately. If you want to find out your stroke risk, call your doctor or 1.877.UT.CARES (1.877.882.2737) to make an appointment today!