Acute Stroke Care
At the Torrance Memorial Stroke Center, treatment begins from the moment
the 911 call is placed. Our paramedics are specially trained in the assessment
and early management of stroke patients. As soon as they identify an acute
stroke patient, they alert the
Torrance Memorial Emergency Department and begin the rapid cascade of treatment that can reduce brain damage.
The paramedics can begin treatment in the field, starting medications and
IVs. They then bring stroke patients to a special "back door",
where our emergency team immediately converges on the patient. Our emergency
physicians are all board certified, and our Nurse Champions are specially
trained in acute stroke care.
The "Golden Hour"
Once the patient enters our doors, the Torrance Memorial Emergency Department
is on a time line called the "golden hour". Within ten minutes
of arrival, a physician sees the patient and determines whether they are
having a stroke, or a different type of medical problem. Within 25 minutes,
the patient is moved to imaging and receives an emergency CT scan, a critical
imaging study that allows the medical team to determine which type of
stroke the patient has had, or is having.
Torrance Memorial TeleStroke Program
Patients are assessed, diagnosed and treated faster and more effectively
than ever before at Torrance Memorial. Through TeleStroke, a video-conferencing
technology enable specialists at Cedars-Sinai to communicate with Torrance
Memorial’s ER team to examine the patient, interpret brain images,
confirm the diagnosis and provide recommendations just as if they were
at the bedside.
Clot Busting Drugs
The results of the CT scan helps the stroke team determine treatment. The
patient who has had the most common type of stroke, a blockage of a blood
vessel in the brain, may be eligible to receive the FDA-approved, thrombolytic
drug, tPA (tissue plasminogen activator), commonly referred to as the
"clot buster" drug. If tPA is given within the first three hours
of the onset of stroke symptoms, it can greatly reduce the effects of
an acute ischemic stroke. Safely giving tPA will restore blood flow to
the affected part of the brain.
The American Heart Association has endorsed this three hour time window;
the longer it has been since the patient first developed signs of numbness,
weakness, or paralysis the more dangerous it is to give a clot busting
medication to them. The clock starts ticking when the patient first has
symptoms. From that moment, the stroke team has 180 minutes to begin treatment
with tPA. The Pharmacy and Laboratory Departments have an important place
on the Stroke Center team, enabling the physicians to begin treatment
within the three-hour window. They quickly run emergency blood work and
other tests, and are on call to mix medications, so that the patient receives
treatment as soon as a diagnosis is confirmed.
Not everyone with a blockage qualifies for tPA. Not all patients will need
a clot buster. Patients may not qualify because of underlying medical
problems or other risk factors.
The key test to see whether or not it is possible to give the clot busting
drug, tPA, to an acute stroke patient is a non-contrast CT scan of the
brain. At Torrance Memorial, a patient receives a CT scan within 25 minutes
of arriving in the Emergency Department.
A CT scan takes x-rays of the brain, in "slices" from top to
bottom. The CT scan shows whether a stroke is caused by a blockage, or
by bleeding. If a patient has a blockage, the physicians can then determine
whether or not the patient is eligible for clot busting medication. What
is therapeutic for one patient is disastrous for another. Clot busting
medication can never be given for a hemorrhagic stroke, or stroke caused
by a leak or rupture of a blood vessel into the brain.
Learn More About Torrance Memorial's Radiology Department