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	Blake Smyle, RN, Emergency Room Nurse

“A team effort starts in the field,” says emergency nurse Blake Smyle, RN. In eighty-year-old James Tressler’s case, his son noticed his father’s slurred speech when they stopped their eighteen-wheeler at a dairy farm to pick up milk.

Tissue plasminogen activator (tPA), the only clot-busting drug approved by the U.S. Food and Drug Administration, must be administered intravenously within the first three hours of stroke symptoms, and not everyone is a candidate. If given promptly, tPA can reduce the effects of stoke.

Mr. Tressler’s son immediately called 911. Arriving at the scene, Emergency Medical Services (EMS) conducted a preliminary stroke test and interviewed the son to learn when the symptoms first appeared—critical information for whether tPA can be given.

EMS notified Meritus Medical Center’s Emergency Department (ED) of the patient’s estimated arrival time and condition, immediately causing pagers to buzz for the stroke team. Emergency medicine physicians, nurses, radiology and lab staff, stroke care specialists, the stroke unit, and the Intensive Care Unit (ICU) all make up the hospital’s stroke team.

Meritus Medical Center is a state-approved primary stroke center. “We have a door-to-needle goal of sixty minutes,” stated Lee Fitzpatrick, RN and stroke specialist. That means quick action in the ED when it comes to checking vital signs, conducting a specialized stroke assessment, taking labs and a CT scan, and completing a patient’s medical history.

A new component to the hospital’s stroke center is the “telestroke” partnership with the University of Pittsburgh Medical Center (UPMC) Stroke Institute. An audiovisual link connects the hospital’s emergency department physicians to UPMC’s vascular neurologists twenty-four hours, seven days a week. These stroke doctors undergo two to three additional years of intense vascular neurological training.

For James Tressler, who was unable to talk, move his left side, and focus, his stroke team included two physicians—Dr. Christopher Gentle, Meritus Medical Center emergency medicine, and Dr. Syed Zaidi, UPMC vascular neurologist. Using the power of telecommunications, both doctors reviewed the patient’s CT scan, conducted another specialized stroke assessment, and confirmed the need for tPA.

After one hour of receiving tPA intravenously, Blake Smyle started to see improvement in the patient. “Although his stroke scale wasn’t decreasing, he had increased movement and sensation on his left side and he seemed less confused,” said Blake.

“It was pretty neat to see a doctor from Pittsburgh communicate with dad from a TV screen,” said Rose Redden, James Tressler’s daughter.

For a stroke patient, the first twenty-four hours after tPA administration are critical. The patient’s vital signs and neurological status are closely watched. Now in the ICU, “Team Tressler” included Dr. Mark Baran, hospitalist; Dr. Samina Anwar, neurologist; and Blake, who happened to be working in the ICU the day after Mr. Tressler arrived at the Emergency Department.

 “He was a different person than he was in the ED,” said Blake. “He was almost back to his condition before the stroke. I knew he would be returning to his daughter’s home—not to a long term care facility.”

James Tressler made two more stops before leaving the hospital. Dr. Baran transferred him to the stroke unit for additional observation. The final phase of treatment included Comprehensive Inpatient Rehabilitation Services for intensive speech, occupational, and physical therapy. Within fifteen days, James Tressler was discharged from the hospital.

“When it comes to a stroke, tPA is the only tool in the drawer,” said Jean Thomas, RN and stroke specialist. To use this tool, you need a team inside and outside the hospital, both ready to respond quickly. Another key to stroke recovery and survival is quality care across a continuum. From the patient’s arrival at the ED to his inpatient and outpatient rehabilitation, the hospital plans for every step of stroke care.