Don’t forget the APEX software is
available for education on stroke
and the NIHSS. Please do any
certification updates with your
NIHSS in the APEX software.
When registering for the NIHSS
check off, please use the facility
key code provided to your Nurse
Facilitator. This ensures that your
completion is registered with your
facility.
July 1st marks the start of Year 4
for the AR SAVES program! We are
so happy to have you all as part-
ners on the road to providing Ar-
kansans with timely acute
ischemic stroke care. As always,
we love to hear any feedback,
suggestions or questions regard-
ing how this program can work
more efficiently for you as the
healthcare provider. We value
your input !
The 27th site to join AR SAVES is
Magnolia Regional Hospital.
Please help us to welcome them
as they come on board in June.
In the month of May, there were a
total of 44 consults and tPA was
given 8 times, for a 18% admini-
stration rate.
In the May All-Sites call, a re-
minder was issued to report accu-
rate times on the intake sheet.
For example, instead of guessing
what time the patient went to CT,
if you could provide the actual
time it would be very helpful. Hav-
ing the most accurate information
allows us to pinpoint areas of
improvement in trying to reach
our goal of Door to Needle in 60
minutes.
Please remember to turn in any
invoices for reimbursement by
June 30th!
Please continue to screen your
potential AR SAVES patients utiliz-
ing the tPA checklist. This will
help you determine if the patient
is possibly eligible for tPA admini-
stration, or not. If the patient falls
outside of those checklist pa-
rameters, you can still obtain a
neurology consult by calling the
PCC line at 866-UAMS-DOC.
Also, keep in mind that the pa-
tient should be seen by your ED
physician prior to calling SAVES. A
mini-neuro exam is appropriate
but a full NIHSS exam is not.
H I G H L I G H T S F R O M T H E A L L S I T E S C A L L
T H E A R S A V E S C L O T B U S T E R O F T H E M O N T H
June’s Clotbuster of the month
comes from Ozark Health in Clin-
ton, AR.
Jill, RN and Dr. Pittman went
above and beyond for a patient
experiencing a very large stroke.
Jill demonstrated how to be atten-
tive while working quickly with a
difficult patient. she kept calm
while showing compassion,
knowledge and care.
Dr. Pittman was very kind to the
daughter, as well as the patient .
In addition to this patient, the ED
was busy as well as being in-
spected at the same time, yet he
still assisted with the NIH scale
and with care of t he family.
J U N E 2 0 1 1
P A G E 2
A R S A V E S U P D A T EA R S A V E S U P D A T E
U P C O M I N G
E V E N T S :
*ED’s PLACE
The Top 10 ED Com-plaints
Chris Melton, MD
July 7th at 0710
*ED’s PLACE
OB Emergencies
William Greenfield, MD
August 4th at 0710
In the United States, every 40 seconds someone has a
stroke.
Dr William Pittman accepting
Physician of the Year award
patient with intravenous t-PA.
Thus, not all intracranial hemor-
rhages are created equal. This is
where the clinical expertise of the
neurologist is needed for a judg-
ment call. The eventual question
is: Do the advantages of intrave-
nous t-PA administration exceed
the disadvantages? Also, the
presence of a ventricular shunt,
in my opinion, is not a contraindi-
cation to t-PA in a patient with an
acute ischemic stroke.
Having said all of the above, I
wish to remind the reader that a
patient with shunt or history of
intracranial bleed may have resid-
ual neurological deficits that in-
crease the NIH Stroke Scale
score. For this reason, it is impor-
tant for physicians and nurses to
determine whether the neurologi-
cal deficits in a patient who pre-
sents with an “alleged” ischemic
stroke are definitely worse than
those that the patient had at
“baseline.” This makes the
Early publications from the Na-
tional Institute of Neurological
Disorders and Stroke concerning
intravenous t-PA treatment of
acute ischemic stroke listed sev-
eral exclusion criteria. Chief
amongst those was history of
intracranial hemorrhage. How-
ever, experience over the past two
decades caused many stroke
experts to rethink the wisdom of
these rigid contraindications to t-
PA in patients who desperately
need it. The age of patients is no
longer restricted and most other
exclusions were relaxed depend-
ing on the clinical circumstances.
Exclusions were recently revisited
when a patient presented with
acute stroke symptoms and was
being evaluated for intravenous t-
PA therapy. Head CT scan re-
vealed craniotomy, encephalo-
malacia from an old contusion,
and intraventricular shunt. This
raised the question whether the
patient should be even consid-
ered for intravenous t-PA therapy.
Further history revealed major
head trauma with probable sub-
dural and brain hemorrhages
many years ago. We continued
the evaluation process and the
patient was not given t-PA be-
cause of low Stroke Scale score.
I agree with relaxation of previ-
ously imposed rigid exclusion
criteria, particularly those affect-
ing patients with intracranial hem-
orrhage. The subject is not clear
cut; brain hemorrhages have
numerous causes and a wide
spectrum of sequelae. For exam-
ple, if a patient had brain hemor-
rhage from AV malformation or
intracranial aneurysm, I would not
treat with intravenous t-PA for
fear of causing a fatal intracranial
bleed. However, if a patient had
traumatic subdural hematoma or
intracerebral hematoma more
than a decade ago and now pre-
sents with acute cerebral ische-
mia, then I will probably treat the
T H E R X P A D
P A G E 2
evaluation of the patient
more difficult because the
NIH Stroke Scale score may
have been greater than
zero before the recent dete-
rioration which is now being
blamed on an acute
ischemic stroke. Quantitat-
ing the neurological impair-
ment that is caused by
acute ischemic stroke in
any patient becomes more
difficult in the presence of
long-standing neurologic
impairment.
The moral of the story is
that the “clinical sense” of
physicians and nurses that
evaluate patients is para-
mount in deciding whether
intravenous t-PA should be
given or withheld.
Sami Harik, MD
T H E H O O K U P By Phillip Martin
A few reminders from IT:
• PLEASE always use your remote con-trol to move your camera! The cam-era is the most expensive, and impor-tant, piece of equipment on the tele-medicine cart so treat it with care.
• PLEASE check your batteries in your remote. They may be getting old or corroding and need to be replaced!
• PLEASE remember to send your test CT images weekly. If your radiology department wants to use the same scan for each week, make sure they change the date or name on that image. If not, the repository sees it as the same image and will not re-post it 501-686-8666
Physician Call Center
1-866-826-7362
For emergency transfers, press 9
For all other referring physician calls, press 1
L O O K I N G A H E A D Julie Hall-Barrow, EdD
Page 3 A R S A V E S U P D A T E
What an exciting three years. Since
November 1, 2008 to May 31, 2011,
AR SAVES has consulted on 575 pa-tients with 127 meeting criteria to receive t-PA. To date we have 27
spoke sites that are connected to the
AR SAVES tele-stroke network. We
have been able to increase access to
sub-specialty consults for rural and
urban Arkansans alike. According to
the American Heart and Stroke Asso-
ciation only 38.4% of the state popu-
lation was within a 60-minute drive in
an ambulance drive that was
equipped to provide acute stroke
care. Today, more than 90% of the
population is within a 60-minute
drive of acute stroke care. Although
this is a tremendous improvement,
there is still much work to be done.
The goal of AR SAVES is to be within
a 30-minute ambulance ride to acute
stroke care. Currently we are reach-
ing approximately 60% of the popula-
tion and leaves 40% for us to focus
on this next year.
The AR SAVES Second Annual confer-
ence was a huge success. We re-
ceived many great comments and
regret that as we grow we will have to
move the conference from scenic Mt.
Magazine to Little Rock. With growth
however comes success, and we
hope to attract many more physi-
cians and staff to next year’s confer-
ence. Please help me congratulate
the 2010 -2011 AR SAVES award
winners.
Washington Regional Medical
Center ~ Exceptional Facility of
the Year
Saline Memorial ~ Most Im-
proved Facility of the Year
Dr. William Pittman ~ Physician
of the Year
Rick Washam ~ AR SAVES Team
Member of the Year
Please continue to spread the
word of stroke awareness and
how your hospital is the BEST
place for patients to get to FAST.
D O N ’ T F O R G E T . . .
O U T A N D A B O U T
Community education specifi-
cally aimed at stroke appears
critical to reducing the time for
stroke patient’s arrival at AR
SAVES Tele-stroke site. Many
factors contribute to delays in
seeking treatment for stroke,
but the principal factor is lack
of public knowledge regarding
stroke signs and symptoms
and the need for rapid re-
sponse to those indicators.
At the 2nd Annual AR SAVES
Stroke Conference partici-
pants in the Community Edu-
cation Workshop were given
digital tool-kits with resources
for community stroke educa-
tion. Each person was able to
develop a 2011 Community
Outreach Plan for the next
seven months. These individual
plans included at least two
community outreach events per
month. The education events
could be either passive (ex.
bathroom posters, materials at
barber and beauty shops) or
active (presentations, health
fairs, etc.). Physician office
stroke education kits were also
distributed with order forms for
additional kits.
AR SAVES facilitators and their
teams are accepting the chal-
lenge of initiating specifically
targeted education regarding
stroke risk factors, stroke symp-
toms, and the appropriate re-
sponse to signs and symptoms
Page 4 P A G E 2
June's flower is the rose or hon-eysuckle
June's birthstone is the pearl, Alexandrite, or moonstone.
No other month begins on the same day of the week as June.
June 1, 1938– Superman comics are launched
June 2, 1935– Babe Ruth’s last baseball game
June 3, 1965– Edward White became the 1st American to walk in space
June 6– Dalai Lama– Tibetan spiritual leader was born
June 8– Frank Lloyd Wright-Architect was born
June 10– Judy Garland– actress, singer was born
June 11, 1979– John Wayne died
June 11– Jeannette Rankin– 1st woman elected to Congress
June 12– Anne Frank– Holocaust survivor, author was born
June 14, 1775– The US Army was founded
June 15, 1836– AR entered the Union
June 16, 1876– Mark Twain’s Tom Sawyer published
June 18– Paul McCartney– singer was born
June 18, 1983- Sally K Ride became America’s 1st woman in space
June 22, 1868– AR was readmit-ted to the Union
June 23, 1955– Disney’s Lady and the Tramp opened in Los Angeles, CA
June 26– Pearl S Buck-novelist was born
June 27– Helen Keller was born
June 30, 1936– Gone With the Wind was first published
Interesting Facts www.twitter.com/arsaves
Contact Stacy Pitsch for comments and/or suggestions at [email protected]
of stroke by calling 911.
As you plan your community
education campaign remember
one of the major goals of
stroke education is to decrease
the time from stroke symptom
onset to emergency depart-
ment. The challenge for your
AR SAVES Team is to give hope
to your communities that
“Stroke is an emergency and
stroke is treatable!”
T H E F R E S H M E N C L A S S
Five Rivers Medical Center
in Pocahontas is the 25th
site to join AR SAVES!
Five Rivers Medical
Center is a 50 bed hos-
pital with 3 ICU beds
available. The ED has a
total of 7 beds and sees
7600 patients annually.
The ED staff has been
treating Acute Ischemic
Strokes with tPA since
2003. Mandy Dollins,
RN, CNO and Danna
Guntharp, RN-CEN,
serve together as Nurse
Facilitators for this or-
ganization. Pamela
Smith serves as the IT
Facilitator. Dr. William
Lewis serves as Medical
Director.
Mandy Dollins, RN has
been the Chief Nursing
Officer at FRMC for 4
years. She has prac-
ticed as an RN for 14
years with 10 years ex-
perience as an ED Su-
pervisor, flight nurse,
patient care co-
coordinator and ED
staff nurse.
Danna Guntharp, RN is
the Nursing Supervisor
of the ED and has been
an RN for 12 years with
experience in Cardiac
Catheterization, OR,
Page 5 P A G E 2
Medical-Surgical Super-
visor and staff nurse,
and as a Nursing In-
structor.