telemedicine for acute neurological disease - gpt 2014
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Telemedicine for Acute Neurological DiseaseTo Boldly Go Where No One Has Beamed Before
Matthews Gwynn, MDAcuteCare Telemedicine
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Stroke Facts
• The 4th leading cause of death in the United States
• The #1 cause of adult disability in the United States
• 795,000 Americans suffer strokes each year• 87% of strokes are ischemic, 13% are
hemorrhagic• 134,000 deaths each year• 2,000,000 brain cells die every MINUTE
during stroke • Women are TWICE as likely to die from
stroke than breast cancer
• 6,400,000 stroke survivors (2% of U.S.)Connect to Quality 2
“Connect to Quality”
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Telestroke: Scientific Validation
• Audio/Video telemedicine evaluation of an acute stroke patient leads to better decision-making and safety than telephone only consultations
• The NIH Stroke Scale (NIHSS) via telestroke consult is reliable
• Neurologists can reliably interpret brain CT images to confirm the diagnosis of acute ischemic stroke and establishing eligibility for IV-tPA
• IV-tPA can be administered safely through telemedicine and with outcomes comparable to those observed in patients being treated at tertiary care centers
• Telestroke networks have been proven cost effective
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Case of Acute Stroke
• 46 yo woman developed dysarthria, right hemiplegia about 8:00 AM
• Quickly presented to Dale Medical Center• Teleneurologist responded 2 minutes after
receiving call and performed consultation immediately NIHSS=8
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Connect through remote presence
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Activase given at 9:10 AM after normal CT scan confirmed, and patient then transferred to Southeast Alabama Medical Center
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MRA of Brain--Left M1 stenosis
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Discharged 4 days later with only mild expressive aphasia
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Stroke Mimic• 57 yo man developed lower extremity
numbness and weakness 2 days before presentation to local ER in Tennessee. Upper extremities, bowel and bladder normal.
• URI 2 weeks beforehand• NE showed hyporeflexia with assistance
from PA on site• BLE 4/5 weakness, especially proximally• Diminished light touch and pain sensation
from T12 on trunk down• Able stand only with assistance
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DIAGNOSIS?
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“Connect to Quality”
Sampling of Client HospitalsGeorgia
Alabama
Tennessee
South Carolina
Florida
ArizonaPending
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* In partnership with Eagle Physician Group
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Thank You