👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...
Stroke continuum ceu_ 2010_website
1. The Stroke Continuum from a Public Health Perspective: an online presentation MA Department of Public Health 2010
2. The Stroke Continuum Prevention Recognition 9-1-1 Emergency Medical Services Emergency Department Inpatient Hospitalization Rehabilitation Re-integration to the Community
3.
4.
5. Blood Supply to the Brain Each artery supplies blood to specific areas of the brain. Stroke occurs when one of these arteries to the brain either is blocked or bursts. Source: National Stroke Association
15. The Stroke Continuum Prevention Recognition 9-1-1 Emergency Medical Services Emergency Department Inpatient Hospitalization Rehabilitation Re-integration to the Community
16.
17.
18. Awareness, Treatment and Control of High Blood Pressure by Age NHANES: 2005-2006. Source NCHS and NHLBI
24. Obesity Trends Among U.S Adults, 2005 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
25.
26. NHANES, 1971-74, 1976-80, 1988-94 and 2001-2004). Source: Health, United States, 2006, NCHS. Overweight and Obesity in US Children and Adolescents
27.
28.
29.
30.
31.
32. The Stroke Continuum Prevention Recognition 9-1-1 Emergency Medical Services Emergency Department Inpatient Hospitalization Rehabilitation Re-integration to the Community
33.
34.
35.
36.
37.
38.
39.
40.
41. The Stroke Continuum Prevention Recognition 9-1-1 Emergency Medical Services Emergency Department Inpatient Hospitalization Rehabilitation Re-integration to the Community
42.
43.
44.
45. The Stroke Continuum Prevention Recognition 9-1-1 Emergency Medical Services Emergency Department Inpatient Hospitalization Rehabilitation Re-integration to the Community
46.
47.
48.
49. Meta-Analysis of the major IV tPA trials shows clear benefit up to 3 hrs and NOW beyond Lancet, 2004; 363: 768–74 NINDS 12% ECASS3 7%
61. The Stroke Continuum Prevention Recognition 9-1-1 Emergency Medical Services Emergency Department Inpatient Hospitalization Rehabilitation Re-integration to the Community
62.
63.
64.
65.
Notes de l'éditeur
It is very important to understand that stroke does not occur in isolation. It is not just a problem that concerns the person having a stroke and the healthcare providers taking care of the person. Stroke is a public health issue and involves many people, including each of us, in various roles throughout the stroke continuum. This presentation provides an overview of the various components of the stroke continuum.
Injury or death of brain tissue from oxygen deprivation; usually interruption of blood flow A stroke is the rapidly developing loss of brain function(s) due to a disturbance in the blood supply to the brain. When a stroke occurs, lack of oxygenation kills brain cells in the immediate area.
The brain needs a constant supply of blood, which carries the oxygen and nutrients it needs to function. Each artery supplies blood to specific areas of the brain. A stroke occurs when one of these arteries to the brain either is blocked or bursts. As a result, part of the brain does not get the blood it needs, so it starts to die.
The human brain is divided into several areas that control movement and sensory function, or how the body moves and feels. Think of it this way, the heart is the engine of the body; and the brain is the computer central processing unit (CPU). This is a picture of the left side of the brain and shows some of these areas. When a stroke damages a certain part of the brain, that area may no longer work as well as it did before the stroke; and, it can cause problems with walking, speaking, seeing or feeling. The right side of the brain controls the movements and feelings on the left side of the body and determines how artistic we are, including musical and creative talents.
If an artery leading to the brain, or inside the brain, becomes blocked for a short period of time, the blood flow to an area of the brain slows or stops. This lack of blood (and oxygen) can cause a Transient Ischemic Attack (TIA) or mini-stroke, with symptoms such as numbness, trouble speaking, and loss of balance or coordination. These symptoms last for a very short period of time (less than 24 hours although newer recommendation <1 hour) and then disappear. While TIAs cause no permanent brain damage, they are a serious warning sign of stroke and should not be ignored. **NSA website- traditional TIA – symptoms<24 hours; new recommendation TIA symptoms<1 hour**
Ischemic stroke is the most common type of stroke. It occurs when a blood clot blocks an artery, cutting off the flow of oxygen-rich blood to a part of the brain. Unless nearby blood vessels can deliver enough blood to the affected area, brain cells begin to die causing the person to have difficulty using certain parts of their body or completely lose some abilities.
Embolic A blood clot or plaque fragment forms somewhere in the body ( usually the heart or in the large arteries leading to the brain ) and moves through the bloodstream to the brain. People with atrial fibrillation (when the heart beat is irregular) are at increased risk of having an embolic stroke; and usually need to be on a blood thinner to prevent the formation of a blood clot in the heart that could potentially travel to the brain and cause a stroke. Thrombotic A blood clot that does not travel but forms inside an artery supplying blood to the brain.
Strokes caused by a bursting blood vessel in the brain are called hemorrhagic strokes. Although only about 15-20% of all strokes are hemorrhagic, the death rate from hemorrhagic stroke is high.
In the United States, stroke is the 3 rd leading cause of death and the #1 cause of disability. Approximately 780,000 people will suffer a new or recurring stroke this year; about 600,000 are first attacks and 180,000 are recurrent attacks; it is estimated that 500,000 of them could have been prevented. The risk of stroke increases with age, but men and women of any age can have a stroke; for example, Tedy Bruschi (former New England Patriot) at age 30 and Sharon Stone (actress) at age 43 had strokes. The incidence of stroke in children is relatively low; about six strokes in every 100,000 children per year and, at least one-third of them occur in newborns.
Stroke is the leading cause of adult disability in the U.S. References: CDC: Centers for Disease Control and Prevention (CDC). Stroke Fact Sheets, 2010 AHA : American Heart Association. Heart Disease and Stroke Statistics 2010 Update. Dallas, TX: Circulation. 2010;121:e1-e170.)
Now that you have basic information about stroke, we will go through each of the components of the stroke continuum beginning with prevention.
There are a number of risk factors that can lead to stroke – some cannot be changed and others are modifiable. Reducing or eliminating these risks will significantly decrease the risk of having a stroke. Of the risk factors listed, what do you think is the number one controllable risk factor of stroke?
High blood pressure is the #1 risk factor for stroke. High blood pressure is often called the “silent killer” because it doesn’t have any symptoms.
This slide shows how various age groups – the red is for the 20-39 years old; the blue represents the 40-59 years old; and the cream colored is for the 60+ years old - and the percent who are aware of HBP, treated for HBP, and have their HBP controlled. Even people who are being treated do not have their blood pressure adequately controlled. It is important to have and achieve a BP goal.
This slide breaks down HBP statistics by age and by gender. Interestingly, younger men are more likely to have HBP than younger women until they age and then women overtake men. Also, note the percent of younger adults with HBP 16% of men 35-44 and 28% of men 45-54. We do not think of HBP as a younger person’s condition and yet almost ¼ of men 35-54 have HBP.
This slide shows Trends for High Blood Pressure in Adults ages 35 and older: by race/ethnicity and gender. In this slide you can see that for each race and gender, the prevalence of high blood pressure has generally been increasing over time. Non-Hispanic black men and women have higher rates of high blood pressure than White or Hispanic men and women.
Being more than twenty pounds overweight increases the risk of having a stroke, heart attack and dementia. Being overweight or obese, lack of physical activity and poor diet are risk factors for many chronic conditions, including diabetes and heart disease. Body Mass Index overweight more than 25 and below 30; obese 30 or higher.
The next few slides show obesity trends over a 10-year period from 1995 – 2005. In 1995 we have shades of blue with the highest category 15-19% of the adults in the state in the obese category.
In 2000, we add a new category-the cream color shows that 20% or greater of the adult population in the state are obese. In this slide, Colorado is the only state remaining in the 10-14% range.
Since 2000 there are now 2 more categories of obesity added to the map – orange 25-29% of the adult population and red 30% or greater. The states with the highest rates of obesity are West Virginia, Louisiana, and Mississippi. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980. Colorado remains the leanest state in the US although their obesity rate is increasing rapidly. Hawaii, Vermont, and Connecticut are other states with lower rates of obesity. MA is 5 th leanest state, with 21% of the adult population classified as obese.
In MA. 7.4% of adults have been diagnosed with diabetes. People with diabetes are two to four times more likely to have a stroke. Good management of diabetes includes eating healthy, being physically active, and maintaining good control of blood sugar, blood pressure, and blood lipids.
You may have read or heard about the big concern about obesity in children. The light blue color shows the significant increase in the % of children and adolescents who are overweight or obese. We are also beginning to see an increase in the number of adolescents diagnosed with type 2 diabetes. Since type 2 diabetes in children is a new phenomenon, public health officials worry about the effects of type 2 diabetes on childbearing and on the development of diabetes complications occurring at a much younger age such as early adulthood. CDC estimates that if current trends continue, of the children born in 2000 1 of 3 will have diabetes during their lifetime; for Hispanic and African American children the prediction is even worse – 1 in 2.
People with high blood cholesterol have an increased risk for stroke. Also, it appears that low HDL (“good”) cholesterol is a risk factor for stroke in men, but more data are needed to verify its effect in women. AHA
Exposure to tobacco: Exposure to tobacco smoke by others increases the risk of heart disease and stroke. (CDC) Cigarette smoking has been linked to the buildup of fatty substances in the carotid artery, the main neck artery supplying blood to the brain. Blockage of this artery is the leading cause of stroke in Americans. Also, nicotine raises blood pressure; carbon monoxide reduces the amount of oxygen blood can carry to the brain; and cigarette smoke makes blood thicker and more likely to clot. By quitting, at any age, the risk of lung disease, heart disease, and a number of cancers including lung cancer is reduced. (NINDS)
Alcohol abuse can lead to multiple medical complications, including stroke. For those who consume alcohol, a recommendation of no more than two drinks per day for men and no more than one drink per day for non-pregnant women best reflects the state of the science for alcohol and stroke risk. American Heart Association
Drug addiction is often a chronic relapsing disorder associated with a number of societal and health-related problems. Drugs that are abused, including cocaine, amphetamines and heroin, have been associated with an increased risk of stroke. Strokes caused by drug abuse are often seen in a younger population. AHA
We move along the stroke continuum to recognition of the signs and symptoms of stroke and the importance of calling 9-1-1.
According to the BRFSS…
The MA Department of Public Health developed the FAST campaign to increase public awareness of stroke signs and symptoms. The FAST acronym was adapted from the Cincinnati Pre-Hospital Stroke Scale - accounts for the majority of strokes (ischemic).
For community education purposes – time is added to show what to do in the event of these signs.
FAST: (FACE) Ask the person to smile. When a person tries to smile the difference between the affected side of the face and the unaffected side will be much more obvious, as you can see in this picture. Weakness can cause sudden drooling or numbness. You may see the person touching their face or lips, trying to ‘feel’ their face.
FAST: (ARM) Ask the person to raise both arms. If one arm drifts down, or if it won’t go up at all, the part of the brain that controls that arm is being affected. Ask them to close their eyes. May first notice something wrong when the person having a stroke drops something, has difficulty putting on a sweater or difficulty writing. They may complain of numbness in the arm. The leg on the same side may also be affected, first noticed when the person stumbles or has difficulty standing or walking. If you notice stumbling, do the arm test to determine if there is weakness on one side of the body.
FAST: (SPEECH) To see if speech is being affected… Ask the person to repeat a simple phrase, for example ‘the sky is blue’. Does it sound normal? Or is it slurred, confused or jumbled? Show the person a common object and ask them what it is. A stroke can affect speech in different ways. The speech may be slurred, the person may sound drunk or they may speak clearly but without making sense. Words may be jumbled… The person may not understand what other people are talking about or they may suddenly forget how to read or write. You may be able to communicate verbally with a person having a stroke by asking them to sing the answers to your questions. It is not enough to ask if they are okay.
FAST: (TIME) Any of the symptoms mentioned can indicate that the brain has been injured and it’s important to take them seriously. It’s an emergency… That means it’s time to call 9-1-1. Every minute that goes by, more brain cells die. These cells will not come back. Depending on where in the brain the stroke happens, the ability to do certain things dies along with the cells. The sooner you call 9-1-1 to get to the emergency room, the more brain cells you can save. Going in an ambulance is the best way to save time and brain cells.
Other stroke signs and symptoms that a person may experience themselves and are not generally observed by others. The “suddens” also include signs and symptoms of hemorrhagic stroke, which are not covered by the FAST acronym.
After recognition, the next step along the stroke continuum is the importance of calling 9-1-1, emergency medical services and transport to the emergency department.
Calling 9-1-1 and arriving by ambulance improves outcomes for patients suffering stroke symptoms. dispatchers and EMTs are trained to recognize the signs and symptoms of stroke. they communicate with the hospital emergency department to activate stroke alert so that hospital staff is prepared when the patient (ambulance) arrives saving valuable time Stroke patients are 3 times more likely to receive tPA if they arrive by ambulance than private car. In Massachusetts, ~60% of suspected stroke victims arrive by ambulance.
Time is of the essence when dealing with stroke. Time lost = brain lost. Treatment can reduce stroke damage. Why is there such a delay for people to get to the hospital? There are several reasons: 90% of strokes do not cause pain. The symptoms can appear or disappear after just a few minutes. The person having a stroke is often unaware that anything is wrong, or unable to communicate. And sometimes symptoms of stroke occur while the person is sleeping. Observers may not realize that the problem is serious. They may think that the person is drunk, clumsy or having a senior moment.
The Massachusetts Department of Public Health and the Office of Emergency Medical Services have collaborated to improve the knowledge and awareness of stroke symptoms by emergency dispatchers and EMTs.
The next components along the stroke continuum - Emergency Department and Inpatient Hospitalization
Assure hospitals have systems in place to accurately diagnose and treat Assure data available to monitor system performance Voluntary; want all hospitals to qualify for PSS; review process Emergency diagnostic and therapeutic services provided by a multidisciplinary team Available 24 hours per day, 7 days per week to patients presenting with symptoms of acute stroke
Recombinant = genetically engineered The window for tPA administration has been increased to 4.5 hours. Still, time is of the essence since brain cells continue to die every minute that treatment is delayed.
Need Refs
Institutional attitude and support – includes providing the needed resources to administer tPA timely.
Massachusetts was one of the first states to work with CDC on developing the Coverdell stroke registry. Currently, six state health departments are funded to participate – GA, MA, MI, MN, OH, NC.
In 2007, The Joint Commission, the Paul Coverdell National Acute Stroke Registry and American Heart Association/American Stroke Association Get with the Guidelines SM harmonized stroke performance measures (Disease-Specific Stroke Performance Measure Set) for all 3 programs.
Collaboration between MDPH, ASA, and PSS Hospitals – QI – focus on quality improvement, standardized performance measures, and systems changes.
Room for improvement
Focus on trends over time Dysphagia, stroke education, and tPA use
For the last 2 components – rehabilitation and re-integration to the community, we will combine the 2.
There are currently many initiatives in Massachusetts to improve the transition of care from the acute care hospital to primary care. After rehabilitation, we move to the re-integration back into the community and then the cycle repeats itself again. Unfortunately, there is an increased risk of re-occurring stroke so it is especially important for stroke survivors, their families, and healthcare providers to work together to reduce the risk for a recurring stroke.
Please take a few minutes to complete the evaluation form.
