By Anthony Ferroggiaro, MD, MHA, FACEP, Assistant Professor of Emergency Medicine at OHSU, Department of Emergency Medicine Medical Director at CMH Emergency Department
I am pleased to be working with CMH and OHSU in providing emergency care to Astoria and the surrounding communities, including an emergency system that provides a high level of stroke assessment and treatment.
At Columbia Memorial Hospital we have board-certified emergency physicians who are trained to recognize stroke symptoms and provide rapid emergency care. Two more physicians started working in the emergency department in July. Dr. Kim Imbesi joined us from the University of Pennsylvania and Dr. Shannon Lee joined us from Oregon Health and Science University. Both have comprehensive training in trauma and critical care including the management of heart attacks and stroke.
Our emergency department has an established protocol for potential stroke patients. Usually we meet the patient and the EMS crew, when we receive pre-arrival notification, at the emergency department entrance and complete a rapid neurological history and exam. At that time, we decide whether the patient, still on the ambulance gurney, will receive immediate CT imaging. We use advanced CT imaging that identifies vessels and clots as well as bleeding in the brain.
When the patient returns to the Emergency Department often the OHSU stroke neurologist has the opportunity through telemedicine, a two-way video system, to evaluate and interact with the patient, assessing the patient’s speech, movement of arms and legs and completing other focused tests. The neurologist can also review the CT images obtained at CMH and sent to OHSU.
After a review of the images and telemedicine exam, the stroke neurologist may request a patient transfer to OHSU by ground ambulance or by helicopter. In some cases, prior to transport to OHSU, thrombolytic (clot busting) medications are given in the CMH Emergency Department. The decision to give thrombolytics is dependent on the type of stroke and other circumstances of the presentation. Patients and the patient’s family are part of the decision-making team because the thrombolytic treatment has some risk of causing bleeding.
Unfortunately, many strokes are not identified in the community. It is our hope that the Emergency Department could receive the patient early during his or her stroke such that we could provide maximum treatment and hopefully reverse or limit the stroke injury. Any health question, even some concern that seems minor to a patient, could be an emergency so we encourage anyone with possible stroke symptoms to seek care immediately.
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