The Right Call; the Best Outcome
Prad Sabharwal was at home talking on the telephone with his brother early one morning when his right hand suddenly went numb. Within minutes, the 56-year-old St. Louisan couldn’t move his arm at all and then, just as sudden, his right leg also wouldn’t move. Sabharwal hung up the phone and called his wife, Kelly, who had just left the house to meet a friend for breakfast.
“I couldn’t understand him at all because he couldn’t talk,” said Kelly. “He was slurring his words. I kept asking him if he was all right and he finally said no. I called 9-1-1 immediately.”
Only a few blocks away, Kelly raced home and was startled when she walked in the door to see her husband’s face drooping on one side. As she reached out, she realized he couldn’t even squeeze her hand.
“The paramedics who came in right after me said it was probably a stroke,” Kelly said. “It all happened so fast. One of them handed me a card and told me to immediately follow the printed instructions before I tried to follow them to the hospital.”
The card directed her to call the Emergency Department at Barnes-Jewish Hospital and say a pre-printed sentence: I’m calling with an ambulance stroke card. May I speak to the stroke doctor?
Immediately she was put in direct contact with a stroke specialist who took a brief medical history and verified the time stroke symptoms started. Simultaneously, the paramedics in the ambulance alerted the hospital to have a stroke team waiting for their arrival.
“Time is so critical,” explained David Carpenter, MD, medical director of clinical stroke services at Washington University. “The sooner we can diagnose and start treatment, the better the patient outcome.”
A stroke occurs when blood flow, and therefore oxygen, is cut off from an area of the brain. It can occur when there’s a clot blocking a blood vessel or when a blood vessel actually bursts in the brain. In either case, brain cells begin to die off within minutes of not receiving oxygen. In addition, for cases in which there’s a blood clot, the use of a clot-busting drug called tissue plasminogen activator, or tPA, only is effective within a short timeframe from the onset of a stroke. The bottom line—in identifying stroke patients, every second counts.
“The old process of evaluating a patient once they came into the emergency room took a lot of time,” explained Dr. Carpenter. “We wanted to shrink that timeframe, so a tremendous effort was put into streamlining our evaluation process within the emergency room for patients arriving with suspected stroke. We also worked with emergency medical service providers in our region and created a comprehensive stroke network. They alert us before a potential stroke patient even arrives.”
The use of the Ambulance Stroke Card that is given to a family member cuts the time needed for verification of stroke onset. Five years ago, Dr. Carpenter noted that the “door to needle” time for the administration of tPA was 60 minutes. Today, that time has been cut in half.
Sabharwal was diagnosed with a large blood clot within minutes of his arrival. In addition to receiving tPA, he underwent an endovascular thrombectomy, a procedure to remove the clot using a catheter inserted into the blood vessel.
“I remember the neurologist showing me an image of Prad’s blood clot before and after the procedure,” said Kelly. “He said my husband was very lucky and that the procedure was successful. When I finally went to see Prad in the ICU during recovery, he started to talk to me and I thought to myself, oh my goodness, I can understand what he is saying again.”
Sabharwal began inpatient rehabilitation involving speech, physical and occupational therapy. He was then transferred to the Rehabilitation Institute of St. Louis for continued outpatient therapy to restore his balance and improve his speech and swallowing. “I passed my driving and thinking tests fairly quickly,” he said proudly. “The droopy eye went away after a few weeks and, although I have some memory shortfalls, I was able to successfully return to my work. I’ve truly been amazed by the whole process of stroke recovery.”
Sabharwal is the perfect example of why everyone should act fast if they think a stroke is occurring. “I was very lucky,” he said, almost six months after his November 2015 stroke. “I don’t have any major cognitive or physical problem that is apparent. That’s pretty amazing to both me and my doctors.”
In fact, so successful has been Sabharwal’s recovery that the hospital stroke team invited Prad, Kelly and the paramedics to speak at a stroke symposium two months after the stroke.
Said Kelly, “It was wonderful to see everyone all together. Our doctor told me there are usually only two outcomes with a severe stroke like Prad’s. He said either you are not here anymore or you are severely disabled. He was quite emotional because he said Prad truly represented the third option—the successful outcome because we moved fast and so did the paramedics and the stroke team.”
“It’s a success story all the way around,” agrees Dr. Carpenter. “Whenever there are signs of a stroke, don’t wait and think about it or try to drive yourself to a hospital. Time is critical. Call 9-1-1. We actually can get the ball rolling faster if you call them first.”
Category: Neurology & Neurosurgery