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 sapitsch@uams.edu

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.

2011 AR SAVES Conference at Mt Magazine

2011 Strike Out Stroke night with the Travelers