How telemedicine helped a stroke patient

My attending doctor (a neurologist) and I were sitting at the nurses’ station discussing a patient who had presented with a seizure when his pager beeped.

“Hold on, I have to call this in”, he said. I listened to snippets of the conversation. “How long has he been like that?” “How far away is the helicopter?” “Alright, let me run to my office and set up my equipment.”

He hung up the phone and got out of his chair while I jumped up to follow. “That was Small Community Hospital,” he said. “They have a suspected stroke patient.” We jogged down the stairwells and across the skyway that connected the office building to the main hospital, making it to his office in short order. There he showed me the stroke network tele-medicine computer that had been set up there. We fired it up and he put on his headset. Within a minute or two, we had video and audio feed of the ER bed at Small Community Hospital where our patient lay.

My preceptor proceeded to examine to the patient, asking him what had happened, if he was able to move various parts of his body, etc. Turns out the patient had aphasia, or an inability to speak. This was his biggest symptom, though he also had partial paralysis of some parts of his body. We got most of the story from his wife. We asked questions about what had been going on, his past medical history, what medications he was on, etc, while the nurses at the hospital took the blood for the necessary lab tests.

To cut the long story short, we ended up deciding that he was a good candidate for tPA, a strong clot-buster that should minimize the effects of his stroke. Medflight showed up and loaded him up for flight to our main hospital while they mixed up the tPA. Given the age and condition of this gentleman, tPA was required to be given with the first 3 hours after his symptoms began.  Using tele-medicine, the decision was made in just over 2 hours. If tele-medicine had not been available, he might have exceeded the 3 hour window by the time he had been flown in.

With the timely intervention of a large network of healthcare providers working together, there’s a good chance he’ll regain his ability to speak. Job well done, everyone.

“Doctor” Matt is a medical student who blogs at “Doctor” Matt’s Musings.

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  • Ólafur Pálsson

    Loved the remote consult. I’m wondering though, unless the tPA takes considerable time to get ready, was there really any time saved since he had to fly to Main Hospital for administration?

  • Matthew Gibson

    A great question! The tPA was actually mixed up and started at the local hospital, and was running during the helicopter flight to the main hospital.