Kootenai | Kootenai Health | Issue 2, 2022

By Kim Anderson The human brain is a marvel. It stores our memories and controls our movements. It is the source of our thoughts, emotions and language. Although it makes up only 2 percent of our body weight, it uses 20 percent of the oxygen we breathe. When something, such as a blood clot, stops the flow of oxygen-rich blood to the brain, the impact is swift and serious. “Each minute your brain is deprived of blood flow, 1 million neurons in your brain die,” said Kate Knight, RN, stroke coordinator at Kootenai Health. “Every minute that passes when someone is having a stroke is critical to save brain tissue.” Acting fast “When we talk about saving 1 million neurons every minute, people often ask how many neurons are in the brain,” said neurologist Ramsis Benjamin, M.D., medical director of Kootenai Health’s stroke program. “There are about 3 trillion neurons in the brain; the same as the number of stars in the universe.” It’s a clinical fact with tremendous personal impact. One that Arlys Brown experienced firsthand. This past November, she and her husband, John, were at home when Arlys noticed she was having trouble getting up from the dining room table. John helped her up and was taking her to the bedroom to lie down. He knew something was not right. “John called a friend and former neighbor, George Schick, and asked him to come over,” Arlys said. “He and his wife came right away. The minute George saw me, he knew I was having a stroke. His mother had had one.” Within minutes, Arlys was in an ambulance on her way to Kootenai Health. “They got me going right away. Everyone did their job fast,” Arlys said. She was familiar with hospitals, having worked as a nurse’s aide in high school, but it was the first time she had ever been hospitalized. Clot-bustingmedications Just 40 minutes after Arlys’ arrival, she was given alteplase, an enzyme that works to break up and dissolve blood clots that can block arteries. It is used to treat both strokes and heart attacks so blood flow can be restored. “Alteplase goes to the clot and immediately begins to dissolve it,” Dr. Benjamin said. “It is most effective when given within the first three hours of a stroke, although under the right circumstances it can still be helpful up to four and a half hours later.” Arlys was admitted to Kootenai Health’s intensive care unit. Nurses on the unit have received special training in the care of stroke patients. All the resources needed to provide that care are available in the patients’ rooms. During admission, Arlys was evaluated by specialists in neurology, hospital medicine, speech and language pathology, physical therapy and occupational therapy. She also received lab work and imaging studies to help her care team provide the most effective and comprehensive care possible. Six days later, when Arlys was discharged, her assessments showed she had no lasting effects from her stroke. Anewstandardof care Recently, Kootenai Health became just the second facility in the state of Idaho to receive approval to also begin using a different medication, tenecteplase, to treat strokes. Tenecteplase has been used for years as a clot-busting medication to treat heart attacks. Physician scientists have considered also using it for treating stroke patients for years. They now have enough well-researched evidence to support that use. “Tenecteplase is more fast-acting than alteplase, so this is a real benefit to patients,” said Dr. Benjamin. “Alteplase can take an hour to reach the clot and break it down, but tenecteplase can be given through a vein, so it can reach the clot and begin to work in just 10 minutes. Every minute we save is 1 million neurons we save. Since receiving approval this January, tenecteplase has become our new standard of care for stroke at Kootenai Health.” Today, Arlys is back to doing the things she loves. When thinking about her experience, she said, “I was lucky! I had excellent care; I feel fine now.” Swift � Serious The highest standard of stroke care— when every minute matters 6