He and the staff had been forewarned by the emergency medical technicians who were transporting Ellertson that he had suffered the stroke just a half hour ago. Kornhauser knew the patient could not communicate and could not move his right side. Precise timing is essential to using TPA, and Kornhauser, assisted by ER trauma staff nurses Michele Schmitz and Carl Alberti, set the hospital's TPA protocol in action for the very first time. Knowing when symptoms first started is just the first step in determining if a particular patient should have TPA therapy. The number of stroke patients who can have this treatment is actually rather low.
Most people wake up with stroke symptoms with no idea of when the symptoms began during the night.
When that happens, medical staff can't consider using TPA because they don't know for sure if the stroke began in that three-hour window. Doctors see the devastating effects of strokes, but when they can intervene and prevent serious damage and accomplish something that will tremendously impact the quality of life for the patient, it is exciting and rewarding. As with any drug therapy, there are risks. And the risks are high with TPA because of the drug's tremendous ability to dissolve clots. Medical staff must be absolutely certain that the stroke does not involve intracranial bleeding and that the patient does not have a history of bleeding problems or high blood pressure.