As per your request, I have reviewed Aaron Green’s medical care rendered from 4/29/15 to 6/10/15 to determine if Mr. Green would have been a candidate for drugs to combat his stroke if he had received medical care sooner. Signs and symptoms of stroke include sudden numbness or weakness in the face, arm, or leg, especially on one side of the body, confusion, trouble speaking, or difficulty understanding speech, trouble seeing in one or both eyes, trouble walking, dizziness, loss of balance, or lack of coordination, or a sudden severe headache with no known cause. The risk factors for stroke include hypertension, cigarette smoking, heart disease, diabetes, cholesterol imbalance, inactivity and obesity. During a stroke every minute counts, requiring fast treatment to reduce the potential brain damage. (NINDS, 2016) The only FDA approved treatment for ischemic strokes is tissue plasminogen activator. TPA works by dissolving the clot and improving blood flow to the part of the brain being deprived of blood. If administered within 3 hours (and up to 4.5 hours in certain eligible patients), TPA may improve the chances of recovering from a stroke. (ASA, 2013) Reviewed Records: • Saint Francis Hospital 4/29/15- 6/10/15 Past Medical History: • Heavy Smoker-One pack a day • Hypertension • Back Surgery Summary of the Medical Events This is a case about a 53-year-old, welder from Oklahoma.
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On 4/29/15, Mr. Green smashed his index finger under a cement pipe while at work. Subsequent, to injuring his finger, he became pale, sweaty and passed out while at work. His employer called his wife and she picked him up from work. While at home, making his lunch, Mr. Green passed out again, which prompted his wife to call EMS (emergency medical service). On 4/29/15 at 1:32 pm, EMS brought Mr. Green to the emergency department of Saint Francis Hospital.
On 4/29/15 at 1:32 pm, RN Arnold documented that Mr. Green had a chief complaint of syncope just prior to falling and bumping into the wall. RN Arnold documented Mr. Green’s last seen normal was 30 minutes ago and Mr. Green had left-sided hemiparesis (weakness on one side of the body).
On 4/29/15 at 2:07 pm, RN Paul documented that EMS reported at 13:00 Mr. Green was talking with his family when he developed a sudden onset of left-sided weakness and started leaning to the left and fell. Mr. Green stated he was light-headed, but he denied LOC (loss of consciousness). On 4/29/15 at 3:06 pm, RN Paul documented that Mr. Green’s girlfriend was at the bedside and stated Mr. Green "smashed his finger at work and passed out, she picked him up at work and he wasn't acting right". RN Paul documented Mr. Green’s girlfriend also reported Mr. Green passed out at home then she called EMS. On 4/29/15 at 3:32 pm, Emergency Department Physician, Dr. Phillips documented according to EMS, Mr. Green had a last seen normal time of 1:00 pm. Dr. Phillips admitted Mr. Green as a stroke alert with complaints of a sudden onset of left-sided weakness. Dr. Phillips documented he accompanied Mr. Green immediately to CT. Dr. Phillips documented Mr. Green did not remember exactly when he started feeling weak, however, EMS stated that he came home from work normal at 1:00 pm. Mr. Green denied any localizing or radiating pains, fevers or chills, cough or cold symptoms, abdominal pain, chest pain, nausea, vomiting or diarrhea. Dr. Phillips documented Mr. Green reported he accidentally smashed his finger at work, but Mr. Green denied any other injuries. Dr. Phillips documented Mr. Green was light-headed, but he denied LOC (loss of consciousness). Dr. Phillips documented under assessment of extremities there was no injury and no concerning deformity. Dr. Phillips documented Mr. Green had a stroke scale score of 7 and Mr. Green met inclusion criteria for peripherally administered TPA (tissue plasminogen activator). However, Dr. Philips documented Dr. Kilpadikar called with the result of the CT and stated that there appeared to be a hyperdense MCA (middle cerebral artery) sign. Dr. Philips documented with those findings, Mr. Green did meet relative contraindication for peripheral TPA. Therefore, Dr. Phillips documented while at the bedside, he discussed these findings with Mr. Green and his sister. Dr. Phillips documented Mr. Green remained hemiplegic on the left side
On 4/29/15, Mr. Green smashed his index finger under a cement pipe while at work. Subsequent, to injuring his finger, he became pale, sweaty and passed out while at work. His employer called his wife and she picked him up from work. While at home, making his lunch, Mr. Green passed out again, which prompted his wife to call EMS (emergency medical service). On 4/29/15 at 1:32 pm, EMS brought Mr. Green to the emergency department of Saint Francis Hospital.
On 4/29/15 at 1:32 pm, RN Arnold documented that Mr. Green had a chief complaint of syncope just prior to falling and bumping into the wall. RN Arnold documented Mr. Green’s last seen normal was 30 minutes ago and Mr. Green had left-sided hemiparesis (weakness on one side of the body).
On 4/29/15 at 2:07 pm, RN Paul documented that EMS reported at 13:00 Mr. Green was talking with his family when he developed a sudden onset of left-sided weakness and started leaning to the left and fell. Mr. Green stated he was light-headed, but he denied LOC (loss of consciousness). On 4/29/15 at 3:06 pm, RN Paul documented that Mr. Green’s girlfriend was at the bedside and stated Mr. Green "smashed his finger at work and passed out, she picked him up at work and he wasn't acting right". RN Paul documented Mr. Green’s girlfriend also reported Mr. Green passed out at home then she called EMS. On 4/29/15 at 3:32 pm, Emergency Department Physician, Dr. Phillips documented according to EMS, Mr. Green had a last seen normal time of 1:00 pm. Dr. Phillips admitted Mr. Green as a stroke alert with complaints of a sudden onset of left-sided weakness. Dr. Phillips documented he accompanied Mr. Green immediately to CT. Dr. Phillips documented Mr. Green did not remember exactly when he started feeling weak, however, EMS stated that he came home from work normal at 1:00 pm. Mr. Green denied any localizing or radiating pains, fevers or chills, cough or cold symptoms, abdominal pain, chest pain, nausea, vomiting or diarrhea. Dr. Phillips documented Mr. Green reported he accidentally smashed his finger at work, but Mr. Green denied any other injuries. Dr. Phillips documented Mr. Green was light-headed, but he denied LOC (loss of consciousness). Dr. Phillips documented under assessment of extremities there was no injury and no concerning deformity. Dr. Phillips documented Mr. Green had a stroke scale score of 7 and Mr. Green met inclusion criteria for peripherally administered TPA (tissue plasminogen activator). However, Dr. Philips documented Dr. Kilpadikar called with the result of the CT and stated that there appeared to be a hyperdense MCA (middle cerebral artery) sign. Dr. Philips documented with those findings, Mr. Green did meet relative contraindication for peripheral TPA. Therefore, Dr. Phillips documented while at the bedside, he discussed these findings with Mr. Green and his sister. Dr. Phillips documented Mr. Green remained hemiplegic on the left side