A Typical Patient's Journey: Stroke Care at DHMC

Know the warning signs

• Sudden numbness or weakness
• Sudden confusion, trouble speaking
• Sudden trouble seeing
• Sudden trouble walking, dizziness
• Sudden severe headache
• Call 911
• Because Time Lost is Brain Lost

Pre-hospital care

• Ischemic stroke symptoms develop
• Ambulance called and responds
• Patient transported to Dartmouth-Hitchcock Emergency Department (ED)
• "Stroke Alert" called to notify Stroke Team to come to ED

Hospital care at Dartmouth-Hitchcock

Emergency Department

• Immediate assessment by ED staff upon arrival of patient
• Stroke Team arrives
• Initial diagnostic testing: blood test, CT scan
• Initial therapeutic medications administered (if indicated)

Inpatient admission

• Patient arrives on Stroke Unit
• Daily clinical care measures to prevent complications
• Additional diagnostic testing performed: vascular studies, MRI, ultrasound of heart
• Assessment of functional impairment and rehabilitation needs
• Education of patient and family begins

Preparation for after-hospital care

• Multi-disciplinary team develops a plan with the patient and family for discharge and rehabilitation care (clinical resource coordinator, physician, nurse practitioner, nurse, social worker, rehabilitation specialists)
• Medication treatment is initiated to prevent another stroke and reduce other risk factors
• Patient goes home with in-home assistance (Visiting Nurse Association), if appropriate, or patient goes to rehabilitation or extended care facility
• Follow-up appointments are made in the Stroke Assessment and Prevention Clinic