Fast recognition and treatment can not only make the difference between life and death, but it can also decrease long-term disabilities. To develop a streamlined response to potential stroke patients, the American Heart Association developed the Stroke Chain of Survival. The chain involves eight links or steps to be taken by patients, family members, prehospital and emergency room personnel in caring for stroke patients.
“We are thrilled to support the University of Louisville Hospital – Comprehensive Stroke Center’s U Care program with our RN-led clinical AfterCare model. Patients and their caregivers need more resources and ongoing support when managing the transition from a hospitalization to another setting or home. We look forward to implementing this model and future programs to help UofL Hospital provide a differentiated patient experience for the communities it serves,” said Brian Holzer, M.D., M.B.A., C.E.O. of Lacuna Health.

When a weakened blood vessel ruptures and spills blood into brain tissue, it’s called a hemorrhagic stroke. The most common cause for the rupture is uncontrolled hypertension (high blood pressure). There are two other types of weakened blood vessels that can also cause hemorrhagic stroke: aneurysms (swellings within vessels) and arteriovenous malformations or AVMs (abnormal tangles of blood vessels).


Dispatch: The second step in the chain of survival is ‘dispatch’, which involves activating emergency medical services. In most cases, this involves calling 911. Medical dispatch should be thoroughly trained to identify a possible stroke patient so that the appropriate level of EMS services can be dispatched to the patient.  Simply stated, the faster EMS can be dispatched, the quicker lifesaving treatment can be delivered.
Emergency measures. If you take warfarin (Coumadin, Jantoven) or anti-platelet drugs such as clopidogrel (Plavix) to prevent blood clots, you may be given drugs or transfusions of blood products to counteract the blood thinners' effects. You may also be given drugs to lower pressure in your brain (intracranial pressure), lower your blood pressure, prevent vasospasm or prevent seizures.

Hemorrhagic strokes occur when an artery inside the brain ruptures or when an aneurysm at the base of the brain bursts. Twenty percent of all strokes suffered are hemorrhagic strokes. Symptoms more specific to this type of stroke include headache, nausea and vomiting, neck stiffness, seizures, sudden changes in mental state and lethargy. Hemorrhagic strokes usually occur in the daytime and during physical activity. The symptoms typically begin very suddenly and evolve over several hours.
Delivery:  Delivery is the prompt transport of the patient to a hospital, preferably a stroke center. Emergency medical personnel should be trained in performing a rapid assessment of the patient’s condition. If a stroke is suspected, the patient should be transported to an appropriate receiving hospital as soon as possible. A medical history and baseline mental status should be documented. The time since onset of symptoms should also be noted and is referred to as ‘time zero’, or the last time the patient was seen to be normal. Emergency medical workers need to provide pre-arrival information to the receiving facility so that the ED can prepare for the arrival of a potential stroke patient.

“At UofL Hospital, we continually strive for excellence in the acute treatment of stroke patients,” said Dr. Kerri Remmel, medical director of the UofL Hospital Stroke Center and chair of the UofL Department of Neurology. “U Care adds the vital step of thoroughly programmed follow-up with stroke patients to ensure they continue recovery, avoid unnecessary readmission to the hospital and prevent a second stroke.”
Legal incapacity is an invasive and sometimes, difficult legal procedure. It requires that a person file a petition with the local courts, stating the elderly person lacks the capacity to carry out activities that include making medical decisions, voting, making gifts, seeking public benefits, marrying, managing property and financial affairs, choosing where to live and who they socialize with. Most states' laws require that two doctors or other health professionals to provide reports as evidence of such incompetence and the person to be represented by an attorney. Only then can the individual's legal rights be removed, and legal supervision by a guardian or conservator be initiated. The legal guardian or conservator is the person to whom the court delegates the responsibility of acting on the incapacitated person's behalf and must report regularly his or her activities to the court.
Personal assistants can change your life, but they can be pricey. If you’re working for yourself or for a small company, or if you’re just feeling overwhelmed in your everyday life, hiring a personal assistant might sound like a pipe dream. But for a quick fix, many effective personal assistant apps can be downloaded completely free of cost on your mobile device. Some mobile devices even come standard equipped with virtual assistants, such as Apple’s Siri, Cortana, or Google Assistant—one study found that 42 percent of smart phone users, or 71 million people, used an artificial-intelligence-based personal assistant app. 
Around the clock care is ideal for someone coming home from the hospital after surgery, suffering from a debilitating condition such as a stroke, or someone with Alzheimer’s or other dementia-related conditions and is at risk when left alone unattended. Around-the-clock care is also a good option for family caregivers who need a break or will be away on vacation. Some families even opt for around-the-clock care to ensure their loved one has someone to assist them with the activities of everyday life, to escort them to appointments and outings and to provide care and support as required.
This is another app that is very similar to an actual personal assistant. If you’re in need of someone to take notes or to summarize your meetings, this is the app for you. Tetra uses artificial intelligence to take notes and keep your team in sync. Your team members can place conference calls through the app, which will highlight important moments from the call and will send notes to all members upon call completion, allowing everyone to focus on the conversation instead of having to take personal notes. Tetra is available on the iTunes app store.  
On both occasions I used their service, the caregivers either left minimal or no notes while visiting my elderly parents (no eating, sleeping or bathroom data). After the first visit, I contacted a supervisor at Around the Clock and asked specifically that the caregivers leave notes on eating, sleeping patterns, etc. Instead of improving, on the 2nd visit I only received notes from 1 of 3 caregivers...I paid for 16 hours of caregiving for people who may or may not have even showed up for all I know. Their medical staff is also hit and miss. On my father's post-hospital rehab, one of the 3 nurses missed appts at the house repeatedly...only making 1 of 5 scheduled appointments. After this, I contacted Around the Clock and asked them to send out a more reliable nurse. In the 5 weeks that have passed since, we have received 1 visit from a nurse...nobody makes their scheduled appointments. Is this the care you want for your elderly parents??
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