Technology on Board
To maximize benefits to patients, UH is providing Portage County EMS squads iPads that connect directly to the UH Portage ED through FaceTime. With Mr. R. aboard the ambulance, the EMS squad called the UH Portage Emergency Department via an encrypted FaceTime connection. Emergency medicine physician Dave Konopka, MD, took the call—the first to use the new technology.
“They were about 10 to 12 minutes away from the hospital, and the paramedics and I were communicating the entire trip. The patient was conscious and talking, so I also was able to communicate with him,” Dr. Konopka recalls.
Dr. Konopka continued the MEND assessment with the paramedics, asking Mr. R. a series of questions such as his name and the current month and having him perform simple movements like touching a finger to his nose. Through the telestroke technology and the EMTs’ knowledgeable assistance, Dr. Konopka was able to complete Mr. R.’s stoke assessment during the ambulance trip.
“We knew when his symptoms had started, how they progressed, much of his medical history and his current condition,” he says. “By the time the ambulance arrived at the ED, we were prepared for an incoming patient with a stroke.”
Training, Technology & Teamwork
Deliver Faster Stroke Treatment at
UH PORTAGE MEDICAL CENTER
JOE R. OF KENT WAS AT HIS DOCTOR’S OFFICE on a June afternoon for what he expected to be a routine appointment for his arthritis. This particular afternoon, though, Mr. R’s appointment quickly turned from routine to emergency.
During his preliminary exam with the nurse, Mr. R. began slurring his words, his right arm went limp, and the right side of his face began to droop. Fortunately, the nurse recognized the symptoms of stroke and called 911. Also fortunate for Mr. R., the Kent Emergency Squad, which arrived within minutes, is the first squad in Portage County to be part of UH Portage Medical Center’s new telestroke program.
A First in Stroke Treatment for Portage County
The program’s goal is to reduce the time from the start of a patient’s stroke symptoms to when the patient gets treatment. At its heart is an advanced stroke life support class that the UH EMS Training & Disaster Preparedness Institute is providing for Portage County EMS teams. Institute Director Daniel Ellenberger introduced the training to Ohio from the University of Miami, Florida, where it was developed.
In an intensive eight-hour course, a team of UH advanced stroke life support experts teach EMTs and paramedics how to administer the Miami Emergency Neurologic Deficit (MEND) screening. They learn how to use the screening to evaluate a patient’s functioning on specific mental and physical tasks and use that data plus the patient’s overall symptoms to determine what area of the patient’s brain the stroke is affecting. “MEND helps the EMTs catch strokes that can be missed by other, less intensive stroke assessments, so it’s better for the patient,” explains Raymond Pace, EMS Institute Instructor.
Written by Malavanh Rassavong
Time is critical in treating stroke, stresses Mike Bayus, RN, the head nurse on duty in the UH Portage ED that day. “tPA, the ‘clot-busting’ medicine used to treat stroke, can only be used in patients that meet specific criteria—including receiving treatment within three hours of the start of stroke symptoms.” That’s where telestroke gives the patient and the medical team an advantage, he says.
“Telestroke lets the doctor put his eyes on the patient much sooner, so by the time the patient arrived we knew what we were dealing with, the order for CT was entered and we had alerted the CT team,” Bayus explains. Patients with stroke symptoms undergo a CT scan to make sure there is no bleeding in the brain, which would mean tPA is not safe for that patient.
Mr. R. was in the CT scanner one minute after his arrival at UH Portage—a fraction of the American Heart Association’s recommended 25–minute door-to-CT time. The nurses weighed Mr. R. so the correct dose of tPA could be calculated, and Bayus called the UH Portage Pharmacy to alert them for the potential need for the medication.
Within 15 minutes, Dr. Konopka had read the CT scan, verified it was not a bleeding stroke, and called the stroke specialist at UH Cleveland Medical Center to confirm that tPA was appropriate for this patient. Just 37 minutes after arriving at UH Portage, Mr. R. was receiving IV tPA.
By the time he was transferred to UH Cleveland Medical Center an hour later, Mr. R.’s stroke symptoms had resolved. He stayed overnight at UH Cleveland Medical Center, went home the next day and has made a full recovery.
“The Kent squad and technology played a big role in the successful outcome through their training and initiating telestroke,” Bayus says. “The difference with telestroke is the time to CT, which equals time to tPA. And that can make the difference between complete recovery and lifelong impairment.”
Meanwhile, news of better patient outcomes due the telestroke program is spreading, and the UH EMS Institute is getting bombarded with requests from Portage County EMS teams, Pace reports. To date, the institute has trained 10 teams and is expanding the program as quickly as possible to meet the demand.
Robert Dallara, MD
General pain management,
neuromodulation for post-surgical pain and complex regional pain syndrome
What attracted you to your specialty?
Pain can be very debilitating when it goes on for a long period. I like the interventional aspect, the fact that those who suffer with chronic pain can be helped with different approaches to their condition.
What are some of the most common types of chronic pain you treat?
Pain after back surgery is very common, experienced by about 40 percent of patients. Also, I see a lot of patients with complex regional pain — out-of-proportion pain in a specific area of the body. This condition is caused by a disconnect of the central and peripheral nervous systems.
What are some of the latest treatments for chronic pain?
We have many treatment options today that are safe and effective, including different non-opioid medications. Radiofrequency ablation (RFA) is a noninvasive technology that targets specific nerve endings that are responsible for chronic mechanical back pain. For many patients, an RFA treatment can provide years of pain relief before it needs to be repeated. Neuromodulation is another minimally invasive treatment for chronic pain. It involves applying electrical stimulation that acts as a pain pacemaker and can lead to lasting pain relief for certain types of lower back pain and other chronic ailments.
DR. ROBERT DALLARA
Office at UH Portage
6847 N. Chestnut St. Ravenna, Ohio 44266
Portage Medical Center Expands Services, Welcomes New Doctors
University Hospitals Portage Medical Center invites readers to meet three of the newest additions to the hospital’s medical
staff. These physicians expand the medical center’s specialty care with additional services to meet the needs of area residents.
Mike Bayus, RN, and Jen Schlarb, RN, talk to EMT via UH Portage Medical Center’s new telestroke program.
Christopher Tisdel, MD
Special interests: All foot, ankle, and knee orthopedic conditions, including ankle and knee minimally invasive arthroscopy; ankle and knee total joint replacements; all general orthopedic conditions and fractures
As the director of a new department at UH Portage, what are your goals?
Musculoskeletal complaints are one of the key reasons that people go to the doctor. My number one goal is to get every person in Portage County with these types of problems to think of UH Portage Medical Center as the place to go for care. We’ve recently added hand surgery and sports medicine subspecialists and will be adding a hip and knee replacement subspecialist soon.
Who is a typical orthopedic patient and what are the most common problems you treat?
There really is no typical orthopedic patient. I treat patients ranging from the young athlete with an injury to an 80-year-old with arthritis. The most common problems are the ones that come with age and wear and tear on the body such as arthritis, fractures, and back problems.
What is new in orthopedic surgery?
Techniques for every orthopedic procedure have improved over the past decade. Ankle replacement for arthritis has improved markedly over the past 15 to 20 years to where patients now
regain 60 to 80 percent of motion and, most importantly, get rid of the pain and swelling. We can now perform a lot of knee and ankle procedures with scopes, on an outpatient basis.
DR. CHRISTOPHER TISDEL
Office at UH Portage
Medical Center, 6847 N. Chestnut St. Ravenna, Ohio 44266
Also Sees Patients At UH
Streetsboro Health Center
9318 State Route 14
Streetsboro, Ohio 44241
Emergency medicine physician Dave Konopka, MD, tests a patient to assess severity of stroke
Jonathan Umbel, DO
Special interests: Liver disease, colon cancer screening and prevention
What do you find rewarding about
Helping patients through their disease state to the point where we can work together to manage or cure their disease is very satisfying.
What are some of the most common problems that you treat?
For patients 50 and over,
screening for colon cancer is becoming very common. Colonoscopy has been proven to be the best tool we have to prevent colon cancer, and we are starting to see more people taking advantage of it. For younger patients, I treat a lot of people with chronic digestive problems such as ulcerative colitis and Crohn’s disease.
What is new in digestive disease diagnosis and treatment?
For diagnosis, we now have high-definition colonoscopy that lets us view more details. Also new is a fecal test to screen for the presence of DNA that indicate the presence of advanced polyps. If it’s negative, no need for a colonoscopy
at that point, and the individual should repeat the test in three years. In treatment, we have made major advances in curing hepatitis C. We now have oral medications that cure 95 percent of patients in three months — a major advance, considering the cure rate used to be 30 percent.
DR. JONATHAN UMBEL
Office at UH Portage Medical Center,
6847 N. Chestnut St. Ravenna, Ohio 44266330-297-6060
“Besides the passion I have to help people overcome drug and alcohol addiction, I want to conquer the preconceived notions surrounding addiction and those affected by the disease. I strongly believe, that in order to properly and effectively treat addiction, one must understand it from a medical perspective.”
RENEE KLARIC, LPCC-S, LICDC-CS
PROGRAM MANAGER, MEDICAL SUPPORT PROGRAM, UNIVERSITY HOSPITALS PORTAGE MEDICAL CENTER
Renee has spent most of her career improving the services that patients receive in diverse healthcare markets, both as a practitioner and a businessperson. Her experience in program implementation has led her to this opportunity to combine her skills and knowledge in offering a new and much needed avenue for treating the chronic disease of addiction.