FAST Response to Stroke: Saving Brains & Lives

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Coming up on this episode of the
Healthy, Wealthy and Wise podcast.

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But the goal is, is to stop the
clot or to stop the bleeding.

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And a lot of times that can be done
non surgically, non invasively.

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And that's one of the huge improvements
in healthcare, that you don't

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necessarily have to crack open a
person's skull to stop a stroke.

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Welcome to the Healthy, Wealthy,
and Wise podcast with Dr.

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William T.

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Choctaw, MD, JD.

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This podcast will provide you with
tools and actionable information

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you can use to help live a more
healthy, wealthy, and wise life.

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It's powered by the over 50 years
of medical experience of this Yale

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University Medical School trained
surgeon, who is also a Western

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State Law School trained attorney.

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Executive experience being a former
mayor of Walnut, California, as well as

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the current chairman of the nonprofit
Servants Arms, and as president of

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Choctaw Medical Group, Incorporated.

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This is the Leadership Masterclass
Edition, already in progress.

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So, let's take the two most
common reasons for uh, emergency

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illness that may result in death.

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And we're just going to concentrate
on two out of the top five.

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And we're going to talk about
heart disease, emergency

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heart disease, and stroke.

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Heart disease we've talked about
before on a number of different levels.

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We haven't talked about stroke, um, or
they call cardiovascular accidents, CVA.

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Um, uh, but, but we're going to
talk about them in the context.

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In the context of an emergency episode at
home or outside of the hospital in terms

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of what you should do for yourself or for
those around you or to help maybe somebody

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else who may be experiencing this.

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So let's start with heart disease
or an emergency heart condition.

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We've talked about this before,
there are two main serious things

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that can happen to the heart.

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One is a heart attack, which many
of you are very familiar with.

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Heart attack is something that's
associated with a hardening of the

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arteries, we used to call it, where a
cholesterol plaques or whatever, uh,

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clog the vessels as seen on the right
side here, and those vessels get clogged,

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less and less blood gets to the heart,
uh, and the heart gradually, sometimes

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even faster, Can end up just stopping
or not, not functioning normally.

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That's one heart attack.

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That's one, a cardiac problem
that can seriously cause you to

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want to get to the emergency room.

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And how, how might that present?

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That might present just with
chest pain, um, and it might be a

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chest pain that doesn't go away.

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Um, or where you sort of move around
as well, maybe it's just muscle, maybe

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I, I just sort of strained myself
or whatever, but it doesn't go away.

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Okay.

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Um, and in those situations, if
it's you or someone around you,

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you want to say, you know, we,
we, we need to get this person to

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the emergency room or call 9 1 1.

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That's like bringing the
emergency room to the person.

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Uh, but so I'm talking about the
very highest level of, of, of injury

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or a medical situation that might
occur outside of the hospital.

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So basically hard.

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Related problems, uh, can either be an
electrical problem or a plumbing problem.

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The plumbing problem is the heart attack.

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That's the clogging of the arteries.

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The electrical problem is where you
look at, is what we call cardiac arrest.

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This is where you're out at dinner in a
restaurant and somebody is, uh, gets up

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from, from finished eating and they'll
walk and they just fall on the floor.

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They just fall out immediately or you're
walking through an airport and you see

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somebody's walking in front of you and
they just fall out, uh, immediately.

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That's called cardiac arrest, um,
and cardiac arrest is basically,

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uh, caused by a malfunction of
the heart's electrical system.

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Now the heart is a muscle, as we've
said before, uh, and that muscle

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has to pump regularly to be, to
get the blood around to different

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parts of the heart of the body.

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But it's also an electrical unit, and
just like any other electrical unit,

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if something interrupts that electrical
flow, that function will stop immediately.

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And we call that, uh,
a, a, a cardiac arrest.

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Now one of the things, or yeah, a cardiac
arrest, now one of the things that we

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mentioned last time we talked about this.

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is that men and women are
different, uh, symptomatically.

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Um, uh, and this is
particularly with heart attacks.

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Now heart attacks may present
more slowly than a cardiac arrest,

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uh, depending on the person.

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But the point I want to make is
that men and women react differently

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or have different symptoms
when they have heart attacks.

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The traditional way that I was taught back
in medical school in the 70s, uh, is, you

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know, the crushing substernal chest pain
in the middle of the chest, um, uh, that

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radiates out, uh, to, to the left arm.

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Um, and, and that's usually what
may very well happen with men.

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But women may not have that
crushing substernal chest pain

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that radiates out to the left arm.

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Uh, they may have indigestion.

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Uh, they may, they may feel faint.

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They may just feel very,
very tired and fatigued.

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Um, where, where they, they just
can't move around or they just.

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feel uncomfortable.

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What's my point?

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My point is that health
care is complicated.

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It's complicated.

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You don't want to oversimplify,
particularly when you're

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concerned about an emergency.

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An emergency, by definition, is you
do the most important thing first.

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And again, you want to get those
patients to a hospital or get 9 1 1

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where the paramedics can come to you.

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Sure you remember this picture.

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This is Bonnie James, a young man,
the famous basketball player's son.

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And he's now, I think, playing for
the, playing for the Lakers, playing

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for the Lakers with his father.

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Uh, and I can almost guarantee you,
I don't know anything particular,

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but I can almost guarantee you that
as a father, he says, okay, we're

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going to agree with for you to play.

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That's what you want to do.

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But you're going to play on my team.

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You're going to be on my
team where I can watch you.

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Makes perfect sense.

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Um, I won't go a lot into the sudden
cardiac arrest that young people get,

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but what I will say though, what we
do know, it tends to be congenital,

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uh, many times it's associated with
something called myocarditis, which is

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a type of inflammation of the heart.

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It's just another type of heart
condition that can end up resulting

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in the heart not functioning normally.

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But we certainly, um, uh, want
Bonnie and his, uh, his dad the best.

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I guess they were all at the Olympics
where Bonnie was watching his dad,

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ahem, uh, perform for the United
States in, in, in the Olympics, but we

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certainly wish them, wish them the most.

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Now automatic external defibrillator
is one of those things that's

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helpful for cardiac arrest.

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Cardiac arrest.

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Again, going back to
you're in the airport.

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And there's a guy, or let's say
a guy's walking, he's 50 feet in

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front of you, and he just drops,
just drops, um, um, unconscious.

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Um, and many times, that's why nowadays,
you will have these automatic external

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defibrillators in airports, or large
public places, um, where they can

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sometimes be used in those cases.

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Won't go into a lot of detail about it
here, but I am going to revisit this

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in terms of the church because my, my,
um, uh, opinion has evolved on this

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in the church and I want to address
that, uh, before we finish today.

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So let's talk about strokes.

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We talked about heart disease is
one of those serious things that

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can occur, um, uh, that you, you
want to get, you want to call 911

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and get to the hospital immediately.

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What about a stroke?

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What about a stroke?

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medical term is cardiovascular arrest,
um, or cardiovascular accident,

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uh, um, et cetera, et cetera.

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Um, basically, it's important
to understand the stroke.

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Now, one of the things to keep in
mind that when we talk about cardiac

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arrest, the reason why you do CPR in a
cardiac arrest is to protect the brain.

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Okay, let me say that again.

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The reason why you push on the
chest is Doing CPR is to protect

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the brain because if the brain dies,
now you've got a serious problem.

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Even if the patient starts breathing,
even if the heart starts working again,

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if you haven't gotten blood to that
brain, uh, and that patient ends up being

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brain dead or something to that extent,
you've got a very, very serious problem.

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So my point is that the two are related,
even though they're two different systems.

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But in terms of severity.

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And, uh, serious problem, heart
and, and, and, and head are, are,

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are, are in sync or are connected.

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There are two types of
stroke, two types of stroke.

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One is what we call On the left side here,
a hemorrhagic stroke or a bleeding stroke.

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You have a bleed, you know, for
some reason the blood vessel starts

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bleeding, uh, and that blood starts
spreading out over the brain.

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Now keep in mind the brain is like a
Um, I'm gonna say like a balloon in

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a box that's sitting in fluid, you
know, it's not attached to anything.

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It's just sort of free
floating, sitting in fluid.

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So let's say you're at a heart,
you're at an auto accident, uh,

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and you're not wearing a seatbelt.

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for whatever reason.

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You're in an auto accident, you hit
something, your head goes back and it

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flips forward and it goes back again.

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And what happens is that inside your skull
is that brain sitting in that fluid called

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cerebral spinal fluid and that brain hits
the wall of your skull back and forth.

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And that itself can be hard
enough to disrupt blood vessels,

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just like if you break a bone.

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Or if you hit your arm or something
like that, um, and you can call

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that blood vessel to bleed.

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And if that blood vessel bleeds, then,
then you've got a serious problem.

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Okay.

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So, so you want to be careful,
again, going back to the fall where

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my individuals may hit their heads.

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Um, uh, so that's one type
of stroke, a bleeding stroke.

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Okay.

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The other type of stroke is what
we call an ischemic stroke or you

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can say a, a, a blood clot stroke.

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Uh, and this is sort of like the
heart attack thing where the blood

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vessels, um, um, say like have plaques
in them, particularly the tiny ones,

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and so blood can't get through.

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Um, the heart, the head and
the heart both work 24 seven,

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24 seven, 24 seven, 24 seven.

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And if you deny the brain blood for
roughly approximately four minutes,

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that, that brain starts to die.

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That brain will start to die.

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And when that brain starts to die,
now, now you've got a real serious

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problem, called my brain death.

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Okay.

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And that's a whole different subject.

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But my point is, time is of the essence.

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Time is of the essence.

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It's of the essence with the heart.

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I'm going to argue maybe even more
of the essence with the brain.

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But keep in mind, the two are related.

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The brain gets its blood from the
heart, gets its blood from the heart.

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So if the heart stops, the brain says,
I got four minutes, three to four

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minutes, or something to that effect.

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Uh, and that's why you want to start
pushing on the, on the, uh, doing CPR.

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cardiopulmonary resuscitation to get
the blood, squeezing the blood out

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of the heart, getting it up through
the jugular, the carotid arteries

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up to the brain, up to the brain.

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And that's the most important thing.

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Yeah, you want to get it to other
parts of the body, but you're

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most concerned about the brain.

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But my point is, Two types of stroke,
a clot that stops blood from getting to

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the brain or a bleed that decreases the
amount of blood that gets to the brain.

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They both have similar results.

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One of the things that in, in healthcare
that we teach patients and, and, and

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teach others is about the treatment
of stroke and how to identify.

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a stroke.

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And so one, there are not a lot of
mnemonics and little things that

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people use, but one of the ones that's
most commonly used is called FAST.

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F A S T.

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F A S T.

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And keep in mind, anybody
can have a stroke.

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Anybody can have a stroke.

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Um, I can tell you about a year ago,
a member of my family called me up and

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said, you know, I just, I don't feel well.

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Um, and I can tell that his speech
was a little slurred and I said,

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tell me exactly what's going on.

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And as he could, and that was, um,
he, he lived with some other folks.

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Um, and there was a lady there
and she got on the phone.

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I said, tell me exactly what's going on.

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And she did.

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And she said, I'm taking
him to the hospital.

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And I told her, I said, get him to the
emergency room as soon as possible.

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So one of the things that you may
recognize, and sometimes the patient

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doesn't know what's going on,
particularly with older patients,

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face, we call it face droop.

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The face is very symmetrical.

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When you look at somebody, we
have two eyes, we have a nose, we

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have a mouth, we have two ears.

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And particularly you look at the
mouth, the mouth is symmetrical.

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The face is symmetrical.

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The facial nerve is on
both sides of the face.

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So, when you see one side of that face is
not equal with the other side, that may

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very well be a stroke that's occurring.

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That could be one of your first signs.

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It may not cause pain, it may not cause
discomfort, patient may not even know

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anything is going on in the early, early
stages, but you will know, and you'll

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say, Mom, what's wrong with your face?

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Dad, what's wrong with your face?

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Or whatever.

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Whatever.

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Um, but that could be the first sign.

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Second, another sign is one arm is
sort of hanging more than the other.

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In other words, when you lift your
arms, you can lift them together,

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but, um, you may notice that the
person had, we all have two arms,

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but one isn't moving very much.

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One isn't moving very much, or
even if it's moving, it's not

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moving as well as the other.

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Okay.

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Speech is different.

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There may be a slurring of speech.

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Or the speech may be very confusing.

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They, they may be talking,
but it doesn't make sense.

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You know, they, they say a sentence, but
you say, I have no idea what, what, what,

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what, what he said or what she said.

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. Okay.

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But sometimes that can be a stroke,
that can be a stroke, but it gets

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to the T in FAST is time, time.

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You have a short amount of time to
get that patient to the emergency

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room or get that patient a treatment.

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This is even more different, this is
even more extreme than heart attack.

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Why is that?

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Because what we can do now in
healthcare is we can inject

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medication into that patient early.

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In the early part of the stroke and
stop the stroke or treat the stroke, um,

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and, but the downside of that is every
hospital does not have that ability.

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Point of the Valley does, or they call it,
uh, M& A does, they have it, and most, or

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a lot of hospitals have it, um, but you,
you want to know that in your community.

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You, you want to know, um,
you know, if you buy a house.

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And like when you look at the
schools for your kids, look where

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the hospitals are, and the clinics
are, and the pharmacists are.

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And if there's a hospital you like,
whatever, just call them up and say,

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do you guys have a stroke center?

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A stroke center is very specific.

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It's approved.

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I remember when, uh, because I was, uh,
um, um, in C suite at Queen of Valley

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when it was being evaluated for a
stroke center, so I was a part of that.

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It's very specific.

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Got to have certain types of doctors and
certain types of nurses and everybody

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has a certain type of training, got to
have certain types of radiologists, um,

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cardiothoracic surgeon on call 24 7.

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There's a bunch of things you got to
have, uh, but the goal is, is to stop

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the clot or the, stop the bleeding.

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And a lot of times that can be done
non surgically, non invasively,

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uh, and that's one of the huge
improvements in healthcare.

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that you don't necessarily have to crack
open a person's skull to stop a stroke.

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You know, you can do it with an injection.

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Sorry for the graphic.

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I, I . Sorry, I, I'm a surgeon,
so I tend to think like that.

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I'm sorry.

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I'm sorry.

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. Sorry, sorry, sorry.

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But my point is time is
what you wanna deal with.

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Okay.

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Um, uh, and so the stroke and the
heart attack, uh, can be, uh, are

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connected because if someone has a
heart attack or a cardiac arrest.

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Um, and they don't get CPR, um, what
will kill them, among other things, is

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that, not as they kill them, but what
will disable them, if not kill them,

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is that the brain will die or cannot.

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Um, and, and that, that's
why that's such a big deal.

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So let's think about FAST, F A S T,
it's easy to remember, phase troop,

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um, arm hanging, uh, speech slurred
or speech different, and time.

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Time, time, time.

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Again, call 9 1 1.

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Thank you for listening to this
episode of the Healthy, Wealthy,

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00:18:17,495 --> 00:18:18,925
and Wise podcast with Dr.

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00:18:18,925 --> 00:18:19,335
William T.

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Choctaw, MD, JD.

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We hope you now feel more equipped
with tools and actionable information

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00:18:26,315 --> 00:18:29,875
that will help you live a more
healthy, which includes the mental,

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physical, and spiritual, life.

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00:18:31,605 --> 00:18:36,105
Wealthy, which includes the
financial, health and spiritual and

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00:18:36,105 --> 00:18:41,355
wise, which includes the practical,
theoretical, and emotional life.

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00:18:42,015 --> 00:18:46,845
For this one and past podcast
episodes, blog, books, and news,

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00:18:46,845 --> 00:18:52,785
you can use go to www.twwp.com.

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00:18:53,145 --> 00:18:59,835
That's www.th wwp.com, and you've got it.

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00:19:00,015 --> 00:19:01,305
In the meantime, remember you.

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00:19:01,745 --> 00:19:05,595
You too can be the change
you want to see in the world.

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00:19:06,185 --> 00:19:09,975
You've been listening to the Healthy,
Wealthy and Wise podcast with Dr.

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00:19:09,975 --> 00:19:10,435
William T.

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00:19:10,435 --> 00:19:13,175
Choctaw, MD, JD.