A Day in the Life of a Vascular Neurologist

[fxcelration]

I'm really interested in doing vascular neurology. I've heard a lot about how telemedicine is changing how stroke management as alot of these cases are being handled remotely. I was hoping to see what people's experiences with telemedicine in dealing with strokes have been? I'm particularly interested to hear from people already practicing in the community. Does the ER fire up the the telemedicine machine right when a stroke patient arrives asks the neurologist do the whole NIHSS assessment and make a decision on tpa? Or does the ED do their own assessment and then ask the telemedicine neurologist's blessing? Also how is telestroke coverage handled at your institution? Is it a separate rotation from the general floor patients? Or is telestroke coverage just another pager you have to cover while you are on call? Thanks

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[typhoonegator]

We cover about 35 hospitals on telestroke. It's a separate call schedule from the stroke consult or stroke inpatient service, but sometimes we hold both at once. Patient comes in to ED, local physician gets the story and usually does a quick assessment, sends patient to CT if seems like a possible candidate. Then calls our fellow, who calls me if it sounds legit, and sets up the telestroke connection. Quick story verification, NIHSS, review CT and labs, decision yes/no. Possible transfer for IA if seems like a potential candidate or likely to have other problems, otherwise subacute recs for workup and handoff to the teleneurology consult team, which is separate. Done, on to the next.