fbpx
TeleCare
Careers
Pay My Bill
Learning Center
Stroke Survivors

Back to Previous

Position Statement: Obtaining History from Family Members for Alteplase Contraindications

By: | Tags: | July 31st, 2020

Obtaining History from Family Members for Alteplase Contraindications The purpose of this Position Statement is to clarify the TeleSpecialists physician practice of due diligence before treatments associated with morbidity and mortality such as thrombolytics are administered. In the experience of TeleSpecialists, practicing telemedicine across 24 states with monthly consult volumes of 11,000 patients, also supported by literature*, our view has been that one of the important risk factors for deadly hemorrhagic complication of thrombolytic treatment alteplase is accuracy of history of “Last Known Well”.   It is the position of TeleSpecialists that there are aspects of EMS history obtained from the field, inclusive of “Last Known Well” and alteplase absolute contraindications which may need to be confirmed when possible.   As a patient safety measure, we expect our physicians to do their due diligence and make an effort to obtain this history before thrombolytics are administered. Stroke patient evaluations should be seen through a layered approach, with the initial assessments using quick screening tools (mCSS, BEFAST, etc.) to identify possible stroke patients, but as the evaluation evolves towards the neurologist who is making the ultimate decision about treatment, more time needs to be spent to confirm key historical features regarding information like last known well and presence of potential absolute contraindications.  Given the short time frame EMTs are at the scene and other factors like the stress placed on caregivers due to a family member experiencing acute stroke symptoms, we understand all of this can potentially affect accuracy of information, TeleSpecialists physicians, as supported by the 2015 study, feel that it is often necessary to confirm the history, especially if accurate information cannot be obtained from the patient.   This does not have any implication on the skillset of the EMTs at all whatsoever, but simply is a patient safety measure of due diligence for a treatment associated with significant morbidity and mortality. To this end, we train our physicians to reach out to family, nursing home, etc. to obtain history when patients are not able to provide adequate history as confirmation of the information obtained from EMS. This is an important patient safety practice endorsed and practiced by TeleSpecialists and majority of reputable stroke programs in the United States. Dr. Nima Mowzoon CEO and Founder of TeleSpecialists, LLC 7/29/20 * “Accuracy of First Recorded “Last Known Normal” Times of Stroke Code Patients” J Stroke Cerebrovasc Dis. 2015 Nov; 24(11): 2467–2473.

Nattasha Acevedo, MD

Dr. Acevedo received her medical degree from the Ponce School of Medicine in Puerto Rico and did her neurology residency at Montefiore Medical Center in New York. She went on to do a clinical neurophysiology fellowship at Emory School of Medicine in Atla nta, Georgia and then joined private practice in Fort Myers, Florida. She currently resides in San Juan, Puerto Rico. She likes running, paddle boarding and spending time with family.
dr-nattasha-acevedo-teleneurology
close-link

Bernadette Borte, MD

Dr. Borte received her medical degree from St. Matthew’s University School of Medicine in Grand Cayman. She completed her neurology residency at the University of Iowa Hospitals and Clinics in Iowa City, Iowa. Her areas of interest include inpatient neurology and acute stroke. When not working, she enjoys spending time outdoors with her family. Dr. Borte joined the TeleSpecialist family in March of 2019.
dr-bernadette-borte-teleneurology
close-link

Mazen Almidani, MD

Dr. Almidani is board certified in pediatrics by the American Board of Pediatrics and board certified in epilepsy, as well as neurology with special  qualification in child neurology by the American Board of Psychiatry and Neurology.  Dr. Almidani is happily married with 4 children. His oldest son has autism and his daughter has complicated seizures; both were a drive for him to become a neurologist. Dr. Almidani enjoys soccer, running and spending time with his family. He is very involved with his sons’ therapy and helping with daily challenges. He is double board certified in Pediatric and Adult Neurology and Epilepsy. He sees children and adults. He also participates in charities for children in Syria who may be underprivileged and/or affected by the war. Dr. Almidani joined TeleSpecialists in August 2020.
close-link

Amanda Cheshire, MD

Dr. Cheshire received her medical degree from the University of Louisville School of Medicine in Louisville, Kentucky. She completed her neurology residency at the University of Cincinnati Medical Center in Cincinnati, Ohio. She did a fellowship in neurophysiology at the University of Michigan Medical School in Ann Arbor, Michigan. Dr. Cheshire is double board certified in neurology and clinical neurophysiology. She enjoys traveling, reading and music. She currently resides in Viera, Florida.  Dr. Cheshire joined TeleSpecialists in June 2019.
dr-amanda-cheshire-teleneurology
close-link

Jessica Floyd, MD

Dr. Floyd completed her neurology residency at Mayo Clinic in Jacksonville, Florida followed by fellowship training in clinical neurophysiology with focus in EEG and epilepsy at the Medical University of South Carolina in Charleston, South Carolina. She has particular interest in hospital neurology and patient education as well as the blossoming specialty of lifestyle medicine. She strives to take advantage of every encounter with patients and medical staff to empower them to do their own research into how daily thoughts, choices, and habits can add up to create greater and longer-lasting brain and neurologic health for ourselves and our loved ones. She lives in Florence, South Carolina with her awesome husband of 13 plus years and three beautiful children. She is an avid yogi, astrologer, and lover of food and all things neurology! Dr. Floyd joined the TeleSpecialist family in July 2017.
dr-jessica-floyd-teleneurology
close-link

Nancy Futrell, MD

Dr. Futrell received her medical degree from the University of Utah in Salt Lake City, Utah. She also did her neurology residency at the University of Utah as well as a research fellowship in cerebral vascular disease at Jackson Memorial Hospital in Miami, Florida. She currently resides in Salt Lake City, Utah. She has authored 2 books and 50 peer reviewed papers. 
dr-nancy-futrell-teleneurology
close-link

Rebecca Jimenez-Sanders, MD

Dr. Jimenez Sanders received her undergraduate degree from Emory University, and her medical degree from the San Juan Bautista School of Medicine in Puerto Rico. She completed her neurology residency at the University of South Florida in Tampa, Florida, where she also did a specialized headache medicine and facial pain fellowship. She currently resides in Tampa, Florida with her husband and her two daughters. She is also fluent in Spanish and Italian languages, and enjoys photography, baking, boating, and biking.
dr-rebecca-jiminez-sanders-teleneurology
close-link

Cory Lamar, MD

Dr. Lamar received his medical degree from Meharry Medical College in Nashville, Tennessee. He completed his internship and residency at Wake Forest Baptist Health in Winston Salem, North Carolina. Following residency, he completed a clinical fellowship in neurophysiology, with a concentration in epilepsy. He currently resides in Florida and enjoys outdoor activities.
close-link

Clifford Meyers, MD

Dr. Meyers received his medical degree from Brown University in Providence, Rhode Island and his MBA from the Simon School of Business at the University of Rochester in Rochester, New York. He completed his neurology residency at the University of Rochester, where he also did a neurophysiology fellowship. Dr. Meyers resides in Webster, New York with his wife and daughter. When not doing teleneurology, he enjoys playing sports with his wife and daughter.
dr-clifford-meyers-teleneurology
close-link

Tao Tong, MD

Dr. Tong received her medical degree from the University of Miami School of Medicine in Miami, Florida. She completed her neurology residency at Jackson Memorial Hospital in Miami, Florida, where she also did a neuromuscular/EMG fellowship.  She currently resides in College Station, Texas. Dr. Tong is married with two boys. She enjoys spending time with her family, traveling and reading.
dr-tao-tong-teleneurology
close-link

Shubhangi Chumble, MD

Dr. Chumble attended BJ Medical School. She is a board certified neurologist with a subspeciality interest in sleep medicine. Dr. Chumble did her residency at Howard University in Washington DC and has practiced neurology since 2001 in private and corporate settings. She lives in Melbourne, Florida and loves the sunshine state. Her hobbies include yoga, meditation, cooking , traveling and meeting new people. She also loves to do stained glass, pottery and painting. She joined TeleSpecialists in June 2019.
close-link