"B.E.F.A.S.T" - The New Rules Of Stroke Care with Euly Smith

Seconds decide futures when a stroke strikes, and the biggest lifesaver isn’t a gadget—it’s knowing what to do first. We sit down with nurse practitioner and stroke program leader Euly Smith to unpack the exact steps that protect brain tissue, open doors to modern treatments, and turn a terrifying moment into a survivable story. If you’ve ever wondered how to tell dizziness from danger, or whether driving yourself helps, this conversation gives you a clear plan.

We start with what stroke really is—a brain attack caused by either a burst vessel or a blocked artery—and the B.E.F.A.S.T checklist that anyone can memorize: balance changes, vision loss, facial droop, arm or leg weakness or numbness, speech trouble, and time to call 911. Euly explains why paramedics matter more than car keys: EMS pre-alerts stroke centers, bypasses unprepared hospitals, and gets you straight to imaging. We also dig into the rise of stroke in younger adults and the overlooked risk drivers behind it, from hypertension and high cholesterol to diabetes, smoking, substance use, and undiagnosed sleep apnea.

From there, we explore treatment windows and what “time is brain” actually means. You’ll learn when clot-busting medication can dissolve small-vessel clots, why large-vessel blockages need mechanical thrombectomy, and how specialized biplane imaging suites guide catheters to remove clots at their source. We tackle dangerous myths—like waiting out symptoms or taking aspirin—and reframe TIAs as urgent warnings you can act on. Euly shares the smart questions to bring to your next checkup about AFib screening, blood pressure, glucose control, and sleep studies, plus the community programs that support survivors and families after discharge.

Walk away with a practical, memorable action plan: recognize B.E.F.A.S.T , call 911, request a stroke-certified center, and follow up on your personal risk profile. If this episode helps one person catch a stroke sooner, it was worth every minute. Subscribe, share with someone you love, and leave a review telling us which takeaway you’ll act on today.

Transcript

Sponsor Message & Opening

SPEAKER_00 0:02

Softtech manufactures specialized treatment tables designed to help chiropractors who utilize the activator method, maximize their time, and the success of their procedures. Upgrade to the only adjusting tables endorsed by Activator Methods at SoftechTables.com.

Meet Yuli Smith, Stroke Expert

SPEAKER_01 0:17

Today's podcast is brought to you by SofTech Chiropractic Tables. We finally found a table that is maintenance free as maintenance free as you can get and that will withstand the hard use of chiropractic gear. You can find more information on this table at softechtables.com. Okay, now let's get into the podcast. Hi, this is Dr. Alan Ford, the chairman and founder of Activator Methods International. Welcome to the Activate Your Practice Podcast. We're really excited today because we have a special guest. And today with us is Yulie Smith. She's a nurse practitioner. And we have to thank my wife for getting her here because Judy went to a board meeting. She's a board member of the foundation of the Dignity Health Group here in the state of Arizona. And Judy came back from the board meeting and said, you know, uh, I wish you would have been there because this Yuli Smith came, and she was just the best presenter, and this the whole subject was something that I think that everybody should hear. So Judy called on her contacts at Dignity Health, and uh she got permission to have uh Yuli here. She's a nurse practitioner and she's also the manager of the stroke and sepsis group. And so we're really excited to have Yuli here today. It's good to have you.

SPEAKER_02 1:46

Thank you so much. It's my pleasure. I hope I'll do the justice, as Judy had bragged about in my presentation. But um, we do reach out to our community to spread stroke awareness, and I believe this would be a really great opportunity to reach your audience more people about stroke.

SPEAKER_01 2:04

I have to tell this story because when Judy got home that night, she was telling me about all the things she learned. And uh we got a phone call from a friend of ours in another state, and uh she said, Guess where I was tonight? She was telling him all about it. He says, Oh my goodness, he said, I'm having some of these symptoms. And she said, get to the emergency movement immediately. And he was having a transend ischemic attack at TIA, and he got there in time, and they were able to take care of him, give him the correct uh treatment for it, and he suffered no damage at all. So I told Yuli, gee, one lecture and she saved the person's life. So uh we're thankful for that, Yuli.

SPEAKER_02 2:43

Yes, thank you so much.

SPEAKER_01 2:44

Now, to start with, can you explain briefly what is a stroke and uh why is it uh such a critical uh medical emergency?

SPEAKER_02 2:53

Of course. Um, stroke happens when part of the brain is lacking a blood supply. Essentially, it's the interruption of blood flow or reduction of blood flow to the brain, depriving blood supply and nutrients to that tissue or area of the brain. So, what happens is if our brain is not getting this blood supply, especially if it's prolonged, it can cause damage to that area of the brain. So essentially, when I talk about stroke, I would always say it's a brain attack. There's a damage in the brain caused by lack of blood flow to the brain. It can be either a blood vessel ruptures that leads us to the two types of stroke. One is the bleeding type of stroke, which is when a blood vessel ruptures, blood just pulls around the area of the brain, or a blockage due to blood clot or narrow artery. And that's what we call the schemic type of stroke.

SPEAKER_01 3:50

So that that that's something that people I don't think are aware of a lot. So just do that one more time now. There's the bleeding.

SPEAKER_02 3:56

There's the bleeding type of stroke and the blockage. So I want to call it the wet and the dry type of stroke. So the wet type of stroke when blood just spills all over the brain. And the other type of stroke, the dry stroke, when there's the blockage of blood flow or the narrow artery preventing that flow of blood to the brain. Both of this mechanism causes tissue damage to the brain, where it interrupts the blood flow to the brain. It is really crucial as the cessation of blood flow to the brain happens, the longer we wait, the more tissue damage that happens. And that's when we start exhibiting these stroke symptoms.

The BFAST Signs You Must Know

SPEAKER_01 4:39

What are the most common signs and symptoms? Because Judy said that there were some uh new things. I mean, you know, there's three or four that have been out for some time, and most people don't know those. But I'd like to know what are those, and then what are the new things that you're looking for?

Why Calling 911 Beats Driving

SPEAKER_02 4:54

Yes, so when we talk about stroke symptoms, there are really specific stroke symptoms that I would like to for everybody to know. We use the acronym BFAS, it's easier to remember. So B stands for balance. Usually, we lose our balance in coordination. Sometimes we see patients starting to have the sudden onset of dizziness. They lose their balance, it's like a spinning sensation. They may also experience nausea or vomiting, or other otherwise, sometimes they describe as they're walking like they're drunk, but they did not have any alcohol. So that stands for B. So BFAS, going back to that acronym, E stands for eyes. This is a very commonly missed stroke symptom. Actually, stroke causes loss of vision. So oftentimes when we're looking at picture, we only see half of it, or we lose our visual field. Some patients also experience blurred vision or double vision. Those are all indicators of stroke. Going back to the BFAS again, F stands for face. This is very common. Um, sometimes some patients or some of our community they experience stroke symptoms, but they do not have facial droop. They think, oh, I'm not having stroke. But facial droop is one of them, which is you ask the person to smile, part of their face is droopy or asymmetrical. That's a sign of stroke. And then going back to the BFAS again, I keep saying this BFAS so we can remember it. A stands for arm, which is weakness of the arm, the leg, or one side of the body. The other way to test that if is we ask the person to raise both arms up. If one side drips, that can be a sign that that side is weaker. Um, oftentimes we also lose this sensation on one side. So we may feel numb or tingling, or we just can't feel one side of the body. Now, going back to the BFAS again, S stands for speech. Speech can be um slurring of speech or garbled speech. Some patients may experience difficulty talking or getting words out. They feel like they want to say something, but the words are not coming out correctly. And the other type is we may be talking, but we're not making sense at all. Or sometimes we lose our ability to understand. So some patients may look like they're confused, but it's really the language center of the brain is affected. So that affects the speech. And so the BFAS, the last letter is T, because T is time to call 911. If we experience the balance problem with dizziness, incoordination, loss of vision, facial droop, weakness of one side of the body, or maybe loss of sensation on one side of the body, speech problems, learned speech, difficulty talking, talking and not making sense, it's time to call 911. And the really important thing that I would like to communicate with everybody is calling 911 is really important to get us to the hospital or the emergency department as fast as we can. Like I mentioned a while ago, when that blood flow to the brain is interrupted for a longer period of time, the longer we wait, the more tissue damage that happens to the brain. And calling 911, our emergency medical system would have the ability to take you to the hospital as fast as they can. And they also have protocols in place to take you to the appropriate hospital that can treat a stroke patient.

SPEAKER_01 8:43

And there are different hospitals, aren't there?

SPEAKER_02 8:45

Of course, yes. So here in Arizona or maybe around the United States, there are different hospitals. And not all hospitals have this standardized protocol, coordinated protocol to treat a stroke patient. So we do have certified hospitals like primary stroke centers, strombectomy-capable stroke center, maybe comprehensive stroke centers, who are certified to treat stroke patients, meaning we follow evidence-based practice, we expedite the treatment in taking care of these stroke patients that other regular hospitals may not have.

SPEAKER_01 9:25

Now you're a member of Dignity and/or you are employed by Dignity. And uh how many hospitals does Dignity have in Phoenix?

SPEAKER_02 9:32

So in the Phoenix area, when we're talking about stroke centers, we do have three um certified stroke centers. The two hospitals that I manage, the Mercy Gilbert Medical Center and Chandler Regional Medical Center. We also have our downtown hospital, which is our St. Joseph Medical Center.

Stroke-Certified Hospitals Explained

SPEAKER_01 9:50

So those are three big ones here in Phoenix. I would imagine every other uh town in the United States has the same things, don't they?

SPEAKER_02 9:57

Of course, yes. So there are a lot of major hospitals here in Phoenix that are stroke certified, and we can see them throughout the valley, but not all hospitals have that certification. That's why when we call the paramedics, they are able to bypass the other hospitals who may not be able to provide that timely treatment when a patient is having a stroke.

SPEAKER_01 10:21

One of your the questions here was should I drive myself to the hospital? I guess that's obvious you don't want to drive yourself to the hospital, do you?

SPEAKER_02 10:27

Obviously not. We do not recommend driving yourself to the hospital. Like I've mentioned, our EMS providers can bring you to an appropriate center. Sometimes the stroke may be too bad that you can actually lose your ability to drive. And that's very dangerous when you're driving yourself to the emergency department. With the influx of patients coming to the emergency department, you may not be prioritized as fast as you can compared to calling 911. They activate our hospital before you even get there. So we do have what we call stroke team that gets activated and we wait for the patient. I like to tell them they are treated VIP. When they come to the emergency department, our stroke team, our ER doc, our neurologist are ready to meet this patient upon arrival. And we actually even open our CAT scan and get all this key members of this team to take this patient taken care of. Of course. Calling 911, yes. So if you drive yourself to the ER, I mean, we do not recommend that, but there's also some protocols in place that we triage this patient coming by the door and expedite the treatment, but you're still losing time compared to getting to the hospital as soon as possible with EMS.

Stroke Isn’t Just For Older Adults

SPEAKER_01 11:55

We're going to stop the podcast briefly just to remind you that this podcast is brought to you by SoftTech, the table company in chiropractic that we use. You can find more information on this table at softechtables.com. Many people think of uh strokes as an old person's disease, but uh it's not, is it?

SPEAKER_02 12:15

Well, that's a myth. I would say even if the prevalence of stroke is higher among our older patient population, stroke can affect anyone. We actually have seen increased uh stroke occurrence among our younger patient population. And I would say my youngest patient was 18 years old. Um a lot of things we can correlate it to lifestyle that we have nowadays. Um, a lot of our younger patient population have higher incidence of obesity, high blood pressure. They think that they are young, they're not gonna have stroke or heart attack, and so they don't seek medical help, they don't do their annual physical exam and seeing the doctors, and of course, um other habits that we do, smoking, um, drug abuse, those are all risk factors for stroke that we commonly see we commonly see among younger stroke patients.

Major Risk Factors You Can Change

SPEAKER_01 13:12

What are, and speaking of risk factors, what are the biggest of risk factors?

SPEAKER_02 13:17

So the biggest risk factor I would say is hypertension. But I want to divide the risk factor. When we say risk factor, it's uh your medical problems that increases your chances of having stroke. So if we categorize that, there's this non-modifiable, something that we cannot change about. So let me enumerate quickly about that. Um, age, it can that the older you get, the higher risk for stroke. Um, if you have family history of heart attack or stroke, you're higher risk for having a stroke. We have also seen a higher incidence of stroke among our African American Hispanic population. Um, those are histories that we cannot do anything about. But when we look at this laundry list of risk factors that we can do and modify, it's about 85% of stroke is preventable by acting on this risk factor. So, number one is hypertension or high blood pressure. So a lot of times this is due to the diet that we eat. High sodium, high cholesterol, these are contributing factors to this uncontrolled high blood pressure. Um, high cholesterol, again, they all go together. Diabetes is another risk factor for stroke. And so if you do have diabetes, it's really important to control that glucose level because it attacks the small blood vessels, the arteries, and that can increase our chances of having a stroke. We also see patients with what we call heart problems, atrial fibrillation, or what we call irregular heartbeat, that increases their chances of uh producing blood clot. And we also see patients with sleep apnea. So there are a lot of information about sleep apnea. That means when we are sleeping, it can be at nighttime or during nap time, we tend to stop breathing. And so we're preventing oxygen supply to our heart and our brain. And it has been shown to increase the risk for heart attack and stroke. So those are the major risk factors. I would say obesity again, I mentioned that a while ago, lack of exercise, unhealthy choices of food, and then we go to the smoking. So not our smoking. Smoking by itself accelerates blood pressure, cholesterol deposit in our blood vessels.

SPEAKER_01 15:40

Yes. Now, what do you think of some of the biggest myths are or misunderstandings about stroke?

Myths, TIAs, And Real Warning Signs

SPEAKER_02 15:46

So we talked about the common myth when we say I'm young, I'm not gonna have a stroke until I get old. That's not true. Like I said, we've seen younger uh patients coming to the hospital because of stroke, because they I would say they like they lack focus on their risk factors that I just mentioned. The other myth is if I'm having a stroke symptom, I don't need to go to the hospital because symptoms resolve. That is definitely a myth that I would recommend for us to still seek medical help. Call 911, even if you had the transient episode of stroke symptoms, because it's saying you may be having what we call transient ischemic attack, like do this friend. Um, and that's suggesting that you are at risk of having a full-blown stroke in the near future. And so we must identify your risk factor, address it before it's gonna happen.

SPEAKER_01 16:42

So I think uh average people think a TIA or a transit ischemic attack is not something to be very worried about.

SPEAKER_02 16:49

Definitely not. That's why it's called warning sign of stroke. That means you are about to have a stroke if you do not um address that and look into what's causing that problem.

SPEAKER_01 17:00

What are what are the signs of a TIA?

SPEAKER_02 17:02

Like we said, we'll let's go back again to the BFAST sign, right? So balance in coordination, um, eyes, loss of vision, the facial droop, weakness, and loss of sensation on one side of the body, speech problems, slurring of speech, difficulty talking, those are common signs of tranche ischemic attack, just like stroke, but oftentimes they resolve quickly. And when we do advanced imaging like MRI, we don't see any damage in their brain. But when we overall look at the big picture, these patients may have narrow artery in their neck, carotid artery disease, or may have heart problems or uncontrolled blood pressure that we need to address before they become full-blown stroke later on.

SPEAKER_01 17:49

Got it. Um, for people who have had family history of stroke and those are concerned at their personal risks, what conversation should they be having with their healthcare provider? Uh what questions would they ask their doctor?

Smart Questions For Your Doctor

SPEAKER_02 18:01

We talked about this a while ago about having this regular checkup with their doctor, annual screening. If you do have a history, of course, we want to get screened with high blood pressure, obesity, cholesterol problem, diabetes. Those are the things that we want to talk about, our doctors. If we have history of heart attacks in the family, screening of problems in the heart. Um, there are some devices now that we can use to check for what we call atrial fibrillation, that irregular heartbeat. So those are equally important to discuss with your doctors. Um, if maybe your spouse, you notice that they are snoring at night and they tend to stop breathing in the middle of the night, gasping air, waking up, that's maybe a sign that they have this sleep apnea, and that has to be evaluated so we can address them before it can collectively cause us to have stroke or heart attack.

SPEAKER_01 18:53

That's something new to me, sleep apnea. I I've never thought about it much before, but that's a symptom, isn't it? That you stop breathing and you're lacking oxygen.

Sleep Apnea’s Hidden Stroke Link

SPEAKER_02 19:02

Exactly. And oftentimes we don't notice that because we are sleeping. But some of the key symptoms that our primary care providers should be checking our patients who may have sleep apnea, they ask them questions. Do you get headaches in the morning when you wake up? How many how many hours have you slept tonight? When they say, Oh, I slept 10, 8 hours, but do you feel tired? Usually they feel tired or they need to take a nap on daytime. They feel exhausted. So those may be the indications that they have sleep apnea. Because even if they slept 10 hours, they are not really resting because of that um cessation of breathing while they're sleeping at night.

SPEAKER_01 19:44

Uh then, beyond individual actions, what do you think public health initiatives and community education, what should they provide?

Community Education And Support

SPEAKER_02 19:52

Oh my gosh, that's why I'm here today. And I really appreciate your time inviting me to discuss about stroke. Those are equally important, spreading awareness about stroke. Like Judy, she understood what the strains and symptoms of stroke. She told her friend who called her about it, and it would be spreading awareness about stroke. Um, number two, I would say supporting our hospitals as well, and making sure that any programs can be supported, not just for stroke prevention, community education, but also those post-stroke programs that we provide for our stroke victims who already had stroke. I probably forgot to mention that sudden onset of severe headache can be a sign of the bleeding type of stroke. But either way, if you have the BFAS, it can be the bleeding type of stroke or it can be the dry type of stroke. And I wouldn't recommend our patients to be eating aspirin. That's another common misconception that we see. Um, having a stroke, I should chew an aspirin. Definitely not. Call 911, get to the hospital, and let us take care of you.

SPEAKER_01 21:04

Well, I have a surprise for you.

SPEAKER_02 21:06

Oh well, like surprises.

Donation Announcement & Impact

SPEAKER_01 21:08

No, Judy said, you know, that girl has done such a good job of presenting and doing everything that she needs to be rewarded. So she said uh she has to raise her own money for the Stroke Center. So on behalf of the National Institute of Chiropractic Research, we'd like to present a check to you for$5,000.

SPEAKER_02 21:32

Oh my gosh.

SPEAKER_01 21:33

Because we think that what you're doing needs to be spread. And I know it'll go to the stroke because we've made sure that it's going to the stroke part of the foundation. And uh so we just can't thank you enough for you know coming and alerting our visitors to signs and symptoms that they can save themselves from some real uh care that they have to have to fix things that could be avoided.

SPEAKER_02 21:58

This is excellent. Thank you so much for this. This donation will definitely support our stroke program. And I would say a fraction of our generous donation from our foundation went to establishing one of the biggest advancements of stroke that we have here in our hospital at Chandler, which is our biplane room. Maybe we can talk about it as we are speaking right now.

SPEAKER_01 22:21

Yeah, talk about it.

Clot-Busting Drugs And Time Windows

SPEAKER_02 22:23

So the biplane room is this room or this infrastructure that what where we perform what we call mechanical thrombectomy. So for patients who are having ischemic stroke that is affecting the large blood vessel, oftentimes this clot busting medication that we give in the emergency department may not dissolve this CLT right away. So a more effective method is to go up to the brain and pull the CLT out directly. And that's what we call mechanical thrombectomy. Recently, we just had this certification at Chandler this December of 2025. And we've been able to provide that care here in the East Valley since then. And I would say thank you to the donation of our East Valley Foundation through our generous donors. With this check that you presented, it's probably not just for the hospital infrastructure and programs, but I want to talk about our stroke support group. We do have music therapists, we do have stroke support group leaders. And every year we do what we call stroke camp in Prescott. So it's a two nights, three days event that we do in Prescott, bring together stroke survivors, their family. And it's another way for us to provide this support as they recover after stroke. And all the donations that we receive for our stroke program are really geared towards supporting this community programs that we provide for our stroke patients. So really, really appreciate. Thank you so much, Dr. Fur and Judy.

SPEAKER_01 23:57

Well, you're very welcome. And I think the awareness part, I've learned some things, you know, in the BFAST. That's something that, you know, you can keep in mind when you see somebody or having something if you had it yourself. And just uh being taken to the hospital in an ambulance uh put you in line faster than going by yourself or having your spouse drive you there. And so those are worth their weight in gold.

SPEAKER_02 24:24

That is correct. And and we probably haven't discussed the treatment of stroke. That's why T is really important, aside from getting to the hospital as soon as possible. You may be eligible if you're not having the bleeding type of stroke, the clotting type of stroke, you may be eligible for this treatment. It's called clot busting medication. It's a very potent blood thinner that can only be given within three hours, or maybe sometimes up to four and a half hours when that symptom started. We give it in the vein. It's supposed to find where the clotted, dissolve the clot and opens up blood flow.

SPEAKER_01 25:01

I've heard good things about it. Is it uh is it as good as people say?

Mechanical Thrombectomy Basics

SPEAKER_02 25:07

Yes, it's the standard uh treatment or gold treatment, what we say gold standard treatment for patients who are having a stroke, especially those smaller types or small smaller type of blood vessels that are blocked. But then we go back to the other type of treatment if the patient may not be eligible for the clot busting medication, and we see large clots sitting in their neck or the middle cerebral artery or those deeper part of the brain blood vessels. There's this mechanical thrombectomy, which is a manually uh process. They're using this microcatheter accessing the femoral artery or radial artery going up to the brain and pulling the clot out.

SPEAKER_01 25:49

Yuli, I can't thank you enough because you covered a lot of bases, and boy, there's a lot of information. You may want to watch this podcast twice because uh there's good information here. And again, thank you for making it known to our podcast group because the last time we had 372,000 downloads, and so we know people are listening to it, and so we're really happy and thankful that you were able to come. Thanks for listening to Activate Your Practice Podcast. Remember, this is brought to you by Softtech Table Company. You can find more information on this table at softechtables.com.

SPEAKER_00 26:28

Softtech manufactures specialized treatment tables designed to help chiropractors who utilize the activator method, maximize their time, and the success of their procedures. Upgrade to the only adjusting tables endorsed by Activator Methods at SoftechTables.com.