Early identification and treatment of strokes save lives
Posted on 15 December 2017
Together, ER24 and Mediclinic provide fast and effective care for stroke patients at a time when doing the right thing at the right time can make all the difference.
A stroke, which occurs when the blood supply to part of the brain is interrupted or severely reduced, is a medical emergency. Deprived of oxygen and nutrients, brain cells begin to die within minutes, so prompt treatment is crucial to minimise brain damage and potential complications.
The first 20 minutes
‘We consider a stroke to be a potentially life-threatening emergency,’ confirms Dr Robyn Holgate, chief medical officer of ER24. ‘The most important thing for ER24 to achieve during our first interaction with a caller is to identify a potential stroke, using an initial telephonic FAST stroke assessment. Once a potential stroke is confirmed, the priority moves to getting the patient to definitive care, such as a hospital with a dedicated or stroke-ready facility and we dispatch the advanced life-support response car and an ambulance to the patient, the same way as we would to a motor-vehicle accident.’
First responders will give the patient oxygen if required, or intravenous (IV) therapy, but, says Holgate, the emphasis is on spending as little time as possible on the scene – under 20 minutes is the aim. ‘We pre-notify a stroke-ready hospital that the patient is en route in order to minimise treatment delays,’ she says.
The pre-notification is critical, notes Dr Melanie Stander, emergency medicine manager for Mediclinic Southern Africa. ‘Stroke is a time-sensitive condition, and pre-notification enables the team to get ready for the response that’s needed when the patient arrives.’
On arrival at a stroke-ready facility
On arrival at the hospital, stroke patients are triaged using the South African triage scale. ‘Medical staff use a variety of clinical tools to, first, determine if the problem is indeed a stroke, as many other clinical conditions may present as stroke – for example, very low blood sugar may cause slurred speech, neurological symptoms and even unconsciousness, similar to a stroke,’ explains Dr Stander.
‘Next, they determine the severity of the stroke. Usually, the patient is sent straight to radiology to have a CT scan, and the report tells us whether it’s a blood clot that’s the problem or a bleed (a ruptured vessel).
‘If it’s a blood clot, the patient is comprehensively screened to ascertain whether they’re a candidate for IV drug therapy that will help in breaking up the clot (patients with a propensity for bleeding or those taking certain medications, such as blood thinners, would be excluded); and if it’s a bleed, observation may be all that’s required, although sometimes surgery is necessary to relieve a buildup of pressure in the brain.’
‘Depending on the patient’s clinical condition, he or she will be admitted to a high-care or critical-care unit,’ says Dr Stander. Here, a concerted and constant team effort kicks in, with multidisciplinary action including specialists, physiotherapists, occupational therapists, speech and hearing therapists and specialised nursing staff. ‘Our main priority is to get the patient over this acute phase and stabilise them, so that they can start the rehabilitation process.’
‘Rehabilitation starts the moment the patient enters the health facility,’ Dr Stander says, ‘but the process continues for some months, for some, and may even be years for others. Most often patients have in-patient care for a certain amount of time, and are then referred to a step-down or rehab facility, depending on their needs.
‘The aim is to eventually be able to discharge stroke patients back to their homes at a functional level, although ongoing long-term care may still be needed.’
FAST stroke assessment
- Face: Ask the person to smile. Does one side of their face droop?
- Arms: Ask the person to raise their arms. Does one arm drift downwards?
- Speech: Ask the person to repeat a simple phrase. Is their speech slurred or otherwise not normal?
- Time: If you observe any of these signs, get help immediately – call 084 124.
Dr Holgate notes that most stroke patients arrive at emergency centres in a private car rather than an ambulance. ‘Less than 50% of patients with strokes arrive by ambulance,’ she says.