Stroke is a disease that affects the arteries leading to and within the brain. It is becoming an important cause of premature death and disability in countries like India, largely driven by demographic changes and enhanced by the increasing prevalence of the key modifiable risk factors.
L to R: Dr. Venu Shashank.Y, Staff, Dr. N Kedare, Dr. N Bhandari, Dr. S Borse, Dr. D Khurjekar, Dr. Soumya Chandrashekar, Dr. Kayanoosh Kadapatti, Dr. Ashwini Guge, Dr. Devika Nair, Dr. Disha Wanere
Dr. Soumya Chandrashekhar, Consultant-Accident & Emergency Department at Jehangir Hospital, said, “We regularly monitor a quality indicator, which is the door to needle time in case of a stroke. We were one of the first hospitals to incorporate the CODE STROKE PROGRAM and that has been ongoing since 2015. We see close to 15-20 cases of stroke per month, out of which approximately 7-8 cases go for thrombolytic treatment. We ensure that any stroke patient who comes into the emergency room is assessed immediately. If there are any signs of stroke, then the CODE STROKE is activated on the public announcement system and the entire stroke team comes down to the emergency.”
She further added, “The most crucial step while responding to a case of stroke is keeping track of the “golden hour“. In other words, the first four and a half hours are considered to be the most critical, or “golden“, because after artery blockage, every minute 2 million neurons are lost from the onset, so stroke patients have a much better chance of surviving and avoiding long-term brain damage after receiving a clot-dissolving injection if they arrive at the hospital and receive treatment and drug therapy within 4.5 hour of the onset of symptoms. Time bracket is 60 minutes or less (the door-to-treatment time) of acute ischaemic stroke treatment in hospital after the arrival of the patient.”
The Emergency Medicine Department at Jehangir Hospital is a Level-1 comprehensive tertiary care facility central to the trauma system and is capable of providing total care for every aspect of injury – from prevention through rehabilitation. With an academic and research orientation, it provides a range of state-of-the-art equipment and technology for all kinds of emergency management and support, as well as emergency access to other subspecialties and physicians. The Emergency Medicine Department has a standardised clinical system with implementation of Clinical Pathways, Center of Excellence for Core Emergency Cases, and Clinical Codes (first-of-its-kind) Systems such as CODE STROKE, CODE CARDIAC, and CODE TRAUMA with dedicated in-house numbers to ease the mechanism and provide proper outcomes to the patients, Quality Assurance Program, and Safety Codes Application System.
Speaking on the occasion, Mr. Vinod Sawantwadkar, CEO, Jehangir Hospital, added, “Jehangir Hospital’s stroke programme was launched keeping in view the criticality of the suddenness of stroke for rehabilitating stroke patients. Since then, the hospitals emergency department has saved many lives. Many patients have returned walking to their homes from the emergency department itself. If the patient reaches the hospital within the window period of 4 hours from the onset of the first symptoms, they can be thrombolysed, following which there is a high probability of complete reversal of the deficits suffered. Jehangir Hospital plans to regularly apply for such recognition as it not only motivates the team but also enables us to set new benchmarks and goals for better success and clinical outcomes.”
Talking about the advancements that have happened in the care of stroke patients, Dr. Chandrashekhar said, “We have also recently started a one-of-its-kind system called the Acute Stroke Care – Pathway. This is basically a documentation of the patients health record, which will have history, comments, and developments in the patient’s health. Access to this is given to our doctors in the stroke team, including neurologists, radiologists, physiotherapists, and clinical psychologists. This helps in monitoring the patient’s health and giving the right guidance during their follow-ups. Hence, this provides comprehensive care in a very systematic manner.”
Dr. Sandeep Borse, Neurologist at the Jehangir Hospital, stated, “The majority of cases that we see are from patients of the age of 60 years and above. There are a few cases from the age group of 30-45 years too. This is because of the lifestyle that we are leading nowadays. Irregular eating habits, long work hours, excessive junk food consumption, smoking, alcoholism, COVID infection, etc. can be listed as the reasons. However, a brain stroke is also hereditary in nature.” He further added, “When an acute stroke patient comes within the Golden Hour in the emergency room, a CODE STROKE is activated. Then a rapid neuro examination, CT scan, and MRI are done in no time, following which the decision for IV thrombolysis is taken.”
“If a patient lands up with a major stroke at home and if they reach the hospital in the golden hour then the thrombolytic therapy can be performed. In this therapy the patient is given clot dissolving medicine, or if the clot is very large then a mechanical thrombectomy can be done where the entry to the brain artery is made through the groin artery and the clot is removed. This procedure is specialized and it can be life saving for certain patients. At Jehangir Hospital, we have all kinds of facilities, infrastructure and support to perform all the mentioned therapies,” added Dr. Anand Alurkar, an intervention radiologist at Jehangir Hospital.