By connecting the inter-hospital emergency system and in-hospital red alert, many stroke patients have been successfully treated after only 30-45 minutes in hospital thanks to the quick treatment process and the application of modern techniques at Thanh Hoa Provincial General Hospital.
The 1.5 Tesla MRI scanner at Thanh Hoa Provincial General Hospital helps to screen and evaluate stroke effectively.
At the end of April, 4, the Brain Stroke Unit, Department of Neurology - Stroke, Thanh Hoa Provincial General Hospital suddenly activated the red alarm emergency medical order in the hospital to prepare to handle a case of cerebral stroke with high risk of death being transferred to the lower level. Doctors of related specialties are quickly present, urgently give first aid, save lives in time, minimizing sequelae for 2023 patient after just over 1 minutes of admission.
About 3 hours ago, patient LVH, 66 years old in Dinh Tang commune (Yen Dinh) suddenly had symptoms of difficulty speaking, distorted mouth, lethargy, right hemiplegia, and excitement, so his family took him to a medical facility in the province for emergency treatment. Doctors have prescribed the use of intravenous thrombolytic drugs for the patient. However, because the blocked blood vessel could not be recanalized, the patient's condition gradually worsened. Immediately, doctors at lower level medical facilities had online consultations on Thanh Hoa Stroke Emergency group with experts from the Department of Neurology - Stroke, Thanh Hoa Provincial General Hospital and transferred the patient to Thanh Hoa Provincial General Hospital.
The prognosis of patients requiring urgent emergency intervention, in order to take advantage of the golden time in stroke emergency, because by the time of patient consultation, the patient has entered the 5th hour of the disease, as soon as they receive information about the referral of the lower level, the doctors of the Emergency Center and the Stroke Unit of Thanh Hoa General Hospital have activated the red alarm system in the hospital, notifying the emergency personnel units to get ready for emergency equipment. Within 30 minutes of admission, the patient was given the necessary paraclinical indications. The results of MRI 1.5 Tesla cerebral vessels and cerebral angiography of the patient showed a stenosis of the entire left internal carotid artery with atherosclerosis. Doctors diagnose patients with acute cerebral infarction due to cerebral artery thrombosis, without urgent intervention, the chance of revascularization is very low and the risk of death is possible. Immediately after that, the patient was transferred directly to the intervention room, the doctors of the intervention team conducted a catheter insertion into the femoral artery, accessed the blood clot, and used a Solitaire mechanical instrument to remove the clot. After just over 2 hours of intervention, the re-evaluation results showed that the patient was awake, in good contact, able to speak clearly, and no longer had paralysis of the right side of the body. After 5 days of treatment, the patient recovered well, returned to normal activities and was discharged from the hospital.
Doctor CKII Nguyen Hoanh Sam, Head of Neurology - Stroke Department, Thanh Hoa Provincial General Hospital, said: In case of LVH, if not revascularized in time, the risk of disability, even death is very high. By mastering the technique of taking blood clots with mechanical tools, over the past time, Thanh Hoa Provincial General Hospital has helped many stroke patients escape disability and even death. However, this is a high technique that requires very strict indications, in addition to modern equipment and professional qualifications of doctors, one of the success factors is that the patient must go to the hospital as soon as possible after detecting a stroke within the golden period (the first 6 hours) since the onset of the disease.
According to statistics of the Vietnam Stroke Association, in the past years, the rate of stroke patients admitted to hospital during golden hour is still very low, accounting for only about 10-15%, and about 85-90% of patients entering the hospital late, so they are not able to enjoy modern treatment methods such as intravenous thrombolysis, thrombectomy with mechanical instruments, etc. Emergency Center doctors will immediately connect emergency departments, neurology, imaging diagnostics, vascular intervention... Security, elevators, and nurses give priority to opening their own entrances. Patients were immediately evaluated in the emergency room and promptly received priority-flow CT or MRI. CT and MRI results are consulted and read by relevant specialists right on the PACS system, even remotely on mobile phones, from which to decide on appropriate treatment or intervention plans within a maximum of 30-45 minutes from the time the patient is admitted to the hospital.
In addition, as the province's last-line hospital, experts in neurology - stroke from Thanh Hoa Provincial General Hospital have established a stroke emergency network and online consultation group on neurology and stroke to provide professional guidance to lower-level facilities for urgent and difficult cases. The hospital also regularly organizes training programs and seminars on neurology - stroke with national and international experts to update knowledge for lower-level medical staff. The current trend in the world for cerebral stroke treatment is that small centers will conduct intravenous fibrinolysis, if not recanalized, patients will be transferred to large centers capable of thrombectomy with mechanical instruments.
In order to keep up with the trend of treatment in the world, Thanh Hoa Provincial General Hospital regularly organizes training programs on fibrinolysis for lower levels with the hope that all district hospitals with computerized tomography machines can apply fibrinolysis techniques right at their facilities, so that the proportion of stroke patients receiving timely emergency care and revascularization treatment gradually increases over the years. With the efforts of the emergency and stroke treatment team in the past time, in 2022, Thanh Hoa Provincial General Hospital was awarded Platinum certification by the World Stroke Association (WSO). Up to the present time in Vietnam, Thanh Hoa Provincial General Hospital is one of the few provincial hospitals to achieve Platinum certification.
Post and photo: Ha Phuong
