The functioning of the Stroke Unit is different from the others. Employees must have an innate patience and forbearance as they care for patients with extensive paralysis. How does the Stroke Unit work and how is the treatment of stroke patients?
You can hear an ambulance approaching from afar. When the wheelchair enters the premises of the Institute of Psychiatry and Neurology in Warsaw, the signal ceases. In the emergency room, a doctor called by a nurse runs into the hall. It's an ordinary day. Anotherstroke patient was brought in .
The patient brought by the ambulance is being examined by a neurologist. Mr. Stanisław can hardly pronounce single words. He cannot raise his hand. He doesn't react to the doctor's touch, as if he doesn't feel anything. The doctor quickly makes a decision: computed tomography of the head and blood for tests. The nurse rolls up the sleeve of his shirt and takes some samples. The blood is about to go to the lab, because the tests have to be done very quickly, on a cito. The result of the tomography confirms the doctor's assumptions. It's an ischemic stroke. In other words, the arteries are clogged with a clot, and part of the brain is not receiving blood. Time is running out, so the patient is taken to the stroke unit at the 2nd Neurological Clinic.
Operation of the Shock Department
Each new day at the clinic begins with a briefing, during which all patients' medical records, treatment progress and possible failures are discussed. During these meetings, the scope of rehabilitation exercises is also determined individually for each patient. Each patient is treated with special attention, because it is here that the future of the sick is at stake. There are 10 doctors working in the acute care unit. There are 24 nurses in the entire neurology department, half of whom look after stroke patients. It is an extremely well-coordinated team. They do not have to tell each other what should be done, everything happens almost automatically, but always taking into account the individual needs of the patient. The role of nurses cannot be overestimated. Here you have to lift almost everyone, move them from side to side, change diapers, take care of hygiene, feed, and administer medications in an appropriate manner when the patient has trouble swallowing. It was hard and ungrateful work. It happens that the sick cannot be saved. Then everyone becomes sad.But there is also joy when a patient with a severe stroke begins to walk and talk. A middle-aged man is walking down the corridor. One arm hangs limply along the body. The accompanying wife admonishes him to straighten up. "Good," he says with difficulty. The wife asks a simple question: - Are you hungry? A moment of silence, full concentration and finally comes the difficult to understand answer: - I'm not hungry. The words sound artificial, as if they are coming from the farthest reaches of the brain. This is due to a stroke, but there is hope that rehabilitation will reduce the disability. - Haemorrhagic stroke causes more havoc in the brain. This is what medical statistics say - explains Dr. Adam Kobayashi. - Unfortunately, hemorrhagic strokes more often lead to the death of the patient. But they also happen less often. It's only 10-15 percent. all strokes. The big problem with hemorrhagic stroke is that there is still no effective treatment available. There is little that can be done pharmacologically and operationally for the patient. At the end of the day, Mr. Stanisław's he alth definitely improved. The nurse almost forcibly had to keep him in bed until the attending physician decided whether or not he could get up. It gets better and better, because as a reward for staying in bed, the patient asked for tea.
Treating stroke patients
Contrary to the hustle and bustle of working in the emergency room, it is calmer here. Doctors and nurses are focused on the next patients. They almost whisper so as not to disturb other sick people. The department has 40 beds, nearly half of which are intended for stroke patients. There are no separate rooms here. There is a huge hall divided by curtains into small boxes. A scene from a movie. Equipment monitoring the vital parameters of patients under the walls. Heart work is recorded on the monitors. Tubes, niki. Regular ticking, regular throbbing, all at its own pace. Every now and then the nurse or doctor checks that nothing is wrong. They are quiet, they move without unnecessary nervousness. There is a gentle twilight in the room, which helps you regain your strength. Patients with ischemic and haemorrhagic strokes and subarachnoid hemorrhages, which are also included in strokes, are under the care of doctors and nurses. Mr. Stanisław, who has recently been brought by the ambulance, also goes here. - Patients with ischemic stroke are given thrombolytic drugs whose task is to dissolve the clot blocking blood flow to the brain - explains Dr. Adam Kobayashi, a neurologist. - This treatment must be given no later than 4.5 hours after the stroke occurs. When this time has elapsed, another solution should be found. Of course notall patients benefit from this treatment 100%, but without it, the chances of maintaining the best possible fitness are much lower. Every year, about 300 people with a stroke visit the stroke department at the 2nd Neurological Clinic of the Institute of Psychiatry and Neurology. In the country, a stroke occurs within a year of 60-70 thousand. people. This is more or less the same as in other European countries. The difference between Poland and other countries is that we still have too many people dying from strokes. Fortunately, however, the situation has changed for the better in recent years. Fewer and fewer people are dying from a stroke. This is due to the improvement in treatment standards and greater awareness of the patients themselves. More and more of them know that a stroke needs to be treated in hospital and that they need to get there as soon as possible. Poland is covered by a network of stroke units and, in principle, every patient should be under specialist care. But with this it can be different. It still happens that the patient lies on the inside, where no specialist treatment is provided.
Rehabilitation - a long process of treating stroke
More minutes go by. Mr. Stanisław had already received thrombolytic drugs in a drip. His fate will be decided within the next hour. If the medication dissolves the clot and nothing unusual happens, rehabilitation will begin the next day to prevent permanent paresis, speech impairment and disability as much as possible. "If we missed the time when thrombolytic drugs could be administered, irreversible necrotic lesions would develop in the patient's brain," says Dr. Kobayashi. - Then the administration of such drugs could harm the patient, e.g. cause bleeding, i.e. spilling blood in the brain. But this does not mean, of course, that such patients are left without help. The patient can be given an appropriate dose of aspirin, which has proven effectiveness in treating strokes, although not as spectacular as thrombolytic drugs. Another option is to mechanically remove the clot. Then, a special catheter is inserted through the femoral artery (it is located in the groin), as in the case of coronary angiography, and leading towards the brain, it reaches the place where the embolus is located. Then, with special tools, the clot is grabbed and taken out. Unfortunately, we do such treatments at the hospital's expense, because the National He alth Fund does not reimburse them. However, it is difficult not to use the existing opportunities, since they can save the patient.
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