Time is of essence  in addressing stroke treatment

The saying, “Time is of the essence,” best applies to medical emergencies, such as a brain attack or stroke. This occurs, according to the World Health Organization, when an artery to the brain gets blocked or bursts, thus leading to disability or even death. Its impact can be lessened through early intervention.

Healthcare providers agree that symptom recognition is crucial in the outcome of the medical emergency. For stroke, the acronym BEFAST sums up what to take note of. It stands for Balance loss, Eyesight changes, Face drooping, Arm weakness, Speech difficulty and Time for emergency help.

Dr. Carissa Pineda-Franks, a stroke specialist, gave an explanation on BEFAST to the press at the launch last Thursday of St. Luke’s Medical Center’s highly specialized Stroke Center as its Center of Excellence. The event, which included a presentation by Dr. Manuel Mariano, was held at the top health institution’s branch at the Bonifacio Global City in Taguig.

She said that loss of balance could be detected when the patient can no longer walk straight, while changes in eyesight cause them to bump into objects while trying to move. “Sinasabi lang nila (They just say) it’s blurred or double vision. But sometimes, hindi na nila alam (they don’t know anymore) that they cannot see.”

Pineda-Franks further noted the patient suffering from a stroke has a drooping face, or what Pinoys call ngiwi ang mukha, and a limping arm, or bagsak ang braso. Then there’s difficulty in speech. “Either hindi sila makasalita (can’t speak) or hindi makaintindi (can’t comprehend).” For instance, when they’re asked questions like “What’s your name?” they’ll give an irrelevant answer, such as “I live here.” It means they no longer understand what’s going on.

Then it’s time to bring the patient to a hospital with facilities to treat stroke. “Don’t wait and say, ‘Tignan natin kung gagaling sa bahay’ (let’s see if they get well at home),” the doctor cautioned.” Every minute counts. If you get treated right away, there’s a better outcome.”

If the patient gets to the emergency room within the so-called golden period of four-and-a-half hours after the symptoms manifested, they can be examined right away for the type of stroke and be given the first line of treatment. For the stroke caused by a blockage, there’s the thrombolytic therapy given intravenously to dissolve the blood clot and reconstitute the blood flow and oxygen to the brain.

When the golden period elapses, other forms of treatment will be given depending on the type and severity of the stroke. St. Luke’s Medical Center’s Stroke Service as a Center of Excellence, for instance, explores all possibilities to give the best care to patients.

“It’s basically a unit that has the ways to treat stroke from the time they hit the emergency room until they are discharged,” said Pineda-Franks. For starters, there’s an emergency room catering to stroke patients 24/7 with specialists on standby, from doctors and nurses to radiologists. There’s also an acute stroke unit, which is like an intensive care unit dedicated to stroke patients, that the hospital pioneered in 1999.

A year later, in 2000, St. Luke’s organized its Brain Attack Team and established the Brain Attack Code. The BAT is an interdisciplinary roster of experts, including vascular neurologists, neurosurgeons, Emergency Care Services physicians, radiologists, clinical pathologists, clinical pharmacists, nutritionists, nurses and rehabilitation specialists. Together, they work to ensure that stroke patients receive the best medical care possible.

So when the brain attack code is activated, the BAT adheres to a rigorous timetable, ensuring the utmost efficiency and effectiveness in patient care. To date, St. Luke’s Stroke Service is the only hospital in the Philippines certified by the Joint Commission International for the gold standard of healthcare in stroke.