WHAT IS STROKE?

Stroke (called Brain attack) occurs when the blood supply to a part of the brain suddenly interrupted (ischemic stroke) or when a blood vessel in the brain bursts (hemorrhagic stroke). When an attack lasts only for a few minutes, it is called Transient Ischemic attack TIA, which if left untreated can later develop into a full blown stroke.

About 75% of strokes are ischemic – caused by a blockage in blood vessels. The other 25% is hemorrhagic. the death rate in hemorrhagic stroke is 30% whereas it is 10% in ischemic stroke.

SYMPTOMS OF STROKE

Sudden numbness or weakness, especially on one side of the body

Sudden confusion or difficulty in speaking or understanding speech

Sudden loss of vision in one or both eyes

Sudden difficulty in walking, dizziness, or Loss of balance or coordination.

HOW IS STROKE DIAGNOSED?

Stroke is diagnosed through several techniques:

• Neurological examination

• CT scan

• MRI scan

• MR angio

• Doppler ultrasound

RISK FACTORS

The most important risk factors for stroke are

• Hypertension

• Diabetes

• Smoking

• Heart disease

• High blood cholesterol levels and

• Alcohol consumption

Family members may have a genetic tendency for stroke or share a lifestyle that contributes to stroke.

Some risk factors apply only to women. Primary among these are pregnancy, childbirth and menpause.

INCREASED RISK

• Smokers are 10 times more at risk of developing stroke than nonsmokers

• Hypertension increases the risk by 8 times.

• Diabetics are 3 times more at risk.

IS THRE ANY TREATMENT?

Generally there are three management stages for stroke:

• Prevention

• Treatment of Acute Stroke

• Rehabilitation

PREVENTION

Therapies to prevent stroke are based on treating underlying risk factors.

TREATMENT OF ACUTE STROKE

Acute stroke therapies try to stop a stroke while it is happening. Medication or drug therapy is the most common treatment for stroke. PA (clot buster) is the most common drug therapy used to dissolve clots. When the blood clot is dissolved, blood flows back into the brain. If the blood flow is restored quickly, further brain damage is arrested. Time is very important. It must be given with in three hours of the start of a brain attack.

Interventional Procedures have an important role to play in the prevention and management of acute stroke.

Surgery can be used to prevent stroke, to treat acute stroke, or to repair vascular damage or malformations around the brain.

INFRASTRUCTURE

These treatment modalities can be practiced only in select centers with adequate infrastructure like a well equipped Intensive care unit all monitoring and life support systems such as Multiparameter monitoring and comprehensive ventilators, support from other allied specialties, fast, efficient and safe ambulances for transport of stroke patients, 24 hour emergency services, a modern clinical laboratory, imaging modalities, well trained and experienced nursing staff and physiotherapists. Last but not the least, the availability of qualified and experienced stroke team 24 hours a day on all days.

POST – STROKE REHABILITATION

Involves exercise and training to help the stroke patient relearn everyday activities. Speech therapy is appropriate for patients who have no deficits in cognition or thinking, but have problems understanding speech or written words, or problems forming speech.

WHAT IS THE PROGNOSIS ?

Although stroke is a disease of the brain, it can affect the entire body. Some of the disabilities that can result from stroke include paralysis, daily living problems and pain.

IS THERE LIFE AFTER STROKE ?

Definitely YES.

With timely and proper treatment, complications of stroke can be reduced to a great extant and the patient can be made to lead a near normal / normal life.

DEXA enables the physicians to determine the amount of fat and quantify the regional distribution of fat in an individual and decide whether the patient is under weight, over weight, or obese and to grade obesity.

Over weight and obese people run the risk of developing diabetes, coronary heart disease, hypertension, stroke and osteoarthritis.

It is A point to remember that the risk developing these diseases, is two to three times more than of the normal population and obesity is rightly called the Mother of three deadly diseases and thereby reduces the lifespan of the individual apart from it being a social stigma.

Obesity should be treated as a disease and not a condition and it should be treated on a war footing.

Beware of the seriousness of the problem and prioritise getting tested for timely treatment.

Whom do you prefer ?

If you prefer the slim model, you have made the right choice. Go ahead and read on.

Obesity is a chronic and extremely common reversible disease characterized by excess fat. It develops gradually and often persists throughout life. If untreated obesity emerges as a potent life threatening and disabling risk factor. As a preventable cause of death, obesity is second only to smoking.

PREVALENCE

Obesity has already emerged as an important health problem in India. About 10% to 20% of the total Population are affected by Obesity. The notion that obesity is a condition of the affluent and of the developed countries is not true.

Also it has to be considered as a disease and not as a sign of prosperity.

DEFINITION

Obesity is a excess adipose tissue mass. Normal body fat content :-

Men -10-20% of total body weight

Women -20-30% of total body weight.

NORMAL METABLOSIM

Food (calories) is converted into energy and this energy is utilized by the body for its activities. The unutilized excess calories are converted into fat as triglycerides and stored in fat depots.

CAUSE

Obesity occurs due to an imbalance in energy intake and energy expenditure. Energy intake which is more than energy expenditure, results in weight gain.

TYPES

Central obesity (Abdominal)

Preipheral obesity ( Back & Limbs)

CLASSIFICATION

Primary       Familial

Secondary   Inborn errors of fat metabolism

                  Endocrine disorders

                  Drugs

                  Psychiatric disorders

ASSESSMENT OF OBESITY

The methods of assessing obesity in clinical practice are:-

                  Body mass index

                  Waist to hip ratio

                  Fat distribution

                  Anthropometry

                  CT or MRI for measuring abdominal fat

                  BMD for regional distribution of fat

WHO GUIDELINES

Normal              BMI 18.5  24.9

Over Weight       BMI 25.0  29.9

Obesity Class I   BMI 30.0  34.9

Obesity Class II  BMI 35.0  39.9

Morbid obesity   BMI > 40.

Obese people are 10 times more at risk for developing disease such as coronary heart disease, hypertension, stroke, diabetes and sudden death.

HEALTH RISKS ASSOCIATED WITH OBESITY

    Central obesity has greater risk of cardiac diseases

    Coronary artery disease

    Type II Diabetes Mellitus

    Hypertension

    Stroke

    Dyslipidemia

    Low backache

    Osteo arthritis

    Reduced lung function

    Reflex disease

    Gallstones

    Venous circulatory disease

    Cancer

    Infertility

    Menstrual abnormalities

SOCIAL IMPLICATIONS

Obese people are often ridiculed and face social embarrassment.

They are not preferred for jobs or as spouses

BENEFITS OF WEIGHT REDUCTION

·         Survival increases by 3-4 months for every Kg of weight reduction.

·         Reduces risk of developing diabetes mellitus by 50%

·         Results in reduction of Blood pressure.

·         Reduces LDL cholesterol and Triglycerides and increases HDL cholesterol.

STRATEGIES FOR WIGHT LOSS AND WEIGHT MAINTENANCE

Medical Nutritional therapy (Diet)

Exercise

Behavioral therapy

Drug therapy

Counseling

SURGICAL PROCEDURES

Bariatric procedures

Liposuction

The Trauma an d critical care ambulance service at Sri Gokulam Hospital consists of a fleet of eleven ambulances which are stationed at strategic places and are duly linked to the hospital.

The ambulance nearest to the site of the accident is immediately mobilized on receiving an emergency call.

The ambulances are equipped with oxygen supply, latest transport ventilator,

Multiparameter monitor, defibrillator with external pacing paddles and splints for immobilization of fractures. The experienced ambulance crew executes the ‘Golden Hour Care’ until hospitalization.

CASUALTY SERVICE

Experienced and Advanced Trauma Life Support trained medical and nursing personal are available day and night to receive, resuscitate and stabilize a critically injured patient. The causality is always mass casualties.

LABORATORY SERVICE

The Laboratory is equipped with automated biochemistry analyzer, blood gas analyzer, electrolyte analyzer, automated immuno analyzer, Spectrometer etc..

Aerobic and anaerobic culture and sensitivity tests are performed.

BLOOD BANK

Round the clock Blood bank, approved by the Government, caters to the complete blood requirements for all emergency cases.

DIAGNOSTIC IMAGING SERVICE

Diagnostic imaging services plays a vital role in the management of trauma patients.

The department has the entire range of imaging facilities like X – ray unit, Ultrasonography, CT scan and MRI scan.

OPERATION THEATER

The operation theater complex has the state of the art infrastructure and is equipped with an image intensifier and an operating microscope and all monitoring systems. Trained staffs are ever ready to tackle major trauma related surgery of various specialties.

INTENSIVE TRAUMA CARE WARD

A specialized intensive care unit had been dedicated exclusively for the trauma patients. It is housed with multiparameter monitors, ventilators and other vital life support systems and are managed by nurses trained in intensive care.

POSTOPERATIVE WARD

The postoperative ward is equipped with all monitoring and life saving systems. The ward is managed by experienced and trained staff to ensure a safe postoperative period for the patient.

DEDICATED SURGICAL AND MEDICAL TEAM

Trauma service often demands multi specialty teamwork and here at Sri Gokulam Hospital, we have a trauma team comprising of surgical, medical and anesthetic specialists to successfully manage any trauma.

PHYSIOTHERAPY

The role of Physiotherapy cannot be ignored, as it is indispensable in trauma care. It should go hand in hand with the trauma team for better outcome.

The department has laser therapy, ultrasound therapy, electro therapy and rehabilitation equipments like interferential therapy, short wave diathermy, motor and functional training equipments, etc.., for mobilizing, ambulating and rehabilitating trauma patients.

AWARENESS PROGRAMMES

Awareness programs relating to “ways and means” of preventing road traffic accidents are organized regularly for the public.

A photo exhibition comprising of Photographs depicting accidents are conducted every year in and around Salem, Dharmapuri and Namakkal districts Since 1999.

The highlight of the exhibition being that the public is given a glimpse of the agony of both the victims and the relatives and the disability caused by the road traffic accidents. The shocking statistical data of the annual road traffic accidents and the mortality rates are also exhibited, which cautions the mind of every single road user.

REHABILITATION

Trauma Care is not complete, if the victims are not trained to regain back their normal life, which is achieved by rehabilitation.

Trauma Critical Care

Ambulance Service

A Statewide Trauma and Critical care Ambulance Service

Signaling the first of a distinctly new ambulance service which is full – fledged in terms of patient care in all respects.

In the last decade remarkable improvement was noticeable in the qualitative care of trauma cases in the hospitals. At the same time the loss of precious and valuable human lives could not be prevented owing to the lack of a proper transport system suitably designed with life saving devices to ensure protection of the grievously injured and the seriously sick from further deterioration during transit.

Proper transport of patents to the hospitals has undoubtedly got a bearing on the outcome of the treatment extended to them. It should therefore be realized that the care of the critically ill and injured is incomplete without a proper transport systems despite having all facilities in the hospitals for their treatment.

Sri Gokulam Hospital has addressed this challenging problem by launching A Statewide Critical Care Ambulance Service  the first of its kind in this region.

This is an ambulance service which is nothing short of a mini ICU on wheels manned by well experienced and trained staff and equipped with the state – of – the – art monitors, life support systems, external pace maker, Immobilization kit for spine and extremities to cope with any situation that arises while shifting a patient from the accident site to the hospital.

Separate transport ventilators are available in the ambulance for newborn babies, children and adults needing ventilatory support, the unique features being that a patient can be ventilated continuously for 12 hours.

The ambulance also has ventilators for neonates and transport incubators for the newborn.

The trauma and critical care ambulance service consists of a fleet of ambulance vans located in strategic areas duly linked to the hospital and can be mobilized in a moment. On receiving a call for the ambulance, the one nearest to the place of call will be pressed into service immediately.

On reaching the site, first aid is immediately given, resuscitation done, treatment started right at the accident site itself without losing any precious time, and the treatment continued while in transit till the patient reaches the hospital.