Key decision of the city to resolve a dramatic medical urgency type that affects four porteños per day

The City of Buenos Aires published in its official bulletin three important novelties as part of a change that made in the protocol with which the SAME had been addressing the cases of Ischemic strokethe first cause of disability and the third cause of death of Argentina, which only in the Buenos Aires radius affects about 1,500 people per year, around four per day.

It is a pathology that can leave tremendous sequelae, but for which There is a medication that can appease those effects. A type of family of the family of the so -called “thromboembolithic”, which has an important limitation: it must be administered Before 4.5 hours From the event. That time, which is worth gold, is what experts like to call “window of opportunity.”

The better a health system works, the more chances that more people enter through that window. For all that to happen, the diagnosis (or the suspicion of the diagnosis) must be immediate. And after that, have a health center on hand With the logical conditions to address the case. Of all these aspects this novelty treats.

But before continuing it is advisable to remember that there are two types of stroke: the hemorrhagic (for which the medication commented above is not used) and the ischemic. The latter occurs, not by a “spill” (to put it informally) but because of a clot that moves to the brain through the bloodstream, from some other place in the body.

If it is more frequent to hear about this type of stroke it is because the ischemic generates the paintings of Between 7 and 9 out of 10 patients. And, most importantly, because it has that window of opportunity to avoid serious sequelae that could lead to irreversible disabilities.

Some time ago Clarion He informed the intention of some provinces to generate federal networks so that, beyond the interprovincial limits and the great distances between populations with little endowed health centers, patients with these events could be treated in that reduced window of opportunity. Creating such networks implied that whoever arrived in a remote room with FAV suspicion, had the chance that the generalist doctor (not a neurologist, in most cases) had the resources to communicate by Teleconsulta with specialized referents in some regional health center, received the relevant help to make the early diagnosis and apply the Protocol of ACV possible for that particular situation for that particular situation.

Although the case of the City of Buenos Aires is very different (the distances are much more limited and the population, tremendously more numerous than in other parts of the country), the modernized protocol that is communicated now, although it is not a huge turn on the subject, takes some essential steps in that same direction.

According to the official text, “the ambulance doctor, having recognized a patient with signs and symptoms compatible with ACV, who is in the therapeutic window (with less than 4.5 hours of evolution) must communicate the ACV code to the SAME operational table and follow the corresponding operation.” Now, what changed with respect to how all this was so far?

The main thing, Laura Cordero, Undersecretary of Hospital Care of the City of Buenos Aires shared, is that more hospitals are working to receive these cases. There were only two and Now there are sixgeographically distributed in a way that covers a good part of the Buenos Aires territory.

“Previously we had only two hospitals with Stroke unit and currently expanded six; two with Stroke and four unit with what is called Stroke Team,” explained the official. To the Pirovano and Ramos Mejía hospitals, which already attended ischemic stroke, now they joined The Durand, the Argerich, the Fernández and the Santojanni.

The second change has to do with the mode of action of the SAME, which now “directly directs’ to the hospitals where the initial treatment is performed -Prolysis-, which consists of the infusion of endovenous medication for an hour.”

“Once the probable stroke is detected, communication is activated within the ‘Code Code’ group. Which includes all the actors involved: doctors, non -medical professionals, nurses, pharmacists, technicians, specialists in images, administrative, cameras among others, in order to shorten diagnostic times and allow the realization of the treatment in window.”

In other words, The intention is not wasting time Moving the patient to the nearest hospital to, once the diagnosis is made, derive it to another center that is able to address the case. On the other hand, the sole suspicion of ischemic stroke should activate the device in such a way that the SAME is directed directly to one of the six mentioned hospitals. The closest.

The third point is linked to that, and it is that – explained the official – does not waste time (from now on) trying whether or not there will be bed in the place of transfer, something that evidently happened, in line with the dramatic national figure (and the city does not handle different data) that 60% of ischemic strokes are not approached on time.

“The emergency is considered, it is moved by SAME without bed availability process and, when activating the code, the hospital is prepared to wait for the arrival: the doctor awaits the patient, the tomograph prepares, the specialists are directed to the tomograph to immediately evaluate the image; nurses and pharmacists have prepared the medication; hemodynamists prepare to perform the procedure,” said Cordero.

If the patient improves or reverses their symptoms after an initial control of 48 to 72 hours, it will make early rehabilitation at the Rocca hospital. But, “if it does not improve, it goes to a second complexity of treatment, which is mechanical thrombectomy, a surgical procedure that is performed in hospitals that have angiographer and professional team trained in this high complexity procedure.”

For the official, as all these steps flow better, more patients can access a rehabilitation that allows them continue with their lives in the best possible way. Unlike what usually happens, that rehabilitation should now be “early, directed and coordinated.”