HASU - Hyper Acute Stroke Unit

What is HASU? Why is it important?

HASU stands for Hyper Acute Stroke Unit which can mean the difference between life and death in most cases. These units bring specialists from different fields, experts in their field, and the latest medical technology in terms of equipment and instruments under one roof.They aim to provide complete treatment for stroke victims, 24 hours a day, thereby reducing mortality rates and avoiding long-term disability.

Till now, the response to a stroke incident has been poor. There are many reasons for this, which include:-

Poor awareness - People are not aware of stroke symptoms and often call emergency services too late.

Poor response - The unavailability of a quick, well trained and experienced emergency response unit that can assess and control the situation at once.

Poor facilities - The unavailability of latest technology and experienced specialistsleads to less optimal care and communication.

What should one expect in a HASU?

A HASU team will typically consist of:-

  • A stroke specialist
  • Interventional radiologist
  • Neurosurgeon
  • Rapid neuro ICU intensivist
  • Dedicated stroke unit
  • Trained nursing support
  • Advanced equipments

What is their role?

  • Initial assessment - As soon as the patient is admitted, they will be rapidlyassessed by the specialist HASU team.
  • Immediate treatment - Immediate MRIs and scans will be taken and depending on the results, treatment for stroke started.
  • Round the clock care - Because of sudden and abrupt changes in conditions of stroke victims, they need to be monitored 24 hours a day for as long as the HASU team deems necessary.
  • On call specialists - The multidisciplinary specialist team will be on call 24 hours a day, 7 days a week till the patient is stable.
  • Interdepartmental consultations - The HASU team will oversee the patient’s condition and coordinatebetween different department specialists as and when needed.

Stroke care around the world

Response to a stroke is crucial. During a stroke, due to a clot or blockage, oxygen to the brain is reduced and this can cause anything from memory loss, to paralysis. Medical centers and hospitals around the world have only recently realised the importance of a dedicated medical response for a stroke victim.

The London Hyper Acute Stroke Unit (HASU) model shows that faster access to tests and specialist treatment, and the associated efficiencies, have improvedthe outcome for stroke patients and have helped to save many lives.

In Australia, The Acute Stroke Services Framework (2015) has passed a recommendation that all hospitals admitting 75 or more patients with stroke per year should have a stroke unit.

In the USA, they have just started the MSU or Mobile Stroke Unit, in Houston Texas, and are trying to implement it elsewhere.

And in India... at Kauvery Hospitals.

Taking giant leaps in creating a center of medical excellence, Kauvery Hospitals is centralising stroke treatment, specialist doctors and advanced medical technology under one roof by being the first hospital in India to provide a Hyper Acute Stroke Unit in Chennai.

This move would help in ensuring that stroke patients have access to immediate response, rapid diagnosis and treatment. At Kauvery Hospitals, we have specialist staff and services specifically for stroke and our after care is aimed at improving outcome for people who have suffered a stroke.

During their stay at Kauvery Hospital, all necessary tests will be done with the latest medical equipment and in consultationwith experienced and well known specialists, all of whom bring a very specific set of skills in order to provide excellent quality care.


Status Epilepticus

In patients with a normal form of epilepsy, the seizure may last upto 2 minutes and may or may not be followed by unconsciousness. The patient gains consciousness quickly and comes back to the normal state. In some patients however, the seizure lasts more than 5 minutes and up to 30 minutes, or there are multiple seizures happening in series giving very little or no time for the patient to recover.

This and the fact that breathing may not have been normal during this period results in reduced oxygen supply to the brain, causing severe neurological damage to the brain or even death. This condition is called Status Epilepticus or SE and shows a high rate of morbidity and mortality. It is far too serious to be handled like regular epileptic seizures which is why, there are specialists who are called in to treat SE.

There are various risk factors for SE. Generally, people with regular epilepsy show a lower incidence of developing SE. Instead, people with acute mental illnesses, such as brain tumors, infections such as meningitis, craniocerebral trauma due to an accident or injury, any cerebrovascular disease, drug abuse, exposure to toxic chemicals and some metabolic disorders,are all at risk of SE. Generally, mentally challenged children below 15 years of age are at a much higher risk.

Diagnosis of the problem involves recording an EEG, followed by intense observation during a seizure. Treatment for SE depends on the risk factors and medication history and includes a wide variety of anti-epileptic drugs.


Head Injury

The head is the most important part of the human body as it houses the brain. The skull is a thick bony cage that protects the brain from injuries, vibrations or pressure. However, when the head is injured due to a variety of reasons, there can be deep and long-term damage to the brain. Causes and risk factors for head injuries include: falls, vehicle-related collisions, violence, sports injuries, explosive blasts and combat injuries.

Head injuries can be of different types:

  • Concussion or a mild blow to the head
  • Fracture of the skull bone, which includes linear skull fractures, depressed skull fractures, diastatic skull fracture and basilar skull fracture
  • Blood clots developed in the brain after an injury, also called as Intracranial hematoma (ICH): This includes Epidural hematoma, Subdural hematoma and Contusion
  • Diffuse Axonal Injury (DAI) that happens when the head is shaken violently

Similarly, there are several symptoms of head injury depending on the above type of injury, and further, they can show up anytime immediately after the injury to several weeks thereafter. Symptoms include headache, nausea, light-headedness, spinning head, poor balance, temporary ringing in the ears, mild confusion to severe disorientation, loss of consciousness, vomiting, seizures, mood swings, memory loss, abnormal eye movements, etc.

Diagnosis includes a series of tests such as blood test, X-ray, CT scan, EEG and MRI scan. Treatment options again vary from merely resting, to applying a cold pack to the head, adhesive bandage, antibiotic ointments, stitches, hospitalization for observation, and surgery.


Spine Trauma

Spine trauma is a condition that arises out of a severe blow to the spinal column, most often leading to a fracture. The trauma can damage the vertebrae, ligaments, discs, the spinal column or the spinal cord itself. The spinal cord contains a spinal canal filled with spinal nerves which carry messages and sensation between the spinal cord and other parts of the body. In case of a spinal trauma, these nerves could be partially or severely damaged. Accordingly, they could severely affect sensation, strength, sexual health and normal body functions. The symptoms may not be obvious always, which is why, it’s important to consult a doctor immediately.

Spine trauma can happen due to falls, accidents such as vehicle collisions, violence, sports injuries and alcohol abuse. Diseases such as inflammation of the spinal cord, arthritis, osteoporosis and cancer can also be risk factors for spine trauma.

Symptoms of spine trauma are several, ranging from difficulty breathing, coughing or clearing secretions from the lungs, pain or an intense stinging sensation, exaggerated reflex activities or spasms, loss of movement, loss of sensation, loss of bowel or bladder control, severe back pain or pressure in your neck, head or back, difficulty in balancing and walking, etc.

Diagnosis includes various options. While X-rays only indicate broken vertebrae, a CT scan or an MRI is required to assess the extent of damage to the spinal column. Treatment options include realigning the broken pieces, a halo vest, surgical stabilization using mechanical elements and surgical interventions in case of deep neurological damage.


Fractures and Joint Dislocations

Orthopaedic injuries can be serious and traumatic, requiring immediate care and possibly surgeries. Accidents happen, even to the most careful of people and therefore, providing immediate and appropriate management of trauma care contributes very significantly to the long, short or intermediate term results. At The Kauvery Institute of Orthopaedics and Neurosciences, we provide special care in the management of both simple and complex injuries to the musculoskeletal system.

Commonly treated trauma injuries include but are not limited to:

  • Injuries that impact part or parts of the musculoskeletal system in an accident
  • Compound fractures of a complex nature to the hips and knees
  • Shoulder, wrist, elbow trauma management
  • Ankle fractures
  • Minimally invasive fracture repairs
  • Complications arising on account of trauma
  • Ankle Sprain
  • Shoulder dislocation
  • Stress Fractures
  • Meniscus Tear
  • Tennis Elbow
  • Plantar Fasciitis
  • ACL Tear
  • Rotator Cuff Tear
  • Distal Radial Fracture
  • Carpal Tunnel Syndrome

Our round the clock accident and trauma management services offer the highest level of all possible care to the seriously injured patients. The Kauvery Institute Orthopaedics Accident and Trauma care team of medical experts, include trauma/acute care surgeons, neurosurgeons, vascular surgeons, plastic surgeons and other physicians who address traumatic injuries. This collection of expertise ensures that patients receive the best possible care to help maximize recovery and speed up their return to normal activities.

Fracture & Treatment

  • The most advanced medical technology
  • A constant upgradationof an array of diagnostic devices and orthopaedic instruments

We treat patients who are victims of a fresh auto accident or those who suffer from long term aftereffects of auto accidents, with the use of the latest orthopaedic techniques.

A fractured bone can become infected. Our trauma care experts initiate quick efforts to decontaminate the broken ends of the bone (s), so as to expeditiously stabilize the patient and help in the healing process. Speed is always the essence in detecting bone infections in patients and in treating it.

Pelvic and acetabulum (cup shaped socket of the hip) fractures are of a very serious nature and depending on the displacement or instability of the hip, our team of surgeons may perform a surgery. The surgery will be performed to align the cartilage surface, to remove any debris from the joint and consequently to restore stability to the hip.

In some case mal-union of fractures or non-union of fractures can occur. When a bone does not heal within 6 to 9 months, after a fracture, it is said to be a non-union. In cases of mal-union, the bone heals irregularly in an imperfect position. In both cases it causes pain and allows limited mobility for months or even for years after the original injury.

Regardless of the nature of trauma to your musculoskeletal system, at The Kauvery Institute of Orthopaedics and Neurosciences, we endeavour to provide the best of care, utilizing our collectivemedical acumen, state of the art technology and international medication safety care to restore our patients’ quality of life.


Polytrauma Management

Polytrauma refers to multiple traumatic injuries that a person has been subjected to.This can be due to falling from a height, a vehicular collision accident, severe sports injury, explosions, etc. Accordingly, such traumas are classified as blunt force trauma, penetrating trauma, burns and environmental injuries.

These injuries are most often fatal, or lead to life-long disability. The first hour after the injury, called the golden hour, will decide the outcome and possibilities of full recovery. Therefore, time is of essence in managing polytrauma and all forms of polytrauma management involve stabilizing the patient, shifting them to a specialized medical facility and administering drugs or preforming procedures such as surgery.

Once the patient is brought to a specialized medical facility, the initial examination and subsequent interventions are classified into primary surveys and secondary surveys.

  • The primary survey is known by the mnemonic ABCDE, which stands for – open the airway, stabilize breathing, establish circulation, assess disability, and finally expose the patient.
  • The secondary survey is a thorough examination and a series of tests such as ultrasonography, CT scan, chest X-ray, pelvic X-ray, blood test, etc. are done. After these tests are conducted, the physicians then dive deep into the patient’s age, occupation, medical history, lifestyle, medication history, etc. to identify or rule out risk factors for disability and death.

Once all the above surveys are conducted and interventions performed successfully, the patient is discharged. Thereafter, the rehabilitation process begins, and this involves a physiotherapist, speech and language therapist, occupational therapist and psychiatrist, in order to accelerate long-term recovery.


Limb Replantation

Limb Replantation is a microsurgical procedure in which a severed arm is reattached or replanted to the body. An arm can be severed due to an industrial injury or an accident. If the severed piece is brought to the hospital in good condition, along with the victim, there is a possibility of complete replantation. Again, the success rate of replantation depends on whether the severed portion was cleanly cut off, or crushed, or pulled off.

The replantation is a complex surgery involving reattaching of the broken bone, reconnecting the severed blood vessels, and repairing the damaged nerves, tendons, ligaments and muscles surrounding the bone. The surgery accordingly is very challenging and technically demanding.

At KION, we have a multidisciplinary team of orthopaedic surgeons, neurosurgeons, cosmetic surgeons and an array of specialists who are involved in the procedure. To begin with, the damaged tissue at the location of the cut, is carefully removed. Next, the ends of the bone in the body and severed part, are joined together using mechanical components. Once the bone is held in place, it becomes easier to reconnect the other tissues. In the last step, veins, nerves, muscles, ligaments and tendons are repaired, and this may involve the use of grafts from other parts of the body.

Once the patient is discharged, long-term recovery along with regaining complete functionality in the arm is the priority. This may involve physiotherapy, pain-killers, psychiatric counseling (to overcome emotional trauma) and finally occupational therapy to help the person get back to work, and resume a normal lifestyle.

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