Senior Head Bump on Blood Thinners: Subdural Hematoma a Ɛnkɔ Anim a Ɛkyɛ a Ɛkyɛ Wɔ Ahwease Ketekete Akyi¶

Mpanyimfo ɔpepem pii a wɔn mfe akɔ anim nom nnuru a wɔkyerɛw ma wɔn a wɔde ko tia mogya mu nkwammoaa a ɛma mogya tu anaa nnuru a ekum mogya nkwammoaa da biara da de siw atiridiinini a ɛma mogya tu, ahurututu mu ntini a ɛma mogya tu, anaasɛ koma mu stent a ɛtwetwe, a nea ɛka ho ne apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), edoxaban (Savaysa), warfarin (Coumadin), clopidogrel (Plavix), ticagrelor (Brilinta), ne da biara da aspirin. Sɛ ɔpanyin bi a ne mfe akɔ anim a ɔnom nnuru yi mu biara hwe ase wɔ ntama so, hwe ase na ne asen mu bubu, anaasɛ ɔde wɔn ti bɔ adididan mu kabinet pon a wɔabue mu anaa kar pon ano kɛkɛ a, abusua no taa home ahotɔ sɛ ɔpanyin no adwene antu ne ho, ntwa ne ti nhwi a mogya retu no, na ɔyɛ n’ade sɛnea ɛsɛ koraa anwummere no fã a aka no. Saa ahobammɔ ho adwene a ɛnteɛ no yɛ afiri a edi awu sen biara wɔ nkwakoraa ne mmerewa ayaresa a egye ntɛmpɛ mu no mu biako.

Wɔ ɔpanyin a ne mfe akɔ anim a ɔnom nnuru a ɛma mogya yɛ mmerɛw mu no, mogya a ɛba wɔ ti nhwi mu no di bere nhyehyɛe abien a ɛsono emu biara a ɛde ne nkwa to asiane mu akyi: mogya a ɛba atiridii mu a ɛyɛ hu anaasɛ ɛkyɛ wɔ nnɔnhwerew 6 kosi 48 a edi kan no mu, ANAA Chronic Subdural Hematoma (cSDH) a ɛtrɛw brɛoo wɔ ti nhwi no mu ** adapɛn 2 kosi 6** wɔ ɛno akyi ti a ɛyɛ ketewaa bi a ne werɛ afi anaasɛ ɛbɛhwe fam kosi sɛ ɛbɛmia amemene no na asuasua ɔyare a ɛma obi hwe ase anaasɛ adwenemhaw a ɛba ntɛmntɛm. Sɛ ɔpanyin bi a ne mfe akɔ anim a ɔnom nnuru a ɛma mogya tu no ti bɔ anaa ɔhwe ase biara, anaasɛ onya adwene mu naayɛ foforo, ɔdae, ne ti yɛ no yaw, ɔkasa a ɛnyɛ den, anaasɛ ne nan a ɛkɔ ɔfã biako wɔ asehwe akyi nna anaa adapɛn bi a, frɛ wo mpɔtam hɔ nɔma a egye ntɛmpɛ (911 wɔ United States ne Canada no, . 112 wɔ Europa Aman Nkabom no nyinaa mu, . 999 wɔ United Kingdom no; hwɛ nɔma ahorow a egye ntɛmpɛ) ntɛm ara. Sɛ wopɛ nkwakoraa ne mmerewa ho nsɛm a egye ntɛmpɛ a ɛfa ho a, hwɛ nkwakoraa ne mmerewa asehwe ho a wɔsan nya bere a wontumi nnyina hɔ no, . ti a wɔapirapira, na polypharmacy, nnuru a wɔnom boro so, dodow a wɔannye, ne mfomso a ɛwɔ pill organizer mu.

Yɛ eyi mprempren¶

1. Kɔ Ayaresabea Dwumadibea a Ɛho Hia Ntɛmntɛm a ɛbɛn wo no kɔyɛ Ti CT Scan a ɛnyɛ nsonsonoe ntɛm ara bere biara a ɔpanyin a ne mfe akɔ anim a ɔnom aduru a ekum mogya a ɛtwetwe mogya anaasɛ ɛko tia mogya mu nkwammoaa kɔkɔɔ bɛbɔ wɔn ti so, sɛ mpo wɔanyɛ tuntum da na wɔte nka sɛ ɔte nka ɔha biara mu nkyem 100 a. Ayaresa mu adwenemhaw ho akwankyerɛ (ACEP, NICE NG232, ne ACS TQIP) hyɛ sɛ wɔnyɛ ti CT scan ntɛm ara ma any anticoagulated ɔyarefo a odi ne ti a apirapira akyi ɛmfa ho sɛnea akisikuru no daa adi ketewaa bi anaasɛ sɛnea wɔn Glasgow Coma Scale nkontaahyɛde no te sɛ nea ɛfata no.
2. Kura Eliquis, Xarelto, Pradaxa, warfarin, anaa Plavix dodow a edi hɔ a wɔahyɛ da ayɛ ho nhyehyɛe no mu kosi sɛ Emergency Department oduruyɛfo no bɛhwɛ Ti CT scan no mu. Mfa anwummere anaa anɔpa mogya a ɛyɛ mmerɛw aduru no mma da bere a woahwe ase anaa woabɔ wo ti akyi pɛɛ ansa na wɔde CT mfonini agye amemene mu mogya a ɛbɛtɔ no atom. Fa pill nkotoku pɔtee no bra ER na ka kyerɛ triage nurse no dɔn bere pɔtee a wɔmenee dodow a etwa to no.
3. Mma aspirin, ibuprofen (Advil/Motrin), naproxen (Aleve), anaa Goody’s/BC Powder da mma tiyɛ anaa asen mu yaw wɔ asehwe akyi. Nnuru a ɛnyɛ steroid a ɛko tia ɔyare mmoawa (NSAIDs) ne aspirin ma mogya mu nkwammoaa a ɛma mogya tu no di dɛm na ɛma mogya a ɛtɔ kɔ nipadua mu a edi awu no dɔɔso wɔ ɔpanyin a wɔahyɛ no aduru a ɛma mogya tu no mu.
4. Suspect a "Delayed Chronic Subdural Hematoma" sɛ ɔpanyin bi nya nantew foforo a entumi nnyina, ne nan mu mmerɛwyɛ a ɛnyɛ anifere, ɔda awiabere, ne nipasu mu nsakrae, anaasɛ ne ti yɛ no yaw a ɛyɛ mmerɛw wɔ adapɛn 1 kosi 6 wɔ asehwe BIARA akyi a. Sɛ mpo ER ti CT scan a edi kan a wɔyɛe wɔ da a wɔhwee ase no mu da hɔ ɔha biara mu nkyem 100 (anaasɛ sɛ ɔpanyin no anbɔ wɔn ti tẽẽ da nanso ohuu amane mpofirim a whiplash jar a efi fam a ɛba wɔn asen anaa wɔn asen so), ntini a ɛsen kɔ subdural space no mu no betumi agye nnafua 14 kosi 42 na ama amemene no amia. Hwehwɛ san yɛ Ti CT scan a ɛnyɛ nsonsonoe ntɛm ara.
5. Sɛ ɔpanyin no hwee ase na ontumi nsoa emu duru wɔ ne nan biako so, anaasɛ wɔadan nan biako akɔ abɔnten (wɔdannan ne ho wɔ akyi) na ɛte sɛ nea ɛyɛ tiaa sen foforo no a, ma wɔntra fam na frɛ 911 (112 anaasɛ 999) for a suspected Hip Fracture. Mma ɔpanyin a wɔayɛ no aduru a ɛma mogya tu a n’asen abubu so nkɔ nkongua anaa kar nkongua so da: asen kɔn a ɛyɛ nsensanee anaa intertrochanteric nnompe asinasin betumi atetew mogya ntini a atwa ho ahyia no mu na mogya lita 1 kosi 1.5 akɔ mu wɔ asen no mu bere a wɔde akɔ asen no mu wɔ ɔkwan a ɛmfata so no.
6. Ka kyerɛ ER triage desk no ntɛm ara sɛ ɔyarefo no wɔ Anticoagulant so enti wɔkanyan "Code Trauma / Anticoagulated Head Strike" protocol. Ka aduru no din pɛpɛɛpɛ sɛnea ɛbɛyɛ a ayaresabea nnurutɔnbea no betumi asiesie intravenous reversal agent pɔtee no (te sɛ Andexxa / 4-Factor PCC for Eliquis/Xarelto, Praxbind ma Pradaxa, anaa Vitamin K + Kcentra ma warfarin) sɛ CT scan no kyerɛ sɛ amemene mu mogya retu denneennen a.

Gyinaesi dua: Triage ma ɔpanyin a wɔde anticoagulated ayɛ no bere a wahwe ase anaasɛ ne ti abɔ akyi¶

flowchart TD
    A["Mpanyimfo a Wɔanyinyin a Wɔnom Nnuru a Wɔde Yɛ Mogya (Eliquis, Xarelto, Warfarin, Plavix) no Ahwease anaa Ne Ti a Ɛbɔ"] --> B{"So asehwe no sii NNƐ (Acute Phase) anaasɛ NNANA/DADAA AKYI (Delayed Phase)?"}
    B -->|"Esii Ɛnnɛ / Wɔ Nnɔnhwerew 48 Mu"| C{"Frɛmfrɛm Kɔkɔɔ Nsɛnkyerɛnne Biara: Nhumu a ɛyera, ɔfe, tiyɛ a emu yɛ den, adwene a ɛyɛ basaa, n’aniwa a ɛnyɛ pɛ, anaasɛ n’asen a ɛyɛ dɛm?"}
    C -->|"Yiw: Frɛmfrɛm Kɔkɔɔ a Ɛwɔ Hɔ"| D["Frɛ 911 / 112 / 999 Ntɛm ara: Kɔ so dinn, kura mogya-thinner dodow a edi hɔ no mu, siesie wo ho ma ER Head CT + Reversal Agent"]
    C -->|"Dabi: Ɛte sɛ nea ɛyɛ 100% sɛ ɛyɛ nea ɛfata, sɛnkyerɛnne biara nni ho"| E["DA SO ARA KƆ HOSPITAL ER NNƐ kɔyɛ Mandatory Baseline Non-Contrast Head CT Scan"]
    E --> F{"Dɛn na Initial ER Head CT no Kyerɛ?"}
    F -->|"Positive ma Mogya a Ɛyɛ Den"| G["ICU Ntini mu Oprehyɛn Ho Nkɔmmɔbɔ Ntɛm ara + IV Anticoagulant a Wɔdannan (Andexxa / Kcentra / Praxbind) ."]
    F -->|"Negative (Clear Mfitiase CT) ."| H["Monitor for 6-Week Delayed Chronic Subdural Window: Hwɛ sɛ wobɛfa nantew mu, woada, anaasɛ woayɛ basaa foforo anaa"]
    B -->|"Ɛsii Nnafua 3 Kosi Adapɛn 6 A atwam"| I{"So ɔpanyin no reda anifere kwan so nantew FOFORO adi sɛ ontumi nnyina pintinn, ɔda, adwene a ɛyɛ basaa a ɛsakrasakra, ɔkasa a ɛyɛ mmerɛw, anaasɛ ne ti yɛ no yaw?"}
    I -->|"Yiw: Sɛ mpo Na CT a Edi Kan a Wɔayɛ Adapɛn a Abɛsen Biara no Da Ada hɔ a"| J["Kɔ Ayaresabea ER Ntɛm ara na Hwehwɛ sɛ Wɔyɛ Non-Contrast Head CT bio na ama Woayi Subdural Hematoma a enni sabea no afi hɔ"]
    I -->|"Nsɛnkyerɛnne biara nni hɔ"| K["Kɔ so yɛ nhwehwɛmu a wɔyɛ daa wɔ asehwe ano ne dapɛn dapɛn ntini mu nhwehwɛmu kosi Nnawɔtwe 6"]

Ɔfã 1 (Nnɔnhwerew 0 kosi 48): Asiane a ɛwɔ amemene mu mogya a ɛbɛtɔ denneennen ne nnuru a ekum mogya a ɛtwetwe no a wɔdannan no ntɛm¶

Sɛ ɔpanyin bi a ne mfe akɔ anim a ɔnom nnuru a ɛma mogya tu no bɔ wɔn ti nnɛ a, nnuruyɛfo a wɔhwɛ ntɛmpɛ so no di kan haw wɔn ho wɔ acute subdural hematoma, subarachnoid hemorrhage, anaa intraparenchymal contusion ho. Wɔ ayaresabea nhwehwɛmu ahorow a wɔyɛe wɔ nkwakoraa ne mmerewa a wɔde nnuru a ekum mogya a ɛtɔ kɔ nipadua no mu a wɔde wɔn ho kɔ dwumadibea a wɔhwɛ ntɛmpɛ so a wɔn ani da hɔ kɛse a wɔanya Glasgow Coma Scale nkontaahyɛde a edi mũ a ɛyɛ 15 (wɔkasa sɛnea ɛsɛ, mmerɛwyɛ a wɔde wɔn adwene si so, nkae a wontumi nkae) bere a wɔahwe ase wɔ fam akyi no, ɔha biara mu 6 kosi 10 wɔ mogya a ɛtɔ wɔ tirim a ɛyɛ nnam a wotumi hu wɔ Ti CT so dedaw, na ɔha biara mu nkyem 0.6 kosi 2.5 foforo nso nya nea ɛkyɛ mogya a ɛba ntɛmntɛm wɔ nnɔnhwerew 6 ne 24 ntam.

Nnuru a ɛma mogya yɛ mmerɛw, asiane a ɛwɔ mogya a ɛbɛtɔ mu, ne nnuru a wɔde ko tia ayaresabea a wɔdannan no ntɛm a wɔde toto ho¶

Bere nyinaa fa ɔpanyin no nnuru a wɔakyerɛw anaa nnuru a wɔde yɛ nnuru nkotoku bra Dwumadibea a Ɛhwɛ Ntɛmntɛm so no. Mogya a wɔde yɛ aduru a ɛma mogya tu no kuw pɔtee no na ɛkyerɛ sɛnea ayaresabea no gyae amemene mu mogya a ɛde ne nkwa to asiane mu anaasɛ esiesie ɔyarefo no ma oprehyɛn a egye ntɛmpɛ a ɛbɛma n’asen mu abubu anaasɛ wayɛ burr-hole:

Ɔfã 2 (Nna a Ɛto so 3 kosi Nnawɔtwe 6): Subdural Hematoma a Ɛkyɛ (cSDH) a Ɛkyɛ a Wobehu .¶

Sɛ mpo ɔpanyin bi a ne mfe akɔ anim kɔ ER da a ɔhwee ase, wɔyɛ no Ti CT scan a ɛnyɛ nsonsonoe, na wɔka kyerɛ no sɛ "Asɛmpa, CT scan no yɛ nea ɛfata koraa, wubetumi akɔ fie," asiane no NNI awiei.

Nokwarem no, nkwakoraa ne mmerewa a wohui sɛ wɔwɔ Chronic Subdural Hematoma** kɛse no mu bɛyɛ ɔha biara mu nkyem 25 kosi 35 yɛɛ Ti CT scan a edi kan a ɛyɛ daa da a wɔhwee ase no anaasɛ wontumi nkae mpo sɛ wɔbɔɔ wɔn ti efisɛ na akuturuku a edi kan no (anaasɛ mpire toa a wɔde bɔɔ mpofirim esiane sɛ ɛhwee ase nti) no sua koraa.

1. Pathophysiology a ɛwɔ afã 3 a ɛfa amemene mu mogya a ɛkyɛ adapɛn 4 ho¶

Ɛbɛyɛ dɛn na amemene mu mogya atu adapɛn 3 kosi 5 wɔ CT scan a ɛfata akyi?

flowchart TD
    A["Da a edi kan: Ti a Ɛbɔ Ketekete anaasɛ Ɛhwe ase wɔ Hip/Buttocks (Whiplash Acceleration) ."] --> B["Micro-Tear wɔ Taut Bridging Ntini a Ɛtwa Atrophied Subdural Ahunmu"]
    B --> C["Nna a Ɛto so 1 kosi 5: Tiny Venous Ooze (Teateaa dodo sɛ wubehu wɔ Da-1 CT mu anaasɛ egyae bere tiaa bi) ."]
    C --> D["Nnafua 7 kosi 21: Fibrin Clot Paepae Ma Ɛyɛ Protein Nsu a Ɛyɛ Den + Neomembrane a Ɛho Hyehyɛ Atwa Nneɛma a Wɔaboaboa Ano Ho Ahyia"]
    D --> E["Adapɛn 2 kosi 6: Ntini a Ɛtwetwe Ntini a Ɛyɛ mmerɛw a Ɛretu wɔ Neomembrane Micro-Bleed Mu Kɔ so (Anticoagulants & Osmotic Fluid Pull na ɛkanyan)"]
    E --> F["Critical Mass Reached (80 to 150 mL): Amemene Mfinimfini Nsakrae -> Nantew a Ɛkɔ Mpofirim, Dae, Adwennwen, anaa Mmerewa a Ɛte sɛ Akisikuru"]

1. Stage 1 - The Silent Micro-Tear (Days 1 to 5): Sɛ obi bɔ ketewaa bi anaasɛ ɔbɔ mpofirim a, ɛtetew ntini ketewaa bi a ɛyɛ bridging. Wɔ amemene a akyɛ a ɛwɔ subdural space a ɛyɛ ayamye mu no, ntini mu mogya a ɛyɛ tratraa bi sen fa amemene no a ɛyɛ kurukuruwa no so.
2. Stage 2 - Membrane Encapsulation and Liquefaction (Nna 7 kosi 21): Wɔ adapɛn a ɛto so abien ne abiɛsa mu no, nipadua no bɔ mmɔden sɛ ɛbɛfasu afi mogya dedaw no ho denam ntini a ɛyɛ tratraa (neomembrane) a enyin twa ho hyia no so, bere a enzymes ma mogya a ayɛ tumm no yɛ nsu ma ɛbɛyɛ nsu a ɛyɛ den a ɛte sɛ motor-oil (hygroma / chronic hematoma).
3. Stage 3 - Continuous Capillary Re-Bleeding (Adapɛn 2 kosi 6): Neomembrane a wɔayɛ no foforo no ayɛ ma wɔ ultra-fragile, leaky microscopic capillaries. Esiane sɛ ɔpanyin no renom Eliquis, Xarelto, warfarin, anaa Plavix nti, saa membrane capillaries a ɛretu no kɔ so san de mogya kɔkɔɔ foforo kɔ abura no mu da biara da. Adapɛn 3 a edi kan no, amemene a atwitwa no gye kotoku a ɛrenyin no a ɛyaw biara nni mu. Afei, wɔ Da a ɛto so 21 anaa Da a ɛto so 35 no, kotoku no du mililita 80 kosi 150, ɛma baabi a aka wɔ ti nhwi no mu nyinaa sa, na ɛpia amemene no kɔ nkyɛnkyɛn (midline shift).

2. "Great Neurological Imitator": Nsɛnkyerɛnne 6 a ɛnyɛ anifere a ɛkyerɛ sɛ obi anya Subdural Hematoma a enni sabea¶

Ntini ho animdefo frɛ Chronic Subdural Hematoma "The Great Imitator" efisɛ ɛntaa mma Hollywood asehwe a ɛyɛ nwonwa mfiase no. Mmom no, abusua mufo ne nnuruyɛfo a wɔhwɛ ayarefo titiriw taa bu no wɔ ɔkwan a ɛnteɛ so sɛ "Alzheimer yare a ɛreyɛ kɛse," "adwenemhaw," "nkwakoraa ne mmerewa," anaa "akisikuru ketewaa bi."

Hwɛ saa 6 classic warning signs yi wɔ baabiara a ɛda nnafua 3 ne adapɛn 6 ntam wɔ asehwe anaa ahwease biara akyi:

1. "Gait Drift" Foforo anaa Hintidua a Wonkyerɛkyerɛ Mu (Mpɛn pii no ɛyɛ #1 Nsɛnkyerɛnne a Edi Kan Sen Biara):
2. Ɔpanyin no fi ase dannan ne ho kakra kɔ ɔfã biako wɔ ɔkwan no so, ɔbɔ wɔn nan, ɔkyere wɔn nansoaa, anaasɛ ɛsɛ sɛ okura afasu mu na ama wakɔ aguaree. Esiane sɛ subdural hematoma te amemene no atifi motor strip (a ɛhwɛ nan ne dua no so) so nti, nan no mu apraxia a ɛnyɛ anifere ne kari pɛ a wɔhwere no taa da adi nna bi ansa na abasa no ayɛ mmerɛw anaasɛ kasa asakra.
3. Awia Da a ɛsakrasakra ne "Dɔnhwerew Pa / Dɔnhwerew Bɔne" Ɔbrɛ:
4. Sɛ edu 09:00 a, ɛte sɛ nea ɔpanyin no ho yɛ hyew na onim ade yiye, nanso ebedu 13:00 no, na wɔrebɔ wɔn ti ase wɔ wɔn nkongua so bere a wɔrebɔ nkɔmmɔ, ɛyɛ den sɛ wɔbɛda, anaasɛ wɔrehwɛ wɔn ho denneennen. Alertness a ɛsakrasakra yɛ agyiraehyɛde a ɛkyerɛ sɛ intracranial pressure a ɛkɔ soro fi nsu subdural collection mu.
5. Subacute Personality Change, Anibiannaso, anaa "Adwenemhaw a Ɛfi Ase Ntɛmntɛm":
6. Nokware Alzheimer yare no kɔ so wɔ mfe mu, ɛnyɛ adapɛn 2 da. Sɛ ɔpanyin bi a obetumi asiesie ne ho, de TV remote adi dwuma, na wabɔ nkɔmmɔ a ɛfata adapɛn 3 a atwam ni no adwene tu fra mpofirim, ne bo fuw, ɔyɛ anibiannaso, anaasɛ ontumi nkɔ nsu mu dapɛn yi a, susuw sɛ ɔwɔ Chronic Subdural Hematoma (anaasɛ ɔyare mmoawa a ɛnyɛ komm; hwɛ adwene a ɛyɛ basaa mpofirim wɔ nkwakoraa ne mmerewa mu: UTI a ɛyɛ komm, urosepsis vs. stroke).
7. Tiyɛ a ɛyɛ mmerɛw, ɛyɛ mmerɛw, ɛkɔ so daa (anaasɛ Moma so a Wɔbɔ/Rubbing wɔ Nkwakoraa ne mmerewa a Wɔnka Nsɛm Mu):
8. Mpanyimfo a wɔn mfe akɔ anim a wɔwɔ subdural hematoma a enni sabea no mu bɛyɛ ɔha biara mu 50 bɔ amanneɛ sɛ wɔwɔ nhyɛso a ɛyɛ yaw a ɛyɛ mmerɛw na ɛyɛ yaw a ɛyɛ kɛse bere a wɔada fam anaasɛ wɔrefefe no, bere a ɔha biara mu 50 a aka no nni tiyɛ biara nni hɔ efisɛ amemene no a ɛyɛ mmerɛw no ma dural stretch receptors yɛ mmerɛw.
9. Mmerewa a Ɛyɛ Anifere a Ɛwɔ Ɔfã Baako (Hemiparesis) anaasɛ Pronator Drift:
10. Bisa ɔpanyin no sɛ ɔmfa ne nsa abien no nyinaa nkɔ n’anim tẽẽ a ne nsateaa nhwɛ soro simma 10 a n’ani abɔ mu: sɛ ne nsa biako dannan nkakrankakra kɔ mu na ɛkɔ fam (pronator drift), anaasɛ sɛ wofi ase tow wɔn kɔfe kuruwa anaasɛ wɔtwe mpaboa biako a, kɔ ER ntɛm ara.
11. Asɛmfua-Hwene Gyinabea, Ɔkasa a Ɛnyɛ Den, anaa Focal Seizures:
12. Sɛ hematoma no mia benkum fam fã kasa cortex no so a, ebia ɔpanyin no bɛpere sɛ obenya nsɛmfua a wɔtaa de di dwuma, kasafĩ nnyigyei, anaasɛ obenya ne nsa biako anaa n’ano ntwea so a ɛwosow bere tiaa bi a ɛyɛ nnyigyei a ɛyɛ dɛ.

Tebea 2: Anticoagulated Hip Fracture vs. Pelvic Fracture bere a ɔpanyin bi ahwe ase akyi¶

Sɛ ɔpanyin a ne mfe akɔ anim a ɔnom nnuru a ɛma mogya tu hwe ase a, ɛnyɛ ne ti nkutoo na mogya tu no a ɛde ne nkwa to asiane mu. hip fracture (proximal femur fracture) anaa pelvic ring fracture wɔ ɔpanyin a wɔahyɛ no aduru a ɛma mogya tu mu no yɛ nnompe ne mogya mu ahoɔden a egye ntɛmpɛ:

1. Hu Classic Signs a ɛkyerɛ sɛ Hip Fracture wɔ Fam:
2. Nan a Wɔayɛ Tiaa ne Nea Ɛda Akyi: Hwɛ ɔpanyin no nan abien no nyinaa bere a ɔda wɔn akyi: sɛ wɔbɔ nan biako kɔ abɔnten kɔ fam wɔ digrii 45 kosi 90 na saa nan no hwɛ sɛ ɛyɛ tiaa sen nan foforo no sɛntimita 2 kosi 5 (nsateakwaa 1 kosi 2) a, asen kɔn anaa intertrochanteric hip bone no mu abubu.
3. Groin anaa Anterior Thigh Pain on Any Hip Rotation: Sɛ mpo "impacted" anaasɛ hairline hip fracture wɔ baabi a nan no hwɛ tẽẽ a, ɔpanyin no benya ɛyaw a ano yɛ nnam wɔ groin crease no mu tɔnn bere a ɔrebɔ mmɔden sɛ ɔbɛma wɔn nan ase afi fam anaasɛ ɔbɛsoa emu duru no.
4. Occult Hip anaa Pubic Ramus Fracture (Bere a Initial X-Ray Is Normal): Wɔ nkwakoraa ne mmerewa a nnompe mu yare a ɛkɔ soro kodu ɔha biara mu nkyem 5 kosi 10 a wɔhwe ase na wontumi nsoa wɔn nan mu duru a wonni akyi berɛmo mu yaw mu no, asen a ɛyɛ tratraa X-ray a edi kan wɔ ER no te sɛ nea ɛteɛ efisɛ mpaapaemu kwan no ntu (occult femoral neck fracture). Sɛ ɔpanyin bi ntumi nnantew wɔ asehwe akyi ɛmfa ho sɛ wɔayɛ no asen X-ray a enye a, ayaresabea akwankyerɛ hwehwɛ sɛ wɔyɛ Asen MRI anaa CT scan a egye ntɛmpɛ ansa na wɔama wɔabɔ mmɔden sɛ wɔbɛsoa wɔn mu duru.
5. Asiane a Ahintaw a Ɛwɔ Mogya a Ɛtɔ Mu wɔ Mogya a Ɛyɛ Den So:
6. Femur ne pelvis wɔ mogya a ɛkɔ ntini mu kɛse. Intertrochanteric hip fracture anaa pubic ramus anaa sacral pelvic fracture wɔ ɔyarefo a ɔnom Eliquis, Xarelto, anaa warfarin mu no betumi ama mogya 1,000 kosi 2,000 mililita (2 kosi 4 pint) akɔ komm akɔ asen anaa akyi akyi berɛmo no mu mmeae a emu dɔ a mogya biako mpo ntumi nhu wɔ honam ani, na ɛde hypovolemic shock (honam ani yɛ mmerɛw, ne koma bɔ ntɛmntɛm, adwenemhaw, mogya mmoroso a ɛkɔ fam).
7. Nea Enti a Oprehyɛn a Wɔyɛ no Ntɛmntɛm Nsiesiei Wɔ Nnɔnhwerew 24 kosi 48 Mu Gye Nkwa:
8. Nnompe ho akwankyerɛ a wɔde ma wɔ ayaresabea (AAOS ne NICE CG124) di adanse sɛ sɛ wosiesie asen a ne mfe akɔ anim a abubu wɔ ** nnɔnhwerew 24 kosi 48 akyi bere a wɔadu ayaresabea** a, ɛtew nnafua 30 a wowuwu, ahurututu mu ntini a ɛyɛ hu, ahurututu mu yare, ne adwenemhaw so fã.
9. Ɛdenam ER a wɔbɛkɔ ntɛm ara na wɔkura mogya a wɔde yɛ aduru a edi hɔ no so no, nnuru a wɔde kum nipadua no ne nnompe mu ahodwiriw akuw no betumi asusuw nnuru dodow, de nea wɔde asi wɔn ani so a wɔde bɛdannan anaasɛ wɔde bere ahyɛ DOAC ahohoro mfɛnsere a wɔde nnɔnhwerew 24 yɛ no mu, na wɔayɛ oprehyɛn dwoodwoo a wɔntwentwɛn wɔn nan ase.

Nea ɛsɛ sɛ woyɛ bere a woretwɛn ambulance no wɔ fam (911 / . 112 / . 999) .¶

Sɛ ɔpanyin bi a wɔahyɛ no aduru a ɛma mogya tu ahwe ase wɔ tile a ɛyɛ den anaa nnua fam na wususuw sɛ ne ti abɔ anaasɛ ne asen abubu a:

• Ma ɔpanyin no da fam anaasɛ ɔntra gyinabea pɔtee a wɔahu no: Mma ntwe wɔn nkɔ soro da na mma wɔnmmɔ mmɔden da sɛ "wɔbɛfa so" akɔ mpa no mu. Sɛ wɔtwe ɔpanyin a wɔayɛ no aduru a ɛma mogya tu no gyina hɔ gyina hɔ bere a wahwe ase akyi a, ebetumi asi asen kɔn a abubu a ɛka no no afi hɔ (a ɛbɛdan pin a wɔde 3-screw pin a wɔde siesie a ɛnyɛ den no ayɛ no asen a wɔde besi ananmu koraa) anaasɛ ɛbɛma syncopal blackout aba sɛ mogya a ɛretu wɔ wɔn mu no ama wɔn mogya mmoroso so atew a.
• Fa nhyɛso a emu yɛ den tẽẽ di ti nhwi a ɛpaapae biara a wotumi hu so: Ti nhwi yɛ ntini a ɛwɔ onipa nipadua mu no mu biako, na ti nhwi a ne tenten yɛ sɛntimita 3 (nsateakwaa 1.2) a wɔapaapae wɔ Eliquis anaa warfarin so no betumi ama mogya mililita 500 akɔ fam wɔ simma 15 mu. Bobɔ mpopaho a ɛho tew a wɔde guare anaasɛ gauze pad a ɛnyɛ ɔyare mmoawa ma ɛnyɛ ahinanan a ɛyɛ den na mia so denden na ɛkɔ so tẽẽ kɔ fam wɔ ti nhwi kuru a mogya retu no so (gye sɛ wote nka sɛ wo ti nhwi abubu a ɛyɛ mmerɛw, ɛte sɛ spongy, a ayɛ basaa wɔ ase, na sɛ ɛba saa a, fa ring-padding nhyɛso a ɛyɛ brɛoo twa anoano no ho hyia).
• Siw fam hypothermia (Rhabdomyolysis and Coagulopathy Protection): Nipadua mu hyew a ɛyɛ nwini (hypothermia a ɛba fam sen digrii Celsius 35 / digrii Fahrenheit 95) ma nnipa mogya a ɛtwetwe enzymes (the lethal triad of trauma coagulopathy) no yɛ obubuafo, na ɛma mogya a ɛma mogya tu no yɛ hu kɛse mpo. Fa ntama a ɛyɛ hyew sie ɔpanyin no mmati ne ne honam ani ne ase a worenhuruhuruw n’asen a abubu no, na dannan dan no mu thermostat no kɔ soro bere a nnuruyɛfo a wɔboa nkurɔfo no rekɔ so no.

Mpɔtam hɔ ntɛmpɛ nɔma ne adwumakuw no nhyehyɛe ahorow¶

Fa nɔma ahorow a egye ntɛmpɛ ne ɔman no ayaresabea ahodwiriw ho nhyehyɛe ahorow yi di dwuma bere a ɔpanyin bi a ne mfe akɔ anim a ɔnom nnuru a ɛma mogya tu no hwe ase anaasɛ ne ti bɔ no:

• Amerika ne Canada:
• Ambulance a egye ntɛmpɛ & Trauma Triage: Frɛ 911 na ɛyɛ. Wɔ CDC Field Triage Guidelines for Injured Patients ase no, mpanyimfo a wɔn mfe akɔ anim (\(\ge\)65 mfe) a wɔnom nnuru a ekum mogya a ɛtɔ gu nipadua mu a wɔn ti abɔ anaasɛ wosusuw sɛ wɔn asen mu abubu no du asiane kɛse mu trauma triage gyinapɛn ahorow a wɔde bɛkɔ ayaresabea a wɔwɔ 24/7 CT mfoniniyɛ ne ntini mu oprehyɛn/nnompe ho tumi.
• Anticoagulation Reversal Akwankyerɛ: Dwumadibea ahorow a wɔhwɛ ntɛmpɛ so di American College of Emergency Physicians (ACEP) Clinical Policy on Mild Traumatic Brain Injury ne American Heart Association (AHA) / Neurocritical Care Society Akwankyerɛ a ɛfa Reversal of Antithrombotics in Intracranial Hemorrhage akyi.
• Aman Nkabom:
• Ntɛmntɛm: Frɛ 999 (anaasɛ 111 sɛ ɛnyɛ nea wontumi nsi pi koraa wɔ aduru ketewaa bi a ɛnyɛ ti a wɔde twitwiw nipadua no ho nkutoo a; ti opira biara a ɛwɔ mogya a wɔde yɛ mogya mu aduru so no hwehwɛ sɛ wɔyɛ Emergency Department nhwehwɛmu).
• NICE Clinical Mandate (NG232): Wɔ National Institute for Health and Care Excellence (NICE) Guideline NG232 (Ti opira: nhwehwɛmu ne ntɛm di ho dwuma) ase no, ɔyarefo biara a ɔreyɛ aduru a ekum mogya a ɛtwetwe mogya (warfarin anaa DOACs) anaa aduru a ekum mogya nkwammoaa (a aspirin monotherapy nka ho) a wapira ne ti ɛsɛ sɛ wɔma no Ti CT scan wɔ nnɔnhwerew 8 akyi wɔ opira no akyi (anaasɛ wɔ dɔnhwerew 1 mu sɛ ntini mu sɛnkyerɛnne biara wɔ hɔ a), mpo sɛ obi ntumi nhu hwee na ontumi nkae ade biara.
• Europa Aman Nkabom:
• Ntɛmntɛm: Frɛ 112 na ɛyɛ. Europa mmeae a wɔhwɛ apirakuru so no di Scandinavian Neurotrauma Committee (SNC) ne European Stroke Organization (ESO) akwankyerɛ a ɛhyɛ sɛ wɔmfa ti CT mfonini ntɛm ara ne PCC/Andexanet/Idarucizumab a wɔdannan no akyi ma ti a ɛko tia akisikuru no akyi.
• Australia ne New Zealand:
• Ntɛmntɛm: Frɛ 000 wɔ Australia anaa ** .111** wɔ New Zealand. Wɔ Australian & New Zealand Guideline for Mild to Moderate Head Injuries (PREDICT) ne NSW / Queensland Health Adult Trauma Guidelines ase no, mpanyimfo a wɔn mfe akɔ anim a wɔde nnuru a ekum mogya a ɛtwetwe mogya anaa clopidogrel/ticagrelor di dwuma nyinaa hia sɛ wɔyɛ ED hwɛ a ɛyɛ ahyɛde na wɔyɛ wɔn ti CT mfonini wɔ ti a wɔabɔ biara akyi.
• India ne Asia-Pacific:
• Ntɛmntɛm: Frɛ 112 (anaasɛ 108 ambulance) wɔ India; de kɔ ayaresabea a ɛto so abiɛsa a wɔde CT scanner a ɛyɛ nnɔnhwerew 24 ne ntini mu oprehyɛn adwumayɛbea ahyɛ mu tẽẽ.

6-Nnawɔtwe akyi osutɔbere fie nhwehwɛmu nhyehyɛe ma ahwɛfo¶

Sɛ wɔde Day-1 Head CT scan a ɛnyɛ papa yii w’awofo a ɔwɔ mogya a wɔde yɛ aduru a ɛma mogya tu no fii hɔ wɔ Emergency Department na wɔde kɔmaa fie a, tintim anaa sie 6-Week Delayed Subdural Watch Checklist yi:

• 1.1. Kyerɛw Da Pɛpɛɛpɛ a Ɛhwee ase wɔ Fridge Calendar no so na hyɛ "Nnawɔtwe 2, Nnawɔtwe 4, ne Nnawɔtwe 6" agyirae: Mmusua dodow no ara werɛ fi asehwe ketewaa bi wɔ nnafua 3 akyi. Sɛ wohyɛ adapɛn 6 mfɛnsere agyirae wɔ kalenda no so a, ɛma wohwɛ hu sɛ sɛ w’awofo fi ase yɛ n’ade sɛ ɔda anaasɛ ontumi nnyina ɔsram biako akyi a, ntɛm ara wode sɛnkyerɛnne no bata asehwe no ho na woka kyerɛ ER oduruyɛfo no.
• 2.1. Yɛ "30-Second Morning Walk & Hand-Drift Check" Dabiara: Hwɛ sɛnea w'awofo nantew kɔ anɔpaduan pon so anɔpa biara (hwɛ sɛ ebia veer foforo biara wɔ nkyɛn anaa nan a ɛtwetwe) na hwɛ sɛ ebia wɔde wɔn nsa abien no nyinaa di dwuma pɛpɛɛpɛ anaa.
• 3.1. Bisa Koma Ho Oduruyɛfo anaa Oduruyɛfo a Ɔma Ɔhwɛ Mfitiase Ansa na Woasan Afi Mogya a Ɛyɛ Tete Nnuru Ase Bere A Mogya Atwa Akyi: Sɛ wohuu mogya ketewaa bi a ɛwɔ anom akyi a, nsan mfi Eliquis, Xarelto, warfarin, anaa aspirin ase da kosi sɛ ntini mu oprehyɛn ne koma ho oprehyɛn ne koma ho oprehyɛn begye da pɔtee a wɔbɛsan afi ase a egyina CT a wɔsan yɛ no so no so.
• 4.1. Audit All Over-the-Counter Pain Relievers and Supplements: Yi ibuprofen, naproxen, aspirin, ginkgo biloba, mpataa ngo a wɔde di dwuma kɛse, ne vitamin E capsules nyinaa fi pill nhyehyɛe no mu, efisɛ ɛma mogyatɔw ho asiane no yɛ kɛse ka nnuru a wɔkyerɛw ma mogya a ɛma mogya tu ho. Fa acetaminophen / paracetamol (Tylenol) di dwuma wɔ mmerɛbo mu dodow anohyeto a ahobammɔ wom mu (mpɛn pii no \(\le\)2,000 kosi 3,000 mg/da wɔ mpanyimfo a wɔn mfe akɔ anim mu) sɛ wɔn duruyɛfo pene so wɔ akuru a ɛba wɔ asehwe akyi a.
• 5.1. Yi Nneɛma a Atwa Yɛn Ho Ahyia Asehwe Ho Asiane no Fi hɔ Ɛnnɛ: Fa ntama a wɔde tow a ɛho ayɛ hare, fa anyinam ahoɔden nhama twitwiw, fa anadwo akanea hyehyɛ ɔkwan a ɛkɔ mpa so kɔ aguaree no so, na hwɛ sɛ ɔpanyin no mogya mmoroso nkɔ fam bere a ogyina hɔ no (orthostatic hypotension).

Nsɛm a wɔtaa bisa¶

So ɛho hia ankasa sɛ m’awofo kɔ Emergency Room kɔyɛ Head CT scan sɛ wɔde Eliquis anaa warfarin bɔɔ wɔn ti nanso wɔte nka sɛ wɔn ho ye koraa a?¶

Yiw, bere biara. Akwankyerɛ a ɛfa nnuruyɛ a egye ntɛmpɛ ho wɔ United States, UK (NICE NG232), Canada, ne Australia hyɛ sɛ wɔnyɛ Ti CT scan a ɛnyɛ nea ɛne ne ho bɔ abira ma ɔpanyin biara a ne mfe akɔ anim a ɔnom aduru a ekum mogya mu nkwammoaa kɔkɔɔ (Eliquis, Xarelto, Pradaxa, warfarin) anaa aduru a ano yɛ den a ekum mogya nkwammoaa (Plavix, Brilinta) a ɛbɔ wɔn ti, sɛ mpo wɔanhu hwee da na onni zero a sɛnkyerɛnne ahorow. Nhwehwɛmu ahorow kyerɛ sɛ nkwakoraa ne mmerewa a wɔde nnuru a ekum mogya a ɛtɔ gu nipadua mu a wɔhwɛ na wɔkasa sɛnea ɛsɛ koraa bere a wɔabɔ wɔn ti ketewaa bi akyi no mu ɔha biara mu 6 kosi 10 wɔ amemene mu mogya a ɛretu denneennen a wotumi hu wɔ CT so dedaw.

Ɔkwan bɛn so na amemene mu mogya betumi ada adi wɔ adapɛn 4 akyi wɔ asehwe akyi sɛ ER Head CT scan a wɔyɛe da a ɔhwee ase no yɛ nea ɛfata koraa a?¶

Day-1 Head CT scan nkutoo na ɛkyerɛ sɛ mogya a ɛba ntɛmntɛm na nhyɛso kɛse bɛba da a opirae no nkutoo. Wɔ mpanyimfo a wɔn mfe akɔ anim mu no, amemene no mu a ɛtwetwe fi abɔde mu no trɛw ntini a ɛyɛ mmerɛw a ɛma ɛyɛ mmerɛw a ɛtwam wɔ subdural space no mu no mu. Sɛ obi bɔ anaasɛ ɔhwe ase ketewaa bi a, ebetumi ama ntini nketenkete yi mu atetew wɔ afiri ketewaa bi mu; wɔ adapɛn 2 kosi 6 mu no, nipadua no yɛ ntini a ɛyɛ tratraa bi twa nsu ketewaa a wɔaboaboa ano no ho hyia, na ntini a ɛretu wɔ saa ntini no mu no san san mogya bio wɔ mogya a ɛma mogya tu no nkɛntɛnso ase kosi sɛ subdural hematoma a enni sabea no nyin kɛse araa ma ɛhyɛ amemene no mu.

So ɔpanyin bi betumi anya Subdural Hematoma afi asehwe a ɛbaa baabi a wosii fam wɔ wɔn akyi anaa wɔn asen so a wɔmmɔ wɔn ti wɔ fam ankasa no mu?¶

Aane. Ntini mu oprehyɛn ho animdefo taa sa Chronic Subdural Hematomas wɔ mpanyimfo a wɔn mfe akɔ anim a wɔde nnuru a ekum mogya a ɛtwetwe mogya a wɔn ti anka fam da no mu. Sɛ ɔpanyin bi hwe ase na osi fam denneennen wɔ wɔn dua dompe, n’asen, anaa n’akyi a, basabasayɛ a ɛba mpofirim no ma amemene no di akyi wɔ ti nhwi no akyi sekan fã biako (tumi a ɛtwetwe mpire a ɛnyɛ adwuma), a ɛboro nea ɛdɔɔso sɛ ɛbɛpaapae ntini a ɛyɛ den a ɛtrɛw a mfe akɔ anim a ɛwɔ anom no ase.

So ɛsɛ sɛ mede Eliquis, Xarelto, anaa warfarin dodow a wɔde ma me anwummere no ma bere a wɔahwe ase na wɔabɔ wɔn ti akyi pɛɛ?¶

Dabi, sɛ ɔpanyin bi a ne mfe akɔ anim a ɔnom nnuru a ɛma mogya tu no ti bɔ anaasɛ ɔhwe ase kɛse a, kura wɔn nnuru a edi hɔ a wɔahyɛ da ayɛ a ekum mogya mu nkwammoaa a ɛma mogya tu anaa mogya mu nkwammoaa a ɛma mogya tu no mu kosi sɛ wɔbɛhwɛ wɔn wɔ Dwumadibea a Ɛhwɛ Ntɛmntɛm So na Ti CT scan akyerɛ sɛ mogya a ɛbɛtɔ wɔ tirim no mu. Sɛ womene mogya a ɛma mogya tu no dodow foforo bere a ntini a ɛma ɛyɛ mmerɛw no retu denneennen wɔ ti nhwi no mu a, ɛbɛma mogya no atu ntɛmntɛm na ama ayaresabea a wɔbɛsan akɔ no ayɛ den kɛse.

Mɛyɛ dɛn ahu nsonsonoe a ɛda Chronic Subdural Hematoma ne adwenemhaw a ɛkɔ so daa no ntam?¶

Ntini mu adwenemhaw a ɛma ntini mu yare te sɛ Alzheimer yare no kɔ so nkakrankakra wɔ asram ne mfe pii mu, bere a Chronic Subdural Hematoma ma ne dwumadi so tew ntɛmntɛm wɔ nna pii kosi adapɛn kakraa bi mu. Sɛ obi a ne mfe akɔ anim nya nantew foforo a entumi nnyina, nantew a ɛkɔ nkyɛnkyɛn, ɔda a ɛsakrasakra awiabere (ɔde ne ti to fam wɔ kasamu no mfinimfini), nsu a ontumi nhyɛ ne ho mu foforo, anaasɛ nsa anaa nan a ɛyɛ mmerɛw wɔ ɔfã biako a ɛyɛ anifere wɔ adapɛn 1 kosi 6 mu a, mfa asodi no nto so da wɔ mfitiase adwenemhaw ho kosi sɛ Ti CT scan a ɛnyɛ nea ɛne ne ho bɔ abira no bɛkyerɛ sɛ subdural hematoma a wotumi sa.

Ɛyaw aduru bɛn na asiane biara nni ho sɛ wɔde bɛma ɔpanyin a ne mfe akɔ anim a ɔnom nnuru a ɛma mogya tu a ne ho yɛ no yaw bere a wahwe ase kakra akyi (bere a wɔapow sɛ mogya atɔ amemene mu no)?¶

Sɛ oduruyɛfo yi ɔpanyin no amemene mu mogya anaasɛ abubuw fi hɔ wie a, mpɛn pii no, acetaminophen a ɛnyɛ den (paracetamol / Tylenol) ne ɛyaw ano aduru a ahobammɔ wom sen biara a wɔtɔn ma ayarefo a wɔnom nnuru a ekum mogya a ɛtwetwe mogya (ɛtra hɔ a ne nyinaa nnu miligram 2,000 kosi 3,000 wɔ nnɔnhwerew 24 biara mu wɔ mpanyimfo a wɔn mfe akɔ anim a wɔn mmerɛbo yɛ adwuma yiye mu). Mfa aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), meloxicam, diclofenac, anaa bismuth subsalicylate (Pepto-Bismol) mma da, efisɛ saa nnuru yi sɛe mogya nkwammoaa a ɛtwetwe mogya na ɛma mogya tu kɛse wɔ yafunu ne ti nhwi mu bere a wɔde ka nnuru a ɛma mogya yɛ mmerɛw ho no.

Akwankyerɛ ahorow a ɛfa ho¶

• Nkwakoraa ne mmerewa hwe ase a wɔn ho tɔ wɔn bere a wontumi nnyina hɔ no
• Ti a opira ne concussion mmoa a edi kan
• Adwene a ɛyɛ basaa mpofirim wɔ nkwakoraa ne mmerewa mu: UTI a ɛyɛ komm, urosepsis vs. stroke
• Polypharmacy, nnuru a wɔnom boro so, dodow a wɔannye, ne mfomso a ɛwɔ pill organizer mu

Fibea ne aban akwankyerɛ¶

• Amerika Nnuruyɛfo a Wɔhwɛ Ntɛmntɛm So (ACEP): Ayaresa Ho Nhyehyɛe: Nsɛm a Ɛho Hia wɔ Ayarefo a Wɔanyinyin a Wɔde Wɔn Kɔ Dwumadibea a Ɛhwɛ Nneɛma a Egye Ntɛmpɛ So a Wɔn Amemene mu Apirakuru a Ɛnyɛ Den (Anticoagulation and Antiplatelet Mandatory CT Criteria).
• Ɔman Asoɛe a Ɛhwɛ Akwahosan ne Ɔhwɛ a Ɛyɛ Paara So (NICE, United Kingdom): Akwankyerɛ NG232: Ti Opira: Nhwehwɛmu ne Ntɛmntɛm a Wɔde Di Dwuma (Anticoagulant ne Antiplatelet Ti CT Bere Nhyehyɛe).
• American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP): Nneyɛe Pa Akwankyerɛ wɔ Geriatric Trauma Management ne Anticoagulation Reversal mu.
• Neurocritical Care Society ne Society of Critical Care Medicine (SCCM): Akwankyerɛ a ɛfa Nnuru a Ɛko Tia Ntini a Ɛma Ntini Mu a Wɔdane Wɔ Mogya a Ɛtu wɔ Titiriw Mu (Andexanet Alfa, Idarucizumab, ne 4-Factor PCC Protocols).
• Ɔman Asoɛe a Ɛhwɛ Mpanyinyɛ So (NIA) ne Centers for Disease Control and Prevention (CDC): STEADI (Nkwakoraa ne mmerewa akwanhyia, Owu & Opira a Wogyae) Mpanyimfo a Wɔanyinyin Ahwease ne Amemene mu Opira a Ɛyɛ Hu a Wosiw Ano.