Ame Tsitsiwo ƒe Ta ƒe Ʋuʋu le Ʋuɖemɔ̃wo Ŋu: Subdural Hematoma si Nɔa Anyi Didi ƒe Kwasiɖawo Le Amewo ƒe Anyidzedze Sue aɖe megbe¶

Ame tsitsi miliɔn geɖe noa ʋumenugbagbeviɣitike alo ʋumenugbagbeviɣitike siwo woŋlɔ na wo gbesiagbe be woatsɔ axe mɔ ɖe dzitodzito me ʋu ƒe sisi, aklã me ʋu ƒe sisi, alo dzitodzito me ʋu ƒe sisi nu, siwo dometɔ aɖewoe nye apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), edoxaban (Savaysa), warfarin (Coumadin), clopidogrel (Plavix), ticagrelor (Brilinta), kple gbesiagbe aspirin. Ne ame tsitsi aɖe si le atike siawo dometɔ aɖe zãm la ƒu du ɖe xɔmenuwo dzi, dze anyi hegbã eƒe akɔta, alo tsɔ woƒe ta ƒo ɖe dzodoƒe ƒe nuɖaze ƒe ʋɔtru alo ʋu ƒe ʋɔtru si le ʋuʋu ɖi ŋu ko la, zi geɖe la, ƒomea gbɔa ya ne ame tsitsia ƒe susu meganɔa dɔ wɔm o, eƒe ta metso ʋu si le dodom le eŋu o, eye wòwɔa nu abe alesi wòle le fiẽsi mamlɛa me ene. Dedienɔnɔ ƒe seselelãme alakpatɔ ma nye mɔ̃ siwo wua ame wu le ame tsitsiwo ƒe atikewɔwɔ kpata me la dometɔ ɖeka.

Le ame tsitsi si le ʋu ƒe ʋuʋu ƒe atikewo zãm gome la, ʋu si dona le tagbɔ me zɔna ɖe ɣeyiɣi vovovo eve siwo ate ŋu ade eƒe agbe afɔku me dzi: ʋu si dona le ta me si nu sẽ alo esi tsi megbe le gaƒoƒo 6 va ɖo 48 gbãtɔwo me, ALOO Slow-oozing Chronic Subdural Hematoma (cSDH) si kekena ɖe taɖua me le ɖoɖoezizi me hena ** kwasiɖa 2 va ɖo 6** le ema megbe ta ƒe ƒoƒo sue aɖe si woŋlɔ be alo anyigba ƒe anyidzedze vaseɖe esime wòmiã ahɔhɔ̃a eye wòsrɔ̃a ʋusɔgbɔdɔ alo tagbɔdɔ kabakaba. Ne ame tsitsi aɖe si le ʋumenugbagbeviɣidɔlékuiwo zãm ƒe ta ƒo alo dze anyi, alo tɔtɔ yeye, alɔ̃dɔdɔ, taɖuame, nuƒoƒo ƒuƒlu, alo afɔ ɖeka ƒe ʋuʋu le eƒe anyidzedze ŋkeke alo kwasiɖa aɖewo megbe la, ƒo ka na wò nutoa me ƒe xexlẽdzesi kpata (911 le United States kple Canada, . 112 le Europa Dukɔwo ƒe Habɔbɔa katã me la, . 999 le United Kingdom; kpɔ ɖa xexlẽdzesi siwo wozãna kpata) enumake. Ne èdi ame tsitsiwo ƒe nɔnɔme kpata siwo do ƒome kplii la, kpɔ ame tsitsiwo ƒe anyidzedze ƒe hayahaya ne womete ŋu tsi tre o, . ta ƒe abixɔxɔ, kple atike geɖe dzadzra, atikewo ƒe agbɔsɔsɔ fũ, atikeawo ƒe agbɔsɔsɔ si to, kple atikekuiwo ƒe ɖoɖowɔla ƒe vodadawo.

Wɔ esia fifia¶

1. Yi Kɔdzi ƒe Kpata Dɔwɔƒe si te ɖe ŋuwò be woawɔ Ta CT Scan si me vovototo aɖeke mele o enumake ɣesiaɣi si ame tsitsi aɖe si le ʋumenugbagbeviɣitike alo ʋumenugbagbeviɣitike zãm la dze woƒe ta dzi, ne womedo viviti kpɔ o eye wose le wo ɖokui me be yewole dedie 100 le alafa me gɔ̃ hã. Dɔdaƒe ƒe mɔfiame siwo ku ɖe nuveviwɔame ŋu (ACEP, NICE NG232, kple ACS TQIP) bia be woawɔ ta CT scan kpata hena any anticoagulated dɔnɔ si kplɔ ta ƒe abixɔxɔ ɖo eɖanye aleke kee ʋuʋudedia dze suee alo aleke kee woƒe Glasgow Coma Scale ƒe dzesiwo sɔ o.
2. Lé Eliquis, Xarelto, Pradaxa, warfarin, alo Plavix ƒe agbɔsɔsɔ si woɖo ɖi si kplɔe ɖo me ɖe asi vaseɖe esime Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ ƒe ɖɔkta nato Ta ƒe CT-dɔdamɔnua me. Mègana fiẽsi alo ŋdi me ʋu ƒe sisi ƒe atikekui la gbeɖe le anyidzedze alo ta ƒoƒo vɔ megbe teti hafi woatsɔ CT-nɔnɔmetatawo agbe ʋu ƒe sisi le ahɔhɔ̃ me o. Tsɔ atikekui ƒe aŋetuawo tututu va ER eye nàgblɔ gaƒoɖokui ƒe gaƒoƒo si tututu womi agbɔsɔsɔme mamlɛtɔ na dɔnɔdzikpɔla si wɔa atikeawo.
3. Mègana aspirin, ibuprofen (Advil/Motrin), naproxen (Aleve), alo Goody’s/BC Powder gbeɖe na taɖuame alo akɔtave le anyidzedze megbe o. Non-steroidal anti-inflammatory drugs (NSAIDs) kple aspirin wɔa ʋumenugbagbevi dzĩwo nuwɔametɔwoe eye wòdzia ​​ʋu si dona le tagbɔ me si wua ame ƒe duƒuƒu ɖe edzi le ame tsitsi si ŋu ʋumenugbagbeviɣidɔlékui le me.
4. Bu eŋu be "Delayed Chronic Subdural Hematoma" le ame tsitsi aɖe ŋu ne azɔlizɔzɔ yeye si me mekɔ o, afɔ ƒe gbɔdzɔgbɔdzɔ si menya kpɔna dzea sii bɔbɔe o, alɔ̃dɔdɔ le ŋkeke me, amenyenye ƒe tɔtrɔ, alo taɖuame si me mekɔ o le kwasiɖa 1 va ɖo 6 le anyidzedze AMESIAME megbe. Ne ER ta ƒe CT scan gbãtɔ si wowɔ le ŋkeke si dzi wodze anyi la me kɔ 100 le alafa me (alo ne ame tsitsia meƒo ta tẽ kpɔ o gake wòkpe fu kpata hã whiplash jar tso anyidzedze ɖe woƒe akɔta alo akɔta), ʋuka siwo le sisim yi ɖe subdural space me ate ŋu axɔ ŋkeke 14 va ɖo 42 hafi aƒo ahɔhɔ̃a nu ƒu. Bia be woawɔ gbugbɔ Ta CT scan si me vovototo aɖeke mele o enumake.
5. Ne ame tsitsia dze anyi eye mete ŋu tsɔ kpekpeme le afɔ ɖeka dzi o, alo afɔ ɖeka trɔ ɖe gota (etrɔ le gota) eye wòdze abe ɖe wòle kpuie wu evelia ene la, na woanɔ anyigba kokoko eye nàyɔ 911 (112 alo 999) for a suspected Hip Fracture. Mègakɔ ame tsitsi si ƒe akɔta gbã si ƒe akɔta gbã la kɔ ɖe zikpui alo ʋu ƒe zikpui dzi gbeɖe o: afɔkpodzi ƒe kɔ si me ʋuʋudedi le alo ƒu kakɛ siwo le ʋukawo dome ate ŋu avuvu ʋuka siwo ƒo xlãe eye ʋu lita 1 va ɖo 1.5 nado le ememe ayi ata ne woʋuʋui madzemadzee.
6. Gblɔ na ER triage desk enumake be dɔnɔa le Anticoagulant zãm ale be woaʋã "Code Trauma / Anticoagulated Head Strike" protocol. Gblɔ atike ƒe ŋkɔ tututu ale be kɔdzi ƒe atikedzraƒea nate ŋu adzra intravenous reversal agent tɔxɛa ɖo (abe Andexxa / 4-Factor PCC na Eliquis/Xarelto, Praxbind ene. na Pradaxa, alo Vitamin K + Kcentra na warfarin) ne CT scan ɖe ahɔhɔ̃ me ʋu si le dɔ wɔm fia.

Nyametsotsoti: Triage na ame tsitsi si ŋu ʋumenugbagbeviɣidɔlékui le le anyidzedze alo ta ƒoƒo vɔ megbe¶

flowchart TD
    A["Ame Tsitsi Siwo Le Ʋu Ƒe Ʋuʋudeditikewo (Eliquis, Xarelto, Warfarin, Plavix) zãm la dzea anyi alo Ta ƒoƒo"] --> B{"Ðe anyidzedzea dzɔ EGBEA (Acute Phase) alo ŊKEKE/KWASIWO VAYI (Delayed Phase)?"}
    B -->|"Edzɔ Egbe / Le Gaƒoƒo 48 Me"| C{"Aflaga Dzĩ ƒe Dzesi Aɖewo: Ame ƒe susu meganɔa dɔme o, ʋuɖɔɖɔɖɔɖɔ, taɖuame sesẽ, tɔtɔ, ŋkume ƒe ŋkume si mesɔ o, alo akɔta ƒe dɔmawɔmawɔ nyuiea?"}
    C -->|"Ẽ: Aflaga Dzĩwo Le Fifia"| D["Ƒo ka na 911 / 112 / 999 Enumake: Nɔ anyi kpoo, lé ʋu-ɖeka ƒe agbɔsɔsɔme si kplɔe ɖo ɖe asi, dzra ɖo ɖe ER Head CT + Reversal Agent ŋu"]
    C -->|"Ao: Edze abe ɖe wòsɔ 100% ene, dzesi aɖeke mele eŋu o"| E["KPƆKPƆ KPƆKPƆ ER EGBEA hena Baseline Non-Contrast Head CT Scan si Wobia"]
    E --> F{"Nukae ER Ta ƒe CT Gbãtɔ Fia?"}
    F -->|"Enyo na Ʋu si Dona Kpekpeɖeŋu"| G["ICU Ahɔhɔ̃mekawɔwɔ ƒe Aɖaŋuɖoɖo Enumake + IV Anticoagulant Trɔtrɔ (Andexxa / Kcentra / Praxbind)"]
    F -->|"Negative (CT Gbãtɔ si Me Kɔ) ."| H["Kpɔ Kwasiɖa 6 Delayed Chronic Subdural Window: Kpɔ nyuie le azɔlizɔzɔ ƒe ʋuʋu, alɔ̃dɔdɔ, alo tɔtɔ yeye ŋu"]
    B -->|"Edzɔ Ŋkeke 3 Vaseɖe Kwasiɖa 6 enye sia"| I{"Ðe ame tsitsia le azɔlizɔzɔ YEYE si menya kpɔna dzea sii bɔbɔe o, alɔ̃dɔdɔ, tɔtɔ si le tɔtrɔm, nuƒoƒo ƒuƒlu, alo taɖuame ɖem fiaa?"}
    I -->|"Ẽ: Ne CT Gbãtɔ Kwasiɖa Siwo Va Yi Me Kɔ Gbɔ hã"| J["Yi Kɔdzi ER Enumake eye nàbia be Woagawɔ Non-Contrast Head CT Gbugbɔ Be Woaɖe Subdural Hematoma si Nɔa Anyi Didi O ɖa"]
    I -->|"Dzesi aɖeke mele eŋu o"| K["Yi edzi nànɔ mɔxexe ɖe anyidzedze nu edziedzi kple ahɔhɔ̃mekawo ƒe dodokpɔ kwasiɖa sia kwasiɖa vaseɖe Kwasiɖa 6 lia dzi"]

Akpa 1 (Gaƒoƒo 0 va ɖo 48): Ahɔhɔ̃ me ʋu ƒe dodo kpata ƒe afɔku kple ʋumenugbagbeviɣitike ƒe tɔtrɔ kpata¶

Ne ame tsitsi aɖe si le ʋumenugbagbeviɣitikewo zãm va ta egbea la, atikewɔla siwo kpɔa nudzɔdzɔ kpatawo gbɔ tsia dzi ɖe acute subdural hematoma, subarachnoid hemorrhage, alo intraparenchymal contusion ŋu gbã. Le dɔdaƒe ŋuti numekuku siwo wowɔ le ame tsitsi siwo ŋu ʋumenugbagbeviɣidɔlékuiwutike na siwo va dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ kple ŋudzɔnɔnɔ bliboe kple Glasgow Coma Scale ƒe dzesi deblibo si nye 15 (nuƒoƒo nyuie, gbɔdzɔgbɔdzɔ zero le teƒe ɖeka, ŋkuɖoɖonudzi zero) le anyigba ƒe anyidzedze megbe la, 6 va ɖo 10 le alafa me ƒe ta me ʋu si le dɔ wɔm si dzena le Ta CT me le wo ŋu xoxo, eye 0.6 va ɖo 2.5 le alafa me bubu va xɔa megbetsitsi ʋu si dona vevie le gaƒoƒo 6 va ɖo 24 megbe.

Ʋumenugbagbeviɣitikewo, ʋu ƒe dodo ƒe afɔkuwo, kple kɔdzi ƒe tɔtrɔ kpata ƒe atikewo tsɔtsɔ sɔ kple wo nɔewo¶

Tsɔ ame tsitsia ƒe atikewo alo atikekuiwo ƒe aŋetuwo yi Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ ɣesiaɣi. Ʋumenugbagbeviɣidɔlékuiwutike ƒe hatsotso tututue gblɔa alesi kɔdzia atɔ te ahɔhɔ̃ me ʋu si ate ŋu ade eƒe agbe afɔku me alo adzra dɔnɔa ɖo ɖe akɔta ƒe gbagbã alo burr-do ƒe amekoko kpata ŋu:

Akpa 2 (Ŋkeke 3 Vaseɖe Kwasiɖa 6): Dzesidede Delayed Chronic Subdural Hematoma (cSDH) .¶

Ne ame tsitsi aɖe yi ER le ŋkeke si dzi wòdze anyi, wowɔ Ta CT scan si me vovototo aɖeke mele o, eye wogblɔ nɛ be "Nya nyui aɖee nye be, CT scan la sɔ keŋkeŋ, àte ŋu ayi aƒeme," afɔkua MENYE o.

Le nyateƒe me la, ame tsitsi siwo ade 25 va ɖo 35 le alafa me siwo wokpɔ be Chronic Subdural Hematoma gã aɖe le wo ŋu la ƒe Ta CT scan gbãtɔ si sɔ wɔ wo le ŋkeke si dzi wodze anyi alo womete ŋu ɖo ŋku edzi gɔ̃ hã be yewoƒo yewoƒe ta o elabena ƒoƒo gbãtɔa (alo ƒoƒo ƒe ze si woƒo kpata le esi wòdze anyi) la nɔ sue ŋutɔ.

1. Akpa 3 ƒe dɔlélenutsiŋutete si nye kwasiɖa 4 ƒe ahɔhɔ̃ me ʋu si tsi megbe¶

Aleke ahɔhɔ̃ me ʋu ate ŋu adze le kwasiɖa 3 va ɖo 5 le CT scan si sɔ megbe?

flowchart TD
    A["Ŋkeke 1: Ta ƒe Ʋuʋu Sue alo Geɖe ɖe Akɔta/Akɔta (Whiplash Acceleration) ."] --> B["Micro-Tear le Taut Tɔdzisasrã Vein Tso Atrophied Subdural Teƒe"]
    B --> C["Ŋkeke 1 vaseɖe 5: Tiny Venous Ooze (Tsɔe tsɛ akpa be woakpɔe le Ŋkeke-1 CT me alo atɔ te ɣeyiɣi kpui aɖe) ."]
    C --> D["Ŋkeke 7 va ɖo 21: Fibrin ƒe Ʋuʋudedi Gãna zua Protein Tsi si Woƒo Ƒu + Dzoxɔxɔ Neomembrane Nɔnɔme Siwo Le Nuƒoƒoƒu Ŋu"]
    D --> E["Kwasiɖa 2 vaseɖe 6: Ʋuka siwo me tsi sina tona bɔbɔe le Neomembrane Micro-Bleed me Madzudzɔmadzudzɔe (Anticoagulants & Osmotic Fluid Pull ʋãnɛ)"]
    E --> F["Agbɔsɔsɔ Vevi Si Woɖo (80 va ɖo 150 mL): Ahɔhɔ̃ ƒe Titina ƒe Tɔtrɔ -> Azɔlizɔzɔ Kpata, Alɔ̃dɔdɔ, Tɔtɔ, alo Gbɔdzɔgbɔdzɔ si Le abe Ʋusɔgbɔdɔ ene"]

1. Afɔɖeɖe 1 - The Silent Micro-Tear (Ŋkeke 1 vaseɖe 5): Taƒoƒo sue aɖe alo ta ʋuʋu kpata vuvu ʋuka sue aɖe si xe mɔ na tɔdzisasrã. Le ahɔhɔ̃ tsitsi aɖe si me teƒe si le eƒe akɔta te le dɔmenyotɔe me la, ʋuka me ʋu tsɛ aɖe sina toa ahɔhɔ̃a ƒe ʋuʋudedi me.
2. Afɔɖeɖe 2 - Membrane Encapsulation and Liquefaction (Ŋkeke 7 vaseɖe 21): Le kwasiɖa evelia kple etɔ̃lia me la, ŋutilãa dzea agbagba be yeatsɔ gli atso ʋu xoxoa ŋu to ʋuka tsɛ aɖe (neomembrane) tsitsi ƒo xlãe me, esime enzymes naa ʋu doviviti si ƒo xlãe la tsina wòzua tsi ɣi si le abe motor-oil ene (hygroma / chronic hematoma).
3. Afɔɖeɖe 3 - Ʋukawo Gbugbɔgadzɔ Madzudzɔmadzudzɔe (Kwasiɖa 2 vaseɖe 6): Neomembrane yeye si wowɔ la yɔ fũ kple ʋuka suesuesue siwo te ŋu gblẽna ŋutɔ, siwo le sisim. Esi wònye be ame tsitsia le Eliquis, Xarelto, warfarin, alo Plavix nom ta la, lãkusi ƒe ʋuka mawo siwo le sisim la gbugbɔa ʋu dzĩ yeye ɖea doa me gbesiagbe. Le kwasiɖa 3 gbãtɔwo me la, ahɔhɔ̃ si woɖe ɖe vovo la xɔa kotoku si le tsitsim la vevesese aɖeke manɔmee. Emegbe le Ŋkeke 21 lia alo Ŋkeke 35 lia dzi la, kotokua ƒe kpekpeme ɖoa mililita 80 va ɖo 150, eɖea tsi si susɔ ɖe taɖua me la katã ɖa, eye wòtutua ahɔhɔ̃a ɖe axadzi (midline shift).

2. "Ahɔhɔ̃ŋutinunya Srɔ̃la Gãtɔ": Dzesi 6 siwo menya kpɔna dzea sii bɔbɔe o siwo fia be Chronic Subdural Hematoma¶

Ahɔhɔ̃ŋutinunyalawo yɔa Chronic Subdural Hematoma "The Great Imitator" elabena ƒã hafi wòhea Hollywood ƒe anyidzedze wɔnuku aɖe vɛ le gɔmedzedzea me. Ke boŋ ƒomea me tɔwo kple ɖɔkta gbãtɔwo bua eŋu vodadatɔe enuenu be "Alzheimer ƒe dɔléle si le sesẽm ɖe edzi," "blanuiléle," "tsitsi," alo "ʋusɔgbɔdɔ sue aɖe."

Kpɔ nuxlɔ̃amedzesi 6 siwo wonya nyuie siawo ɖa le afi sia afi si le ŋkeke 3 va ɖo kwasiɖa 6 dome le anyidzedze alo ƒoƒo ɖesiaɖe megbe:

1. "Azɔlizɔzɔ ƒe Ʋuʋu" Yeye alo Nukikli si Womeɖe O (Zi geɖe la, enye #1 Dzesi Gbãtɔ):
2. Ame tsitsia dzea egɔme nɔa ʋuʋum vie yia akpa ɖeka le xɔdɔme la me, nɔa woƒe afɔwo ʋuʋum, léa woƒe afɔbidɛ, alo wòhiãna be woalé gliwo ɖe asi hafi azɔ ayi tsileƒe. Esi wònye be subdural hematoma nɔa ahɔhɔ̃a ƒe mɔ̃ si le etame (si kpɔa afɔ kple akɔta) dzi ta la, zi geɖe la, afɔ ƒe apraxia si menya kpɔna dzea sii bɔbɔe o kple dadasɔ ƒe anyimanɔmanɔ dzena ŋkeke geɖe hafi abɔ ƒe gbɔdzɔgbɔdzɔ alo nuƒoƒo ƒe tɔtrɔ.
3. Ŋkeke me Alɔ̃dɔdɔ si le tɔtrɔm kple "Gaƒoƒo Nyui / Gaƒoƒo Vɔ̃ɖi" Kuviawɔwɔ:
4. Le ga 09:00 me la, edze abe ame tsitsia ƒe mo kɔ eye wònya nu nyuie ene, gake kaka ga 13:00 naƒo la, wole ta ʋuʋum le woƒe zikpui dzi le dzeɖoɖo me, esesẽna be woanɔ ŋudzɔ, alo wole ŋku lém ɖe wo ŋu ƒuƒlu. Nu ŋudzɔ si le tɔtrɔm nye dzesi si ɖea taɖuame ƒe nyaƒoɖeamenu si le dzi yim tso tsi ƒe subdural nuƒoƒoƒu me ƒe dzesi.
5. Amenyenye ƒe Tɔtrɔ Subacute, Ðekematsɔleme, alo "Tagbɔdɔléle Si Dzɔna Kabakaba":
6. Alzheimer ƒe dɔléle vavãtɔ yia ŋgɔ le **ƒe ** me, gbeɖe le kwasiɖa 2 me gbeɖe o. Ne ame tsitsi aɖe si ate ŋu ado awu, azã TV ƒe adzɔgemɔ̃, eye wòaɖo dze si sɔ kwasiɖa 3 enye sia la tɔtɔ zi ɖeka, do dziku, metsɔ ɖeke le eme o, alo mete ŋu ɖua aɖuɖɔ le kwasiɖa sia me o la, ke ɖikeke le eŋu be Chronic Subdural Hematoma (alo silent infection; kpɔ tɔtɔ kpata le ame tsitsiwo me: UTI si me womeƒoa nu le o, urosepsis vs. stroke).
7. Taɖuame Fafɛ, si me mekɔ o, si nɔa anyi ɖaa (Alo ŋgonu ƒoƒo/tutu le ame tsitsi siwo menye nyagbɔgblɔ o me):
8. Ame tsitsi siwo ade 50 le alafa me siwo ŋu subdural hematoma si nɔa anyi didi le gblɔ be taɖuame si nu mesẽ o, si le veve sem le nyaƒoɖeamenu me si nu sẽna ɖe edzi ne womlɔ anyi alo le kɔdzim, gake taɖuame zero mele ame 50 le alafa me mamlɛawo si o elabena ahɔhɔ̃ ƒe ʋuʋu nana dural stretch receptors meganɔa anyi o.
9. Akpa Ðeka ƒe Gbɔdzɔgbɔdzɔ si menya kpɔna dzea sii bɔbɔe o (Hemiparesis) alo Pronator Drift:
10. Bia tso ame tsitsia si be wòalé abɔ eveawo ɖe wo ŋgɔ tẽe eye eƒe asibidɛwo nadze ŋgɔ dzi sɛkɛnd 10 eye wòmiã ŋku: ne asi ɖeka trɔ blewuu yi eme eye wòdzo yi anyime (pronator drift), alo ne wodze woƒe kɔfi kplu dada gɔme alo he afɔkpa ɖeka la, yi ER enumake.
11. Nyawo Didi ƒe Tɔtɔ, Nuƒoƒo si me mekɔ o, alo Focal Seizures:
12. Ne ʋumenugbagbeviɣidɔa te ɖe miame ƒe gbegbɔgblɔ ƒe lãkusi ŋu la, ame tsitsia ate ŋu aʋli vevie be yeake ɖe nya siwo bɔ ŋu, atsɔ nyagbewo aƒo ɖii, alo akpɔ asi ɖeka alo nu ƒe dzogoe aɖe ƒe ʋuʋu kpuie le ɣeyiɣi ƒe didime nu.

Nɔnɔme 2: Anticoagulated Hip Fracture vs. Pelvic Fracture le ame tsitsi aɖe ƒe anyidzedze megbe¶

Ne ame tsitsi aɖe si le ʋumenugbagbeviɣitikewo zãm dze anyi la, menye ta koe nye afisi ʋu dona le si ate ŋu ade eƒe agbe afɔku me o. akɔta ƒe gbagbã (proximal femur fracture) alo pelvic ring fracture le ame tsitsi si ŋu ʋumenugbagbeviɣitike ɖo me nye ƒumeŋuɖui kple ʋu ƒe dɔwɔwɔ kpata:

1. De dzesi Dzesi Klasik siwo ɖea akɔta ƒe gbagbã le anyigba:
2. Afɔ Kpuie Kple Gota: Lé ŋku ɖe ame tsitsia ƒe afɔ eveawo siaa ŋu esime womlɔ woƒe akɔta: ne wotsɔ afɔ ɖeka ƒo ɖe gota ɖo ta anyigba le dzogoe 45 va ɖo 90 dzi eye afɔ ma dze abe ɖe wòle kpuie sentimeta 2 va ɖo 5 (inch 1 va ɖo 2) wu afɔ evelia la, ke afɔkpodzi ƒe kɔ alo intertrochanteric hip bone gbã.
3. Akɔta alo Anterior Thigh Pain on Any Hip Rotation: Ne "impacted" alo hairline hip fracture le afisi afɔa dze dzɔdzɔe le hã la, ame tsitsia ase veve sesẽ le akɔta ƒe gogloƒe ne ele agbagba dzem be yeakɔ yewoƒe afɔkpodzi tso anyigba alo atsɔ kpekpeme.
4. Occult Hip alo Pubic Ramus Fracture (Ne Initial X-Ray Is Normal): Le ƒumeŋuɖui tsitsi siwo dzea anyi eye womete ŋu tsɔa kpekpeme ɖe woƒe afɔ dzi evɔ womete ŋu tsɔa kpekpeme le woƒe afɔ dzi evɔ womete ŋu tsɔa kpekpeme le woƒe afɔ ŋu o me la, akɔta gbadzaa ƒe X-ray gbãtɔ si wowɔna le ER la dzena abe ɖe wòsɔ ene elabena fracture line la meʋu o (occult femoral neck fracture). Ne ame tsitsi aɖe mate ŋu azɔ le anyidzedze megbe o togbɔ be wowɔ akɔta ƒe X-ray si mesɔ o hã la, dɔdamɔnu ƒe mɔfiamewo bia be woawɔ Akɔta ƒe MRI alo CT scan kpata hafi woaɖe mɔ na wo be woadze agbagba atsɔ kpekpeme.
5. Ʋudodo ƒe Afɔku Ɣaɣla le Ʋuɖemɔ̃wo Ŋu:
6. Ʋukawo me ʋu gã aɖe le afɔkpodzi kple akɔta. Intertrochanteric hip fracture alo pubic ramus alo sacral pelvic fracture le dɔnɔ si le Eliquis, Xarelto, alo warfarin nom me ate ŋu ado ʋu 1,000 va ɖo 2,000 mililita (2 va ɖo 4 pint) ɖe ata alo megbeƒu ƒe akpa goglowo me kpoo eye ʋu ɖeka pɛ hã madze le ŋutigbalẽa dzi o, si ana hypovolemic shock (ŋutilã si le ɣie, ʋu ƒe sisi gbɔdzɔ kabakaba, taɖuame, ʋu ƒe sisi ƒe ɖiɖi).
7. Nukatae Amekoko Dzadzraɖo Kaba Le Gaƒoƒo 24 Vaseɖe 48 Me Ðea Amewo Ƒe Agbe:
8. Mɔfiame siwo ku ɖe ƒumeŋuɖui ŋu (AAOS kple NICE CG124) ɖo kpe edzi be ne wodzra ame tsitsi aɖe ƒe akɔta ƒe gbagbã ɖo le gaƒoƒo 24 va ɖo 48 tso esime wova ɖo kɔdzi la, eɖea ŋkeke 30 ƒe ku, aklã me ʋu ƒe sisi si wua ame, aklãdɔ, kple tagbɔdɔ dzi kpɔtɔna ɖe afã me.
9. To ER yiyi enumake kple ʋu si wotsɔna tsia ʋu ƒe agbɔsɔsɔme si kplɔe ɖo léle ɖe asi me la, atike siwo naa alɔ̃dɔdɔ kple ƒumeŋuɖui ƒe nuveviwɔame ƒe ƒuƒoƒowo ate ŋu adzidze atike ƒe agbɔsɔsɔ, awɔ atikeawo ƒe tɔtrɔ si woɖo taɖodzinu na alo aɖo ɣeyiɣi na gaƒoƒo 24 ƒe DOAC ƒe tsilele fesrea, eye woawɔ dɔ nɛ dedie kaba madzudzɔmadzudzɔe.

Nusi nàwɔ esime nèle lalam le anyigba be yeaxɔ dɔnɔdzikpɔʋu (911 / . 112 / . 999) .¶

Ne ame tsitsi aɖe si ŋu ʋumenugbagbeviɣidɔlékuiwutike le ge dze anyigba sesẽ alo ati dzi eye nèsusu be ta ƒo alo akɔta gbã la:

• Na ame tsitsia namlɔ anyi alo anɔ nɔnɔme si tututu wokpɔ me: Mègahe wo ɖe woƒe abɔwo ŋu gbeɖe o eye mègana woadze agbagba gbeɖe be "yeazɔe adzo" ayi xɔdɔme me o. Ne wohe ame tsitsi si ŋu ʋumenugbagbeviɣitike ɖo la ɖe tsitrenu le anyidzedze vɔ megbe ate ŋu aɖe afɔkpodzi ƒe kɔ ƒe gbagbã si ŋu wògblẽ nu le la ɖa (atrɔ asi le 3-screw pin dzadzraɖo bɔbɔe aɖe ŋu wòazu akɔta ɖɔliɖɔli bliboe) alo ahe syncopal blackout vɛ ne ʋu si dona le ememe na woƒe ʋu ƒe sisi dzi ɖe kpɔtɔ.
• Dzra ta ƒe vuvu ɖesiaɖe si woate ŋu akpɔ dzi kple nyaƒoɖeamenu sesẽ tẽ: Ta nye ʋuka siwo me ʋukawo le wu le amegbetɔ ƒe ŋutilã me la dometɔ ɖeka, eye taɖa si ƒe didime nye sentimeta 3 (inch 1.2) si woma ɖe Eliquis alo warfarin dzi ate ŋu ado ʋu mililita 500 ɖe anyigba le miniti 15 me. Klo tsilewu dzadzɛ alo gauze-kplu si me dɔlékui mele o wòazu dzogoe ene me tɔ eye nàmimie sesẽe eye nàyi edzi tẽe ɖe taɖa ƒe abi si le ʋu ɖum la dzi (negbe ɖe nèse le ɖokuiwò me be taɖu ƒe gbagbã falɛfalɛ, si le abe ƒumebɔbɔ ene, si te ɖe anyi, le ete, eye le nɔnɔme sia me la, tsɔ asigɛ-padding ƒe nyaƒoɖeamenu blewuu ƒo xlã goawo).
• Mɔxexe ɖe anyigba ƒe dzoxɔxɔ si nu sẽ nu (Rhabdomyolysis kple Coagulopathy Protection): Ŋutilã ƒe dzoxɔxɔ fafɛ (hypothermia below 35 degrees Celsius / 95 degrees Fahrenheit) nana amegbetɔ ƒe ʋu ƒe ʋuʋu ƒe enzymes (the lethal triad of trauma coagulopathy), si wɔnɛ be ʋumenugbagbeviɣitikewo gagblẽa nu le ame ŋu wu. Tsɔ avɔ dzodzoewo ɣla ɖe ame tsitsia ƒe abɔta kple akɔta kple ete evɔ màʋuʋu woƒe akɔta si gbã o, eye nàtrɔ xɔa me dzoxɔxɔdzidzenu ɖe dzi esime kpekpeɖeŋunalawo le mɔ dzi.

Nutome ƒe xexlẽdzesi siwo ku ɖe nudzɔdzɔ kpatawo ŋu kple dɔwɔƒea ƒe ɖoɖowo¶

Zã xexlẽdzesi kpata siawo kple dukɔa ƒe dɔdaƒe ƒe nuveviwɔame ŋuti ɖoɖowo ne ame tsitsi aɖe si le ʋumenugbagbeviɣitike zãm la dze anyi alo ta ƒoe:

• United States kple Canada:
• Ambulance Kpata & Trauma Triage: Yɔ 911. Le CDC Field Triage Guidelines for Injured Patients te la, ame tsitsiwo (\(\ge\)65 ƒe) siwo noa ʋumenugbagbeviɣitike siwo ta ƒo alo wosusu be akɔta gbã la ɖo afɔku gã ƒe nuveviwɔame ƒe dodokpɔ ƒe dzidzenuwo gbɔ hena wo tsɔtsɔ yi kɔdzi si si 24/7 CT nɔnɔmetatawo kple ahɔhɔ̃mekawo ƒe dɔwɔwɔ/ƒumeŋuɖui ƒe ŋutete le.
• Mɔfiame si ku ɖe ʋumenugbagbeviɣidɔ ƒe tɔtrɔ ŋu: Dɔwɔƒe siwo kpɔa nudzɔdzɔ kpatawo gbɔ zɔna ɖe Amerikatɔwo ƒe Atikewɔla Kpatawo ƒe Kɔledzi (ACEP) ƒe Dɔdaƒe ƒe Ðoɖo si ku ɖe Ahɔhɔ̃ ƒe Nuveviwɔame si me nuvevi aɖeke mele o ŋu kple Amerika Dzi Habɔbɔ (AHA) / Ahɔhɔ̃mekawo ƒe Dɔléle Habɔbɔ ƒe Mɔfiamewo dzi hena ʋumenugbagbeviɣitikewo ƒe tɔtrɔ le ʋu si dona le tagbɔ me.
• Fiaɖuƒe Ðeka:
• Nu kpata: Yɔ 999 (alo 111 ne kakaɖedzi mele eŋu kura le ʋuʋudedi sue aɖe ŋutɔ si menye ta o ŋu ko hafi; ta ƒe abi ɖesiaɖe si woawɔ le ʋumenugbagbeviɣidɔlékuiwo ŋu la bia be woawɔ Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo ƒe dɔwɔwɔ kpɔ).
• NICE ƒe Dɔdaƒe ƒe Sedede (NG232): Le Dukɔa ƒe Lãmesẽ Kple Belélename Ŋuti Nusrɔ̃ƒe (NICE) ƒe Mɔfiame NG232 (Ta ƒe abixɔxɔ: dodokpɔ kple edzikpɔkpɔ kaba) te la, dɔnɔ ɖesiaɖe si le ʋumenugbagbeviɣitike (warfarin alo DOACs) alo ʋumenugbagbeviɣidɔtike (si me aspirin ɖeka ƒe atikewɔwɔ mele o) si xɔ abi le ta me la ele be woawɔ Ta CT scan le gaƒoƒo 8 me tso esime woxɔ abi (alo le gaƒoƒo 1 me ne ahɔhɔ̃mekawo ƒe dzesi aɖe le eŋu), ne ame ƒe susu meganɔa nu ŋu o eye ŋkuɖoɖonudzi aɖeke megali o gɔ̃ hã.
• Europa Dukɔwo ƒe Ðekawɔha:
• Nu kpata: Yɔ 112. Europa ƒe nuveviwɔame dɔwɔƒewo zɔna ɖe Scandinavia Ahɔhɔ̃mekawo ƒe Dɔléle Ŋuti Kɔmiti (SNC) kple European Stroke Organization (ESO) ƒe mɔfiame siwo bia be woaɖe ta ƒe CT nɔnɔmetatawo enumake kple PCC/Andexanet/Idarucizumab ƒe tɔtrɔ ɖe ta ƒe abi si tsia ʋu ƒe sisi ŋu dzi.
• Australia kple New Zealand:
• Nu kpata: Yɔ 000 le Australia alo ** .111** le New Zealand. Le Australian & New Zealand Guideline for Mild to Moderate Head Injuries (PREDICT) kple NSW / Queensland Health Adult Trauma Guidelines te la, ame tsitsi siwo katã le ʋumenugbagbeviɣitikewo alo clopidogrel/ticagrelor zãm la hiã be woawɔ ED ƒe ŋkuléleɖenuŋu kple ta CT nɔnɔmetata siwo wòle be woawɔ le ta ƒe ƒoƒo ɖesiaɖe megbe.
• India kple Asia-Pacific:
• Nu kpata: Yɔ 112 (alo 108 dɔnɔdzikpɔʋu) le India; woatsɔe ayi kɔdzi si me wowɔa dɔ le gaƒoƒo 24 ƒe CT-mɔ̃ kple ahɔhɔ̃mekawo ƒe dɔwɔwɔ ƒe dɔwɔƒe le tẽ.

6-Kwasiɖa le adame megbe aƒeme ŋkuléleɖenuŋu ƒe ɖaseɖigbalẽ na dɔnɔdzikpɔlawo¶

Ne woɖe dziwòla si le ʋumenugbagbeviɣidɔlékuiwo zãm la ɖa le Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ kple Ŋkeke 1 ƒe Ta ƒe CT-dɔdamɔnu si mesɔ o eye woɖoe ɖe aƒeme la, ta Kwasiɖa 6 ƒe Subdural Watch Checklist si Wohe Ðe Eme sia alo dzrae ɖo:

• 1. Ŋlɔ Ŋkeke si tututu dzi wòdze anyi la ɖe Fridzi ƒe Ɣletigbalẽ dzi eye nàde dzesii be "Kwasiɖa 2, Kwasiɖa 4, kple Kwasiɖa 6": Ƒome akpa gãtɔ ŋlɔa anyidzedze sue aɖe be le ŋkeke 3 megbe. De dzesi kwasiɖa 6 ƒe fesre le ɣletigbalẽa dzi kpɔa egbɔ be ne dziwòla dze alɔ̃dɔdɔ gɔme alo meli ke o ɣleti ɖeka megbe la, ètsɔ dzesia do ƒome kple anyidzedze enumake eye nàgblɔe na ER ɖɔkta.
• 2. Wɔ "30-Second Morning Walk & Hand-Drift Check" Gbesiagbe: Kpɔ alesi dziwòla zɔna yia ŋdi kplɔ̃a gbɔ ŋdi sia ŋdi (kpɔe ɖa be axadzi ƒe ʋuʋu alo afɔ hehe yeye aɖeke hã le eme hã) eye nàkpɔe ɖa be wozãa asi eveawo le mɔ si sɔ nu hã.
• 3. Bia Dzidɔŋutinunyala alo Ðɔkta Gbãtɔ si Ŋlɔa Ðo Hafi Nàgadze Ʋukɔɖitikewo Gɔme Le Ʋudodo Megbe: Ne wokpɔ ʋu sue aɖe si dona le ʋuka te la, mègadze Eliquis, Xarelto, warfarin, alo aspirin zazã gɔme ake gbeɖe o vaseɖe esime ahɔhɔ̃mekawo ƒe dɔwɔwɔ kple dzidɔŋutinunya nalɔ̃ ɖe ŋkeke si tututu dzi woagadze egɔme ake dzi le CT ƒe liƒo gbugbɔgawɔ nu.
• 4. Dzro Vevesesenutsitikewo Kple Kpekpeɖeŋunu siwo Woƒlena Le Atikewɔƒea Katã Me: Ðe ibuprofen, naproxen, aspirin, ginkgo biloba, tɔmelãmi si ƒe agbɔsɔsɔme sɔ gbɔ, kple vitamin E ƒe atikekuiwo katã ɖa le atikekuiwo ƒe ɖoɖowɔla me, elabena wodzia ʋu ƒe dodo ƒe afɔku ɖe edzi kpe ɖe ʋumenugbagbeviɣitike siwo woŋlɔ na ame ŋu. Zã acetaminophen / paracetamol (Tylenol) le aklã ƒe agbɔsɔsɔ si le dedie me (zi geɖe la, \(\le\)2,000 va ɖo 3,000 mg/ŋkeke le ame tsitsiwo gome) ne woƒe ɖɔkta da asi ɖe edzi na abi siwo woxɔ le anyidzedze megbe.
• 5. Ðe Afɔku si Le Nutome Gã Me Egbea ɖa: Kplɔ xɔmenuwo tsɔtsɔ ƒu gbe siwo me mekɔ o, ƒo elektrikkawo, de zãkaɖiwo mɔ si tso xɔdɔme yi tsileƒe dzi, eye nàkpɔe ɖa be ame tsitsia ƒe ʋu ƒe sisi meɖiɖi ne ele tsitre o (orthostatic hypotension).

Nya siwo wobiaa amewo enuenu¶

Ðe wòhiã ŋutɔŋutɔ be dzinyela nayi Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ aɖawɔ Ta ƒe CT-dɔdamɔnu ne wotsɔ Eliquis alo warfarin ƒo ta gake wose le wo ɖokui me be yeƒe lãme sẽ keŋkeŋa?¶

Ẽ, ɣesiaɣi. Mɔfiame siwo ku ɖe atikewɔwɔ kpata ŋu le United States, UK (NICE NG232), Canada, kple Australia de se be woawɔ Ta CT-dɔdamɔnu si me vovototo aɖeke mele o na ame tsitsi ɖesiaɖe si le ʋumenugbagbeviɣitike (Eliquis, Xarelto, Pradaxa, warfarin) alo ʋumenugbagbeviɣitike sesẽ (Plavix, Brilinta) zãm si ƒo woƒe ta, ne woƒe ta mebu gbeɖe o eye zero le wo ŋu gɔ̃ hã dzesiwo ƒe dzesiwo. Numekukuwo ɖee fia be ame tsitsi 6 va ɖo 10 le alafa me siwo ƒe dzedzeme kple nuƒoƒo nyuie le ta ƒoƒo sue aɖe megbe la dometɔ 6 va ɖo 10 le alafa me ƒe ahɔhɔ̃ me ʋu si le dɔ wɔm si dzena le CT dzi la le wo ŋu xoxo.

Aleke ahɔhɔ̃ me ʋu ate ŋu adze le kwasiɖa 4 megbe le anyidzedze megbe ne ER Head CT scan si wowɔ le ŋkeke si dzi wodze anyi la sɔ keŋkeŋ?¶

Ðeko Ta ƒe CT-dɔdamɔnu si wowɔna le Ŋkeke 1 me ɖea ʋu si dona kabakaba le nyaƒoɖeamenu sesẽ me ɖa le ŋkeke si dzi woxɔ abi la dzi. Le ame tsitsiwo gome la, ahɔhɔ̃a ƒe ʋuʋu le dzɔdzɔme nu kekea ʋuka siwo mebɔbɔ o siwo tsoa aɖuɖɔtoea te la ɖe enu. Ne wogbã alo wodze anyi vie la, ate ŋu ana ʋuka siawo siwo ƒe nyaƒoɖeamenu sue la dometɔ ɖeka navuvu le nusuekpɔmɔ̃ me; le kwasiɖa 2 va ɖo 6 me la, ŋutilãa wɔa ʋuka tsɛ aɖe ƒo xlã tsi sue si woƒo ƒu la, eye ʋuka siwo le sisim le lãkusi ma me la gagbugbɔna ʋuna ɣesiaɣi le ʋumenugbagbeviɣitikewo ƒe ŋusẽkpɔɖeamedzi te vaseɖe esime ʋumenugbagbeviɣidɔ si nɔa anyi didi si le ʋuka me la tsina ale gbegbe be wòate ahɔhɔ̃a ɖe to.

Ðe ame tsitsi aɖe ate ŋu axɔ Subdural Hematoma tso anyidzedze si me wodze anyi ɖe woƒe akɔta alo akɔta le evɔ womeƒo woƒe ta ɖe anyigba ŋutɔŋutɔ oa?¶

Ɛ̃. Ahɔhɔ̃mekakolawo daa Chronic Subdural Hematomas enuenu le ame tsitsi siwo ŋu ʋumenugbagbeviɣitike ɖo siwo ƒe ta meka anyigba gbeɖe o la ŋu. Ne ame tsitsi aɖe ƒu du eye wòɖi sesĩe ɖe woƒe asike, akɔta, alo akɔta la, ahɔhɔ̃a ƒe tsɔtsɔme sesẽ kpata nana ahɔhɔ̃a tsia megbe le taɖua megbe sɛkɛnd ɖeka ƒe akpa ɖeka (si nye ƒoƒo ƒe ŋusẽ si mewɔa dɔ o si ƒoa lãe), si sɔ gbɔ wu be wòagbã ʋuka si le sesẽm, si keke ɖe enu wòxɔ ƒe geɖe le aɖuɖɔtoea te.

Ðe wòle be mana dzinyela ƒe Eliquis, Xarelto, alo warfarin ƒe fiẽsi atike ne wodze anyi heƒo ta vɔ teti?¶

Ao, ne ame tsitsi aɖe si le ʋumenugbagbeviɣitike zãm ƒe ta ƒo alo wòdze anyi vevie la, lé woƒe ʋumenugbagbeviɣitike alo ʋumenugbagbeviɣitike ƒe agbɔsɔsɔ si woɖo ɖi si kplɔe ɖo me ɖe asi vaseɖe esime woda wo kpɔ le Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ eye Ta ƒe CT-dɔdamɔnu aɖe na be ʋu si dona le tagbɔ me la medo go o. Ʋumenugbagbeviɣitike ƒe agbɔsɔsɔ bubu mimi esime ʋuka si xea mɔ na ʋua le dodom vevie le taɖua me ana ʋua nado kabakaba eye wòana kɔdzi tɔtrɔ nasesẽ wu.

Aleke mawɔ ade vovototo Chronic Subdural Hematoma kple tagbɔdɔléle ƒe ŋgɔyiyi si sɔ dome?¶

Ahɔhɔ̃mekawo ƒe tagbɔdɔléle abe Alzheimer ƒe dɔléle ene yia ŋgɔ vivivi le ɣletiwo kple ƒe geɖe me, gake Chronic Subdural Hematoma ya nana dɔwɔwɔ dzi ɖena kpɔtɔna le ŋkeke geɖe va ɖo kwasiɖa ʋɛ aɖewo me. Ne ame tsitsi aɖe ƒe azɔlizɔzɔ yeye si me mekɔ o, azɔlizɔzɔ yi axadzi, alɔ̃dɔdɔ si nɔa tɔtrɔm le ŋkeke me (ʋuʋu ta le nyagbea titina), aɖuɖɔtoe yeye si mete ŋu tsia dzimaɖi o, alo alɔ alo afɔ ƒe gbɔdzɔgbɔdzɔ si menya kpɔna dzea sii bɔbɔe o le alɔ alo afɔ ƒe axa ɖeka dzi le kwasiɖa 1 va ɖo 6 me la, mègabu fɔe gbeɖe ɖe gɔmedzedze ƒe tagbɔdɔléle ta o vaseɖe esime Ta CT scan si me vovototo aɖeke mele o naɖee ɖa be ʋumenugbagbeviɣidɔ si woate ŋu ada le ʋuka me la medzɔ o.

Vevesesenutsitike kae le dedie be woana ame tsitsi si le ʋumenugbagbeviɣitike zãm si le veve sem le anyidzedze sue aɖe megbe (ne wonya gbe ʋu si dona le ahɔhɔ̃ me ko)?¶

Ne ɖɔkta nya ɖe ame tsitsia ɖa le ahɔhɔ̃ me ʋu alo gbagbã ŋu ko la, zi geɖe la, acetaminophen dzro (paracetamol / Tylenol) ye nyea vevesesenutsitike si womeƒlena le atikedzraƒe o si le dedie wu na dɔnɔ siwo le ʋumenugbagbeviɣitike zãm (si nɔa miligram 2,000 va ɖo 3,000 teti le gaƒoƒo 24 ɖesiaɖe me le ame tsitsi siwo ƒe aklã wɔa dɔ nyuie gome). Mègana aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), meloxicam, diclofenac, alo bismuth subsalicylate (Pepto-Bismol) gbeɖe o, elabena atike siawo gblẽa ʋumenugbagbeviɣidɔ ƒe ʋuʋu me eye wonaa ʋu si dona le dɔgboa kple taɖui me vevie ne wotsɔ wo kpe ɖe ʋumenugbagbeviɣitikewo ŋu.

Mɔfiame siwo do ƒome kplii¶

• Ame tsitsiwo ƒe anyidzedze ƒe hayahaya ne womete ŋu tsi tre o
• Ta ƒe abixɔxɔ kple ʋuʋudedi ƒe kpekpeɖeŋu gbãtɔ
• Tɔtɔ kpata le ame tsitsiwo me: UTI si me womeƒoa nu le o, urosepsis vs. stroke
• Atike geɖe zazã, atikewo ƒe agbɔsɔsɔ fũ, atikeawo ƒe agbɔsɔsɔ si to, kple atikekuiwo ƒe ɖoɖowɔla ƒe vodadawo

Dzɔtsoƒewo kple dziɖuɖumegãwo ƒe mɔfiame¶

• Amerikatɔwo ƒe Atikewɔla Kpatawo ƒe Kɔledzi (ACEP): Dɔwɔƒe ƒe Ðoɖo: Nya Vevi Siwo Le Dɔnɔ Tsitsi Siwo Va Dɔwɔƒe Kpata Kple Ahɔhɔ̃ ƒe Nuveviwɔame Fafɛ (Anticoagulation and Antiplatelet Mandatory CT Criteria).
• Dukɔa ƒe Lãmesẽ Kple Belélename Ŋuti Nusrɔ̃ƒe (NICE, United Kingdom): Mɔfiame NG232: Ta ƒe Nuveviwɔame: Dzodzro Kple Edzikpɔkpɔ Kaba (Atikeagulant kple Antiplatelet Head CT Ɣeyiɣikɔntabubuwo).
• Amerika Amekolawo ƒe Kɔledzi (ACS) ƒe Nuveviwɔame ƒe Nyonyome ƒe Nyonyome ƒe Ðoɖo (TQIP): Nuwɔna Nyuitɔwo ƒe Mɔfiamewo le Ame Tsitsiwo ƒe Nuveviwɔame Dzi Kpɔkpɔ Kple Ʋumenugbagbeviɣidɔ ƒe Trɔtrɔ Me.
• Neurocritical Care Society kple Society of Critical Care Medicine (SCCM): Mɔfiame na Trɔ asi le ʋumenugbagbeviɣitikewo ŋu le ʋu si dona le tagbɔ me (Andexanet Alfa, Idarucizumab, kple 4-Factor PCC Protocols).
• Dukɔa ƒe Tsitsi Ŋuti Nusrɔ̃ƒe (NIA) kple Dɔlélenutsitsi Kple Mɔxexe Ðe Enu Dɔwɔƒe (CDC): STEADI (Tɔtrɔ Na Ame Tsitsiwo ƒe Afɔkuwo, Ku & Nuveviwɔame) Ame Tsitsiwo ƒe Anyidzedze Kple Mɔxexe Ðe Ahɔhɔ̃ me Nuveviwɔame Nublanuitɔe.