Ciwon kai na Thunderclap, Hemorrhage Subachnoid, da Ruptured Brain Aneurysm¶

Ciwon kai na thunderclap wani fashewa ne, mai tsananin ciwon kai wanda ke fitowa daga ko'ina kuma ya kai iyakar \(10\rubutu{-out-of-} 10\) mai tsanani tsakanin ** dakika 60 zuwa dakika 60**, kamar tafawar tsawa kwatsam ko ana buga kai a bayan kai da jemage na baseball. Duk ciwon kai na tsawa abu ne mai hatsarin gaske ga lafiya har sai an tabbatar da hakan, domin shi ne al’adar da ke tattare da bugun jini mara rauni (SAH)** wanda aka samu ta hanyar ruptured cerebral aneurysm. Lokacin da blister-kamar kwakwalwa aneurysm ya fashe cikin sararin subarachnoid mai cike da ruwa da ke kewaye da kwakwalwa, jini yana fitowa a karkashin cikakken karfin jini, yana kara matsa lamba na ciki nan take. Ba tare da gaggawa na neurosurgical ko endovascular tsoma baki ba, ruptured aneurysm akai-akai yana sake zubar da jini a cikin sa'o'i 6 zuwa 24 na farko, yana ɗaukar adadin mace-mace fiye da 50 zuwa 70 bisa dari a sake fashewa.

Yi wannan yanzu¶

1. Kira lambar gaggawa ta gida nan da nan sannan a ayyana "Waɗanda ake zargin Subarachnoid Hemorrhage / Ruptured Brain Aneurysm." Buga lamba 911 a Amurka da Kanada, 112 a fadin Tarayyar Turai, 999 a cikin United Kingdom, ko ganin duk lambobin gaggawa. Nemi motar daukar marasa lafiya ta rayuwa ta ci gaba kuma nemi jigilar kaya zuwa asibiti tare da ** aikin tiyata da neuro-interventional rediyon rediyo** (Cibiyar Ciwon Jiki).
2. Rubuta daidai lokacin da ciwon kai ya buge. Ko asibiti zai iya amintar da fitar da jini na kwakwalwa tare da saurin CT scan kadai (tagar 6-Hour Ottawa SAH Rule) ko kuma dole ne a yi huda lumbar (tap na kashin baya) ya dogara da sanin daidai minti daya ciwon ya fara.
3. **Daga kai da gangar jikin mutum zuwa kusurwar digiri 30 sannan a tilasta cikakkiyar nutsuwa. Kada mutum ya tashi tsaye, ya yi tafiya, ko ya sunkuya, ko ya yi tari, ko ya yi tauri a bayan gida (no Valsalva straining).
4. Hana duk abubuwan rage jin zafi na baka (musamman aspirin da NSAIDs), abinci, da ruwaye. Ka kiyaye mutum ba tare da komai ba da baki (NPO) a shirye-shiryen maganin sa barci na gaggawa, coiling endovascular coiling, ko microsurgical clipping, da kuma hana amai da sha'awar shiga cikin huhu.
5. Ka duhuntar da dakin, ka kawar da duk wani hayaniya, sannan ka kwantar da hankalin mutum don hana hawan jini. Jinin subarachnoid yana matukar fusata mabobin da ke rufe kwakwalwa (meninges), yana haifar da tsananin haske (photophobia) da jin sauti. Rage fitilun, shiru talabijin da wayoyi, da yin magana a hankali don haka zafi da tsoro kada su taru da hawan jini da fitar da gudan jini na wucin gadi a kan aneurysm.
6. Ku kula sosai don fatar ido da ta fado, almajiri mai fadi, ciwon kai, ko rashin hayyacinsa kwatsam. Idan mutum ya yi amai ko ya ji barci, sai a mirgina su a hankali a gefensa (alhali yana daidaita kai da wuyansa) don haka hanyar iska ta tsaya a fili. Idan sun daina numfashi kullum, fara nan da nan CPR.

Halin gaggawa da tsawa yanke shawara itace¶

Yi amfani da wannan taswirar tafiyar asibiti bisa ingantacciyar doka ta ** Ottawa Subarachnoid Hemorrhage Dokokin ** da Ƙungiyar Zuciya ta Amirka / Ƙwararrun Kulawa na Neurocritical Society don tantance duk wani mummunan ciwon kai.

flowchart TD
    Start["Mugun Ciwon Ciwon Ciwon Ciwon Ciwon Ciwon Ciwon Kai<br/>Ya Kai Matsakaicin Ƙarfin Cikin Sa'a 1"] --> InstantCheck{"Shin ciwon kai ya kai kololuwar ƙarfin 10/10<br/>a cikin SECONDS zuwa 60 SECONDS<br/>('Thunderclap Onset')?"}

    InstantCheck -->|"Ee: Kololuwar take"| SuspectSAH["BABBAN ZATO GA SUBARACHNOID HEMORRHAGE<br/>(Ruptured Brain Aneurysm, Sentinel Leak, RCVS, ko CVST)"]

    InstantCheck -->|"A'a: An gina shi sama da mintuna da yawa"| OttawaCheck{"Bincika Ma'auni na Dokokin Zubar da Jini na Ottawa Subarachnoid<br/>(Kowane daya halarta yana buƙatar aikin gaggawa na SAH): <br/>1. Shekaru >= shekara 40?<br/>2. Ciwon wuya ko taurin wuya?<br/>3. Shaida hasashe (suma)?<br/>4. Farawa yayin motsa jiki, dagawa, tari, ko jima'i?<br/>5. Thunderclap ciwon kai (nan take yana zafi)?<br/>6. Ƙimar wuyan iyaka akan jarrabawa?"}

    OttawaCheck -->|"Ee: Kowane 1 cikin 6 sharuɗɗa da ke akwai"| SuspectSAH

    SuspectSAH --> CallEMS["Kira 911 / 112 / 999 Nan da nan: <br/> Bayyana 'Thunderclap Headache / Suspected Subachnoid Hemorrhage' <br/> Yi rikodin EXACT minti na farkon ciwon kai"]

    CallEMS --> FirstAid["Kariya na Kariyar Aneurysm Pre-Asibiti: <br/>1. Ɗaga kan gado zuwa digiri 30 (wuyansa madaidaiciya a tsakiyar layi) <br/>2. KUSA BABU aspirin, ibuprofen, naproxen, ko abinci/ruwa <br/>3. Dark, dakin shiru; motsa jiki na sifili ko damuwa Valsalva<br/>4. Bincika yara don faɗuwa ɗaya ko faɗuwar fatar ido (CN III)"]

    FirstAid --> HospitalTime{"Yaya sauri majiyyaci ke kaiwa<br/> na'urar daukar hoto mai ƙarfi ta Brain CT?"}

    HospitalTime -->|"A cikin sa'o'i 6 na ainihin ciwon kai"| EarlyCT["Babban CT mara daidaituwa (<6 hours): <br/> 98.7% zuwa 100% mai kula da m subarachnoid jini, <br/>bi CT Angiogram (CTA) na kwakwalwa tasoshin."]

    HospitalTime -->|"Fiye da sa'o'i 6 bayan farawa (ko farkon farawa)"| LateWorkup["Shugaban marasa daidaituwa CT + CT Angiogram (CTA) <br/> DA Lumbar Puncture (Spinal Tap) don Xanthochromia <br/> idan CT ba shi da kyau, don kama jinkiri / leaks na sentinel"]

    OttawaCheck -->|"A'a: Duk sharuɗɗa 6 ba su nan kuma suna da gwajin jijiya na asali"| OtherEval["Yi la'akari da ciwon kai na Migraine, Tashin hankali, ko Ciwon Sinus:<br/>Nemi kulawar gaggawa idan zazzabi, canjin hangen nesa, ko sabon aura ya kasance"]

Abin da ke faruwa lokacin da aneurysm na kwakwalwa ya rushe: Pathophysiology da "Bleed Sentinel"¶

1. Saccular ("Berry") Aneurysms da Da'irar Willis¶

Kusan kashi 85 cikin 100 na zubar da jini na subarachnoid na kwatsam ana haifar da su ta hanyar fashewar wani saccular (berry) cerebral aneurysm. Ba kamar jijiyoyi masu kauri a cikin hannaye da kafafu ba, manyan arteries a gindin kwakwalwa (** the Circle of Willis*) suna da bangon waje na bakin ciki sosai kuma suna zaune a cikin ruwa mai ruwa ** cerebrospinal fluid (CSF)** cikin ** subarachnoid sarari**. Fiye da shekaru na damuwa na hemodynamic, hawan jini, shan taba, ko tsinkayen kwayoyin halitta, jaka mai bakin ciki ko blister balloons daga cikin cokali mai yatsa (reshe).

Lokacin da wannan bakin ciki aneurysm dome a ƙarshe hawaye ya buɗe: - Jirgin jini na jijiya kai tsaye zuwa cikin ruwan cerebrospinal a hawan jini na systolic (\(120\rubutu{zuwa}}200+\rubutu{mmHg}\)). - A cikin daƙiƙa guda, matsa lamba a cikin kwanyar daɗaɗɗen kai (** matsa lamba na intracranial, ko ICP ) ya yi sama har sai ya kusan daidaita hawan jini. Wannan guguwar matsananciyar matsananciyar matsananciyar matsananciyar matsananciyar matsananciyar matsananciyar zafi tana shimfida sankarau mai saurin raɗaɗi a gindin kwakwalwa, yana haifar da araduwar ciwon kai nan take, kuma sau da yawa yana dakatar da kwararar jini zuwa kwakwalwa a taƙaice, yana haifar da ** rashi na ɗan lokaci (syncope) a cikin kashi 30 zuwa 50 na marasa lafiya. - A cikin marasa lafiya waɗanda suka tsira daga fashewar farko, faɗuwar cutar hawan jini a cikin kwanyar da abubuwan da ke haifar da daskarewa na gida suna haifar da ** fibrin-platelet mai rauni* akan yagewar bangon aneurysm cikin mintuna 1 zuwa 3.

2. "Ciwon kai na Sentinel" (Leak ɗin Gargaɗi): Tagar Tsira na Mako 2¶

Har zuwa ** 20 zuwa 40 bisa dari na marasa lafiya waɗanda ke fama da mummunar fashewar ƙwayar cuta ta kwakwalwa sun sami ƙaramin "ciwon kai na sentinel" (lalacewar gargadi) 2 zuwa 21 kwanakin baya ** wanda aka watsar a matsayin mummunan migraine, ciwon kai na sinus, ko wuyan wuyansa. - A cikin jini na aneurysm, wani karamin tsage-tsaki yana buɗewa a bangon aneurysm, yana zub da ɗan ƙaramin teaspoon na jini zuwa sararin samaniyar subarachnoid, ko bangon aneurysm ya miƙe ba zato ba tsammani (* zubar jini na intramural**). - The person experiences an abrupt, instantaneous thunderclap headache that may last a few hours to a couple of days, sometimes with mild nausea or neck ache, before gradually improving. Because the person can still walk and talk, they take pain pills and stay home. - Me yasa gane ciwon kai yana ceton rayuka: Mara lafiyar da aka yi wa jinya a asibiti bayan an yi musu gargaɗi (lokacin da har yanzu suke a farke, wanda aka lasafta shi da Hunt and Hess Grade 1 ko 2) yana da damar samun 85 zuwa 95 bisa 100 na tsira da kyakkyawan aikin jijiya. Idan aka yi watsi da wannan ledar gargaɗin kuma aneurysm ɗin yana fama da babban sake fashewar kwanaki bayan haka (Hunt and Hess Grade 4 ko 5), ** kashi 50 zuwa 80 na marasa lafiya suna mutuwa ko kuma sun kasance naƙasassu na dindindin ***.

3. Alamar Gargaɗi "Oculomotor Nerve Palsy" (Drooping Eyelid + Blown Almajiri)¶

Wata takamaiman alamar faɗakarwa na jiki na iya bayyana ko da kafin aneurysm ya fashe gaba ɗaya: - Lokacin da bugun jini na baya (PCom) aneurysm ya faɗaɗa, yana danna kai tsaye a kan ** jijiyar cranial na uku (jijiya oculomotor, CN III) ** dama bayan ido. - Wannan yana haifar da kwatsam ciwon jijiyoyin jijiya na uku a gefe guda: fatar ido na sama ta rufe (ptosis), kwayar ido tana juya waje da kasa (“kasa da waje” kallo, yana haifar da hangen nesa biyu), sannan **almajirin da ke wancan gefe ya zama fadi da kasala ko daidaitawa zuwa haske. jijiya). - Dokarta: Duk wanda ya kamu da ciwon kai hade da sabon fatar ido da ya fado ko kuma almajiri mai fadi a gefe daya dole ne a garzaya da shi sashen gaggawa na gaggawa domin a yi gwajin angiogram na CT domin ya kamu da cutar aneurysm mai fadada kafin ta fashe.

4. Wasu Dalilan Masu Barazana Rayuwa Na Ciwon Kai¶

Ko da lokacin da anerysm na kwakwalwa ba shine mai laifi ba, ciwon kai na tsawa akai-akai yana nuna wani rikici na jijiyoyin jini a cikin kwanyar ko wuyansa: - Cerebral Vasoconstriction Syndrome Reversible (RCVS): Yanayin da jijiyoyin kwakwalwa ba zato ba tsammani ba zato ba tsammani a cikin ɓangarori (mai kama da "string of beads" akan angiogram), yana haifar da ciwon kai mai maimaita thunderclap sama da makonni 1 zuwa 2 *** yana haifar da shawa, motsa jiki, tari, magunguna masu tsauri, ko SSRI triptans, ko cannabis). - Cerebral Venous Sinus Thrombosis (CVST):Cutar jini da ke toshe manyan tashoshi na magudanar jini na kwakwalwa, musamman ma a lokacin daukar ciki, lokacin haihuwa, ko masu amfani da maganin hana haihuwa masu dauke da isrogen. - ** Ragewar Jijin Jiji (Cervical Artery Dissection): Hawaye a bangon jijiyar wuya bayan ƙananan rauni, gyaran wuyan chiropractic, ɗagawa mai nauyi, ko tari, yana haifar da ciwon kai ko wuyan gefe ɗaya sau da yawa tare da ** Horner syndrome ** (ƙaramin almajiri da ɗan ƙaramin faɗuwar fatar ido na sama a gefe ɗaya). - Pituitary Apoplexy: Jinin kwatsam ko ciwon ciki a cikin glandar pituitary a gindin kwakwalwa, yana haifar da ciwon kai na tsawa a bayan idanu, farat ɗaya asarar hangen nesa a cikin idanu biyu (* bitemporal hemianopsia**), hangen nesa biyu, da ƙarancin cortisol mai haɗari (duba) rikicin adrenal da cutar Addison ta gaggawa allurar).

Comprehensive comparison: Subarachnoid Hemorrhage vs. Migraine vs. Other Thunderclap Causes¶

Not every thunderclap headache is a ruptured aneurysm, and not every severe headache is a thunderclap headache. Emergency physicians use the features below to distinguish a ruptured brain aneurysm from a severe migraine and from other dangerous vascular emergencies that also cause thunderclap headaches (RCVS, CVST, Cervical Artery Dissection, and Pituitary Apoplexy):

Validated clinical red flags: The Ottawa Subarachnoid Hemorrhage Rule¶

Masu bincike na likitancin gaggawa na Kanada sun haɓaka kuma sun amince da ** Ƙungiyar Zuciya ta Amurka / Ƙungiyar Ƙwararrun Ƙwararrun Amurka (AHA / ASA) ** da ** Kwalejin Likitocin Gaggawa na Amurka (ACEP)**, Dokar ** Ottawa SAH *** tana da kusan ** 100 bisa dari na hankali ** don gano wanda faɗakarwar marasa lafiya tare da matsanancin ciwon kai na gaggawa a cikin sa'o'i na gaggawa ba tare da buƙatar ciwon kai na gaggawa ba. zubar jini.

Idan majiyyaci yana da ** ɗaya daga cikin jajayen tutoci guda 6 masu zuwa , ba za a iya share su ba tare da neuroimaging na asibiti ba: 1. Shekaru \(40\rubutu{shekaru}\) ko sama da haka 2. Ciwon wuya ko taurin wuya (A kula: jinin da ke damun ruwan kashin baya yana ɗaukar awanni 3 zuwa 12 don haifar da taurin wuya na gaskiya, don haka rashin wuyan wuyan a cikin awanni 2 na farko * ba zai taɓa kawar da zubar jini na aneurysm ba). 3. Rashin hayyacin sheda (Suma ko rugujewa lokacin da ciwon kai ya buge). 4. Farawa yayin motsa jiki (dagawa mai nauyi, gudu, damuwa a bayan gida, tari, ko jima'i) 5. Ciwon kai na tsawa** (ciwon yana kaiwa kololuwar tsanani nan take a cikin dakika zuwa minti 1) 6. ** Iyakantaccen jujjuyawar wuya akan jarrabawa** (rashin iya taɓa guntun ƙirji ko ɗaga kan \(8\text{centimeters}\) [\(3\text{inci}\)] daga kan gadon)

Me yasa "Agogon-Sa'o'i 6" ke da mahimmanci: Head CT vs. Lumbar Puncture (Spinal Tap)¶

Lokacin da kuka kira 911 / 112 / 999 nan da nan kuma ku rubuta ** daidai minti daya ** ciwon kai ya fara, kai tsaye zakuyi tasiri yadda daidai da sauri asibiti zai iya gano jinin:

1. Cikin Tagar Sa'a 6 (CT Sensitivity - 98.7% zuwa 100%):
2. Jinin sabo a cikin sararin subarachnoid yayi kama da fari mai haske akan wani yanki da yawa na zamani ** CT scan ba tare da bambanci ba**.
3. Dangane da jagororin AHA / ASA, ACEP, da UK NICE, idan an yi babban babban CT scan ** a cikin sa'o'i 6 na daidai lokacin da ciwon kai ya fara farawa ** kuma ƙwararren likitan neuroradiologist ya fassara shi azaman al'ada gabaɗaya, yana kawar da zubar da jini na subarachnoid tare da ** sama da 98.7 zuwa 99.9 bisa dari na CT akai-akai. [CTA]** na tasoshin jini na kwakwalwa don bincikar anerysm da ba ta karye ba, rarrabawar jijiyoyin mahaifa, ko RCVS).
4. ** Bayan Sa'o'i 6 Bayan Farwa (Me yasa CT Kadai Zai Iya Kewar Jini):**
5. Saboda ruwa na cerebrospinal na ruwa yana yaduwa kuma yana wanke ta cikin sararin subarachnoid (maye gurbin kansa sau da yawa a rana), sabon jini yana farawa kuma yana raguwa akan daidaitaccen CT scan yayin da sa'o'i suka wuce:
   • A cikin sa'o'i 6: Hankalin CT shine \(98.7%\rubutu{zuwa}100\%\).
   • ** A sa'o'i 12 zuwa 24:** Hankalin CT ya ragu zuwa \(90%\rubutu{zuwa}93\%\).
   • ** A kwanaki 3 zuwa 5 (na kowa bayan ciwon kai):** Hankalin CT ya ragu zuwa \(50%\rubutu{zuwa}75\%\).
6. Don haka, idan majiyyaci ya jira har zuwa washegari don zuwa dakin gaggawa kuma CT scan ɗin kansa na bayyana ya zama "na al'ada," ** CT scan bayan awanni 6 BAYA kawar da fashewar aneurysm . Dole ne ƙungiyar gaggawa ta yi ko dai ** Lumbar Puncture (tap na kashin baya) don neman jajayen ƙwayoyin jini da xanthochromia (launi mai launin rawaya wanda aka kafa lokacin da jinin jajayen jini ya rushe a cikin ruwan kashin baya, wanda ya bayyana 6 zuwa 12 hours bayan zubar jini kuma ya kasance a bayyane har zuwa makonni 2) da / ko a ** CT Angiogram na arteries (CTA.)

Wanene ke cikin haɗari mafi girma ga anerysm na kwakwalwa?¶

Rarraba waɗannan abubuwan haɗari na kwayoyin halitta da na likita tare da ma'aikatan jinya da likitocin dakin gaggawa yana haɓaka hoton jijiyoyin jini: - ** Tarihin Iyali na Farko:** Samun dangi biyu ko fiye na farko (iyaye, ɗan'uwa, 'yar'uwa, ko yaro) waɗanda ke da aneurysm na kwakwalwa ko zubar jini na subachnoid yana ƙara haɗarin mutum ninki 4 zuwa 8. - ** Ciwon Koda Mai Ciki Mai Ciki (ADPKD):** Kusan kashi 10 zuwa 15 na marasa lafiya da ke fama da cutar koda polycystic suna tashar intracranial berry aneurysms. - Haɗaɗɗen Nama & Ciwon Jiki: Ciwon Ehlers-Danlos (Nau'in IV), Ciwon Marfan, ciwo na Loeys-Dietz, dysplasia fibromuscular (FMD), da haɓakar aorta. - ** Abubuwan Haɗarin Ƙarfafan Haɗari:*** shan taba sigari** (mafi ƙarfi guda ɗaya da za'a iya canzawa don samuwar aneurysm, haɓakawa, da tsagewa), ** hauhawar jini mara ƙarfi , amfani da barasa mai nauyi, da ** amfani da cocaine ko methamphetamine (wanda ke haifar da hawan jini da ƙarfi yayin raunana ganuwar arterial). - Aneurysm na baya: Kusan kashi 20 cikin 100 na marasa lafiya na aneurysm suna da aneurysms da yawa (aneurysms madubi a bangarorin biyu na Circle of Willis).

Taimakon farko na mataki-mataki yayin jiran motar asibiti¶

Duk wani mataki kafin asibiti a lokacin da ake zargin zubar jini na subarachnoid yana nufin ** hana sake fashewar aneurysm ** da ** kare hanyar iska **.

Mataki 1: Matsayi (Dokar Tsakiyar Digiri 30)¶

• Taimaka wa mutum ya kwanta akan gado ko kujera tare da ** kai da saman jikinsu a sama a kusurwa 30-digiri **.
• Kiyaye kawunansu da wuyansu a daidaita madaidaita a tsakiyar layi (suna fuskantar gaba, ba a juya kai tsaye zuwa hagu ko dama ba, kuma babu wani abin wuya a wuyansa). Juya wuya sosai yana danne jijiyoyi na ciki, yana toshe jini daga magudanar da kai da kuma zubda matsa lamba na ciki.
• Idan mutum yana yin amai, ko barci mai tsanani, ko suma: nan take sai a ajiye shi gefensa a matsayin farfadowa (a kiyaye kansa daidai da kashin bayansa) don haka ba za a iya shakar amai a cikin huhu ba.

Mataki na 2: Ƙaddamar da "Zero Valsalva" da Ƙarfafa Ƙarfafawa¶

• Me yasa sake fashewar ke faruwa: Guguwar jini mai rauni da ke toshe rami a cikin dome mai rugujewar aneurysm yana gudana ne kawai ta hanyar daidaitawa tsakanin matsa lamba a cikin jijiya da matsa lamba a wajen jijiya. Idan mutum ya yi tari, ya yi tari da karfi, ya yi amai da karfi, ya tashi tsaye don tafiya, ko firgita, karfin jininsa ya tashi sama da \(180\ rubutu zuwa } 220\rubutu{mmHg}\), yana busar da gudan jinin aneurysm (sake fashewa).
• Kashe fitilun da ke sama, rufe makafin taga, kashe Talabijin, ajiye dabbobin gida da masu kallo daga cikin daki, sannan a umurci mutum ya yi numfashi a hankali ta buɗaɗɗen baki (kada ya taɓa yin numfashi).

Mataki na 3: Bincika kuma Yi rikodin Alamomin Jijiya (Hunt & Hess / WFNS Clues)¶

Bincika waɗannan alamu guda huɗu masu sauƙi na asibiti kuma rubuta su don ma'aikatan jinya: 1. Matakin Fadakarwa (Scale Glasgow Coma): Shin idanunsu suna buɗe kwatsam? Sun san sunansu, wurin da kuma watan? 2. Duba ɗalibi: Hana hasken ɗaki na yau da kullun (ba hasken walƙiya mai makanta kai tsaye a cikin ido mai ɗaukar hoto sai dai idan ba a sani ba) ko duba a hankali ga ɗaliban biyu. Shin girmansu daidai suke, ko almajiri ɗaya ya fi girma (dilated) ko an haɗa su da faɗaɗɗen fatar ido na sama? 3. Karfin Hannu & Magana: Shin zasu iya matse hannayenku biyu daidai kuma suyi magana a sarari? 4. ** Gargaɗi na Rhythm na Zuciya (Neurogenic Stunned Myocardium):** Babban zubar jini na subarachnoid yana sakin babban haɓakar catecholamines (adrenaline) kai tsaye a kan tsokar zuciya, wanda zai iya haifar da rikicewar bugun zuciya mai haɗari (** arrhythmias**), ɓacin rai na huhu, kumburin bugun jini, ko kamawa kwatsam. Ci gaba da sa ido kan numfashi da bugun jini kowane minti daya har sai ma'aikatan jinya sun haɗa na'urar lura da zuciya.

Step 4: What Happens in the Hospital (Coiling, Clipping, and Nimodipine)¶

Don haka 'yan uwa sun san abin da za su yi tsammani idan sun isa Cibiyar Ƙwararrun Ƙwararru / Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru: - Hanyar hawan jini nan da nan: Likitoci suna amfani da infusions na ciki masu saurin aiki (kamar nicardipine, clevidipine, ko labetalol) don saukar da hawan jinin systolic a hankali ƙasa \(140\rubutu{mmHg}\) don hana sake fitowar jini kafin a sami amintaccen jini. - Kiyaye Aneurysm a cikin Awanni 24:* - ** Coiling Endovascular:** Wani neuro-interventionalist yana zaren microcatheter daga wuyan hannu ko jijiyar makwancin gwaiwa zuwa cikin aneurysm na kwakwalwa kuma ya shirya shi da coils na platinum mai laushi (ko sanya na'urar karkatar da stent/web) don rufe shi daga ciki ba tare da buɗe kwanyar ba. - Clipping Microsurgical: Likitan neurosurgeon yana yin craniotomy kuma ya sanya ƙaramin faifan titanium a wuyan aneurysm don ware shi har abada daga kwararar jini. - ** Hana Hydrocephalus da Jinkirta Cerebral Vasospasm:** Likitoci suna rubuta na baka nimodipine kowane awa 4 na tsawon kwanaki 21 (masu hanawar calcium-tashar da aka tabbatar don kare sel kwakwalwa daga jinkirin jinkirin bugun jini wanda ke tashi tsakanin ** kwanaki 4 zuwa 14** bayan an zubar da jini) kuma yana iya zubar da jini. yana toshe magudanar ruwa na kashin baya (** m hydrocephalus**).

Madaidaicin rubutun sadarwa na 911/112/999 da Triage na Asibiti¶

Yi amfani da waɗannan kalmomi na asibiti daidai don haka mai aikawa da ma'aikacin jinya nan da nan ya gane wani gaggawa mai mahimmanci na neurosurgical maimakon ciwon kai mara kyau:

• Lokacin kiran 911/112/999:*

  • "Ina buƙatar motar gaggawa ta gaggawa a [Adireshin Daidaitawa]. Mai haƙuri shine [Shekaru] mai shekaru [namiji / mace] wanda ya haifar da ciwon kai na gaggawa, 10-out-of-10 thunderclap ciwon kai a [Ainihin Lokaci] wanda ya kai matsakaicin tsanani a cikin dakika. Hemorrhage na Subarachnoid daga fashewar aneurysm na kwakwalwa Mun ɗaga kansa zuwa digiri 30 kuma ba mu ba da aspirin ko wani maganin rage zafi ba.

• Lokacin da yake magana da ma'aikacin jinya na Sashen Gaggawa (musamman ga wanda ake zargi da "Leak Sentinel"):

  • "Wannan majiyyaci yana buƙatar aikin gaggawa na Subarachnoid Hemorrhage workup a ƙarƙashin Dokar Ottawa SAH. A [Ainihin Lokaci], [shi / ta] yana da ciwon kai na tsawa nan da nan wanda ya kai a karkashin 60 seconds, tare da [shekaru fiye da 40 / ciwon wuyan wuyan / ƙaddamarwa na farko / taƙaitaccen hasara na sani.

Lissafin shirye-shiryen gaggawa yayin jiran ma'aikatan lafiya¶

• ** daidai lokacin agogon farkon ciwon kai da aka rubuta ** (yana ƙayyade ko majiyyaci yana cikin taga CT na awa 6).
• Abin da majiyyaci ke yi a daidai dakika daidai ciwon kai ya buge (dagawa, tari, damuwa bayan gida, motsa jiki, ko hutawa).
• Ko majiyyaci ya dan yi baki ko ya fadi a farkonsa.
• Cikakken jerin magungunan kashe jini ko magungunan antiplatelet (warfarin, apixaban, rivaroxaban, dabigatran, clopidogrel, aspirin, ko NSAIDs) don haka asibiti na iya ba da magungunan jujjuyawa nan take idan an tabbatar da zubar jini.
• Duk wani tarihin dangi na kwakwalwa aneurysms ko cutar koda polycystic da aka lura.

Tambayoyin da ake yawan yi¶

Menene ainihin ma'anar "ciwon kai na tsawa", kuma ta yaya ya bambanta da mummunan ƙaura?¶

Siffar ma'anar ciwon kai na tsawa ba kawai yadda zafin zafi yake ba, amma yadda sauri ya kai ga mafi girma: ciwon kai na tsawa yana tafiya daga zafi mai zafi zuwa 10-fita-na-10 matsakaicin zafi a cikin dakika zuwa 60, kamar kwatsam tsawa ko bugun kai. Sabanin haka, har ma da ƙanƙara mafi muni yana farawa a hankali kuma yana ɗaukar mintuna 30 zuwa sa'o'i da yawa don haɓaka ƙarfinsa.

Menene "ciwon kai na sentinel," kuma me yasa yake da haɗari don yin watsi da shi?¶

Ciwon kai na anjima (ko yoyon gargaɗi) wani ciwon kai ne na tsawa kwatsam wanda ɗan ƙaramin tsagewar faɗakarwa ko shimfiɗa a bangon aneurysm na kwakwalwa kwanaki 2 zuwa 21 kafin aneurysm ya fashe a fili. Saboda zubar da jini yana sakin jini kadan kawai, mutum zai iya jin daɗi bayan kwana ɗaya ko biyu kuma ya kuskure shi don ciwon kai; kama zubar da jini a cikin dakin gaggawa yana bawa likitoci damar murɗawa ko yanke aneurysm tare da adadin rayuwa na kashi 85 zuwa 95 cikin ɗari kafin babban fashewar ta faru.

Me yasa ba zan iya shan aspirin ko ibuprofen ba don ciwon kai mai tsanani kwatsam?¶

Lokacin da aneurysm na kwakwalwa ya fara zubowa ko kuma ya fashe, dan kankanin, mai rauni na platelets na jini da fibrin ne kawai ke hana jijiya daga zubo jini a kai a kai a cikin kwanyar. Shan aspirin, ibuprofen, ko naproxen yana hana platelets, yana raunana wannan gudan jini na wucin gadi, kuma yana ƙara haɗarin bala'i, sake zubar jini mai mutuwa a cikin kwakwalwa.

Idan CT scan na asibiti ya zama al'ada, me yasa likitoci zasu iya ba da shawarar bugun kashin baya (cutar lumbar) ko CT angiogram?¶

Daidaitaccen CT scan wanda ba ya bambanta da kai yana kusan kashi 99 zuwa 100 daidai a gano sabon jinin subarachnoid kawai idan an yi hoton a cikin sa'o'i 6 na daidai lokacin da ciwon kai ya fara. Bayan sa'o'i 6, ruwan kashin baya ya fara wankewa da diluting jinin don haka CT scan a fili zai iya rasa jinin; Yin huda lumbar yana gano ƙananan ƙwayoyin jini na jini da launin rawaya (xanthochromia) har zuwa makonni 2, yayin da CT angiogram kai tsaye yana hango arteries don gano aneurysm kanta.

An duba tushe¶

• American Heart Association (AHA) and American Stroke Association (ASA, United States): 2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage (Hoh et al., Stroke).
• Neurocritical Care Society (NCS): Guidelines for the Acute Medical Management of Aneurysmal Subarachnoid Hemorrhage (Neurocritical Care, Treggiari et al., 2023).
• ** Kwalejin Likitocin Gaggawa na Amurka (ACEP, Amurka):** * Manufofin Kula da Lafiya: Mahimman batutuwa a cikin kimantawa da Gudanar da Marasa lafiya da ke Gabatar da Ma'aikatar Gaggawa Tare da Ciwon Ciwon Kai * (* Annals na Magungunan Gaggawa *, Ingantacciyar Dokar Shugaban CT na awa 6 da Dokar Ottawa SAH).
• ** Cibiyar Kula da Lafiya ta Kasa (NICE, United Kingdom):** Hanyar jini na Subarachnoid wanda ya haifar da Ruptured Aneurysm: Ganewa da Gudanarwa (NICE Guideline NG228).
• ** Cibiyar Nazarin Asibitin Ottawa (Kanada):** Dokar Ottawa Subarachnoid Hemorrhage Dokokin don Cutar Ciwon Ciwon Kai (Perry et al., JAMA / CMAJ).

Jagora masu alaƙa¶

• Ganewar bugun jini (FAST) da amsa gaggawa
• Harin ischemic na wucin gadi (TIA / mini-stroke) da rigakafin bugun jini nan da nan
• gaggawar hawan jini vs. gaggawa: lokacin da hawan jini ya wuce 180/120
• Kamewa da girgiza taimakon farko
• Ciwon zuciya na zuciya (CPR) da jagorar AED