ʻO ke poʻo poʻo poʻo nui ma luna o nā mea hoʻokahe koko: Hoʻopaneʻe ʻia nā pule Hematoma Subdural ma hope o ka hāʻule liʻiliʻi.¶

E lawe ana nā miliona o ka poʻe ʻelemakule i nā lāʻau anticoagulants waha a i ʻole nā lāʻau antiplatelet i kēlā me kēia lā no ka pale ʻana i ka ʻeha fibrillation atrial, pulmonary embolisms, a i ʻole coronary stent clots, me apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), edosarin (Pradaxa), edoxaban (Savaysarin) clopidogrel (Plavix), ticagrelor (Brilinta), a me aspirin i kēlā me kēia lā. Ke hāʻule ka ʻelemakule ma luna o kekahi o kēia mau lāʻau lapaʻau, hāʻule a haʻihaʻi ka ʻūhā, a kuʻi wale paha ko lākou poʻo i ka puka kīhini hāmama a i ʻole ka puka kaʻa, hoʻomaha pinepine ka ʻohana inā ʻaʻole nalo ka ʻelemakule, ʻaʻohe ʻoki ʻia ke koko, a hana maʻamau no ke koena o ke ahiahi. ʻO kēlā manaʻo hoʻopunipuni o ka palekana kekahi o nā pahele make loa i ka lāʻau lapaʻau geriatric.

I loko o kahi kanaka makua kahiko e lawe ana i nā mea hoʻokahe koko, e hahai ana ke koko intracranial i ʻelua mau manawa hoʻoweliweli i ke ola: he acute a lohi paha ka traumatic intracranial hemorrhage i loko o nā hola 6 a hiki i 48 mau hola, A i ʻole he slow-oozing Chronic Subdural Hematoma (cSDH) e hoʻonui mālie i loko o ke poʻo o ka poʻo liʻiliʻi no **2 mau pule o ka poʻo. hāʻule ka pae honua a hoʻopaʻa i ka lolo a hoʻohālike i ka hahau a i ʻole ka dementia wikiwiki. Inā loaʻa ke poʻo a hāʻule paha kekahi kanaka ʻelemakule ma ke ʻano he ʻoki koko, a i ʻole e ulu aʻe ka huikau hou, ka hiamoe, ke poʻo poʻo, ka ʻōlelo ʻino, a i ʻole nā lā heʻe wāwae ʻaoʻao a i ʻole he pule ma hope o ka hāʻule ʻana, e kelepona i kāu helu ulia pōpilikia (911 ma ʻAmelika Hui Pū ʻIa a me Kanada, 112 ma waena o ka European Union, 999 ma United Kingdom; ike helu pilikia) koke. No nā ulia pōpilikia pili, e ʻike ka hāʻule ʻana o nā ʻelemakule ke hiki ʻole ke kū, ʻeha poʻo, a polypharmacy, overdose lāʻau lapaʻau, hala hala, a me nā hewa hoʻonohonoho pila.

E hana i kēia i kēia manawa¶

1. E hele i ke Keʻena ʻOihana Hoʻomaʻamaʻa kokoke loa no ka nānā ʻole ʻana i ka Head CT Scan i kēlā me kēia manawa i ka wā e lawe ai kekahi kanaka makua i kahi lāʻau anticoagulant a antiplatelet paha i ko lākou poʻo, ʻoiai inā ʻaʻole lākou i ʻeleʻele a manaʻo he 100 pakeneka maʻamau. Nā alakaʻi trauma Clinical (ACEP, NICE NG232, a me ACS TQIP) e kauoha i ke poʻo wikiwiki o ka maʻi anticoagulate ʻole ** ʻike ʻia ka puʻu a i ʻole ke ʻano maʻamau o kā lākou helu Glasgow Coma Scale.
2. E hoʻopaʻa i ka lāʻau hou aʻe o Eliquis, Xarelto, Pradaxa, warfarin, a i ʻole Plavix a hiki i ka nānā ʻana o ke kauka o ka 'Oihana Emergency i ka Head CT scan. E lawe mai i nā ʻōmole pilala pololei i ka ER a haʻi i ke kahu hoʻāʻo i ka ** manawa pono o ka uaki ua moni ʻia ka maʻa hope loa.
3. Mai hāʻawi i ka aspirin, ibuprofen (Advil/Motrin), naproxen (Aleve), a i ʻole Goody's/BC Powder no ka maʻi poʻo ma hope o ka hāʻule ʻana a i ʻole ʻeha ʻūhā. Non-steroidal anti-inflammatory drugs (NSAIDs) a me ka aspirin e hoʻopau i nā platelets koko a hoʻonui i ka wikiwiki o ke koko intracranial make i kahi kanaka makua anticoagulated.
4. ** Manaʻo he "Delayed Chronic Subdural Hematoma" inā loaʻa kahi kanaka makua i ka hele wāwae hou ʻole, nāwaliwali o ka wāwae, hiamoe i ka lā, hoʻololi i ke ʻano, a i ʻole he poʻo ʻeha 1 a 6 mau pule ma hope o kekahi hāʻule ʻana. ʻO ka venous oozing i loko o ka subdural space hiki ke lawe i 14 a 42 mau lā e hoʻopaʻa i ka lolo. E koi koke i kahi ** hoʻokaʻawale ʻole i ke poʻo CT scan**.
5. Inā hāʻule ka ʻelemakule a ʻaʻole hiki iā ia ke halihali i ke kaumaha ma kekahi wāwae, a i ʻole ua huli ʻia kekahi wāwae i waho (ka ʻōwili ʻia i waho) a ʻike ʻia he pōkole ma mua o kekahi, e hoʻomau iā lākou ma ka papahele a kāhea 911 (112 a i ʻole 999) no ka mea i manaʻo ʻia he ʻAha Hip. Mai hoʻokiʻekiʻe i kahi kanaka makua anticoagulated me ka ʻūhā haki i loko o ka noho a i ʻole ka noho kaʻa: hiki i ka ʻāʻī femoral a i ʻole nā ​​ʻāpana iwi intertrochanteric ke haki i nā aʻa koko a puni a hoʻokahe i ke koko he 1 a 1.5 lita o ke koko i loko o ka ʻūhā ke neʻe pono ʻole.
6. ** E haʻi koke i ka pākaukau hoʻāʻo ER aia ka mea maʻi ma kahi Anticoagulant no laila e hoʻomaka lākou i kahi protocol "Code Trauma / Anticoagulated Head Strike".** E haʻi i ka inoa lāʻau pololei i hiki i ka hale kūʻai lapaʻau ke hoʻomākaukau i ka intravenous reversal agent (e like me Andexxa / 4-Factor PCC no Eliquis, **/Xareldto, /Xareldto, ** Kcentra no warfarin) inā hōʻike ka CT scan i ke koko ikaika o ka lolo.

lāʻau hoʻoholo: Hoʻāʻo ʻia no kahi kanaka makua anticoagulated ma hope o ka hāʻule ʻana a i ʻole ke poʻo¶

flowchart TD
    A["ʻO ka ʻelemakule ma nā mea hoʻoheheʻe koko (Eliquis, Xarelto, Warfarin, Plavix) Loaʻa i ka hāʻule a i ʻole ke poʻo."] --> B{"Ua hiki mai ka hāʻule i kēia lā (Acute Phase) a i ʻole DAYS/WEEKS AGO (Dlayed Phase)?"}
    B -->|"Hana ʻia i kēia lā / i loko o 48 mau hola"| C{"ʻO nā hōʻailona o ka Hae ʻulaʻula: Nalo ka ʻike, ka luaʻi ʻana, ke poʻo nui, ka huikau, nā haumāna like ʻole, a i ʻole ka ʻāʻī?"}
    C -->|"ʻAe: Hōʻike ʻia nā Hae ʻulaʻula"| D["E kāhea iā 911 / 112 / 999 koke: E noho mālie, e paʻa i ka maʻi hoʻokahe koko aʻe, e hoʻomākaukau no ER Head CT + Reversal Agent"]
    C -->|"ʻAʻole: Nānā 100% maʻamau, ʻaʻohe hōʻailona"| E["E HELE MAU I KA HOSPITAL ER I KEIA LA no ke Koleo Baseline Non-Contrast Head CT Scan"]
    E --> F{"He aha ka hōʻike ʻana o ka Initial ER Head CT?"}
    F -->|"Maikaʻi no ke koko ʻeha"| G["Kokoke koke i ka ICU Neurosurgical Consult + IV Anticoagulant Reversal (Andexxa / Kcentra / Praxbind)"]
    F -->|"ʻAʻohe (Mālamalama CT Initial)"| H["Mākaʻikaʻi no 6-Week Delayed Chronic Chronic Subdural Window: E nānā no ka hele ʻana, hiamoe, a i ʻole huikau hou."]
    B -->|"Hana ʻia 3 lā a 6 pule aku nei"| I{"Ke hōʻike nei ke kanaka makua i ka HOU maʻalahi ka hele ʻole, ka hiamoe, ka huikau fluctuating, ka ʻōlelo slurred, a i ʻole ke poʻo?"}
    I -->|"ʻAe: ʻOiai inā maopopo nā wiki CT mua i hala"| J["E hele koke i ka Halema'i ER a koi aku i ke poʻo CT e hoʻokaʻawale i ka Hematoma Subdural Chronic."]
    I -->|"ʻAʻohe hōʻailona"| K["E hoʻomau i ka pale ʻana i ka hāʻule a me ka nānā ʻana i nā neurological i kēlā me kēia pule a hiki i ka pule 6"]

Māhele 1 (Hula 0 a hiki i 48): ʻO ka pilikia o ke koko lolo a me ka hoʻihoʻi ʻana i ka anticoagulant pilikia.¶

Ke paʻi ke poʻo o ka poʻe ʻelemakule e lawe ana i nā mea ʻoki koko i kēia lā, hopohopo mua nā kauka ulia pōpilikia no ka acute subdural hematoma, subarachnoid hemorrhage, a i ʻole intraparenchymal contusion. Ma nā haʻawina hauʻoli o nā poʻe kahiko anticoagulated e hōʻike ana i ke keʻena pilikia me ka helu Glasgow Coma Scale maikaʻi loa o 15 (e kamaʻilio maʻamau, zero focal weakness, zero amnesia) ma hope o ka hāʻule ʻana o ka honua, ** 6 a 10 pakeneka ua loaʻa i ka intracranial hemorrhage ikaika i ʻike ʻia ma ke poʻo CT , a ʻo kekahi ** 0.6 a hiki i 2.5 mau hola i hoʻopaneʻe ʻia ma waena o 2.5 mau hola. mahope.

Ka hoʻohālikelike ʻana i nā mea hoʻokahe koko, nā pilikia o ke koko, a me nā antidotes hoʻihoʻi hou i ka haukapila¶

E lawe mau i ka papa inoa lāʻau lapaʻau a ke kanaka makua a i ʻole nā ʻōmole pila i ke Keʻena Emergency. ʻO ka papa kikoʻī o ka mea hoʻokahe koko e kuhikuhi i ke ʻano o ka haukapila e hoʻōki ai i ke koko weliweli a i ʻole ka hoʻomākaukau ʻana i ka mea maʻi no ka ʻoki ʻāʻī ʻāʻī a i ʻole ka ʻoki burr-hole.

Māhele 2 (Nā lā 3 a i ka pule 6): ʻIke ʻana i kahi Hematoma Subdural Chronic Delayed (cSDH)¶

ʻOiai i ka wā e hele ai kahi kanaka makua i ka ER i ka lā hāʻule, loaʻa iā ʻoe kahi hōʻike ʻike ʻole ʻo Head CT, a haʻi ʻia ʻo *"Nūhou maikaʻi, maʻamau loa ka CT scan, hiki iā ʻoe ke hoʻi i ka home," * ** ʻAʻole i pau ka pilikia **.

ʻO ka ʻoiaʻiʻo, a hiki i ka **25 a 35 ka nui o ka poʻe ʻelemakule i loaʻa i ka Chronic Subdural Hematoma nui ** i loaʻa kahi ** maʻamau maʻamau Head CT scan ** i ka lā o ko lākou hāʻule ʻana a ʻaʻole hiki ke hoʻomanaʻo i ka paʻi ʻana i ko lākou poʻo no ka mea ʻuʻuku loa ka puʻupuʻu mua (a i ʻole ka pahu whiplash hikiwawe mai ka hele ʻana).

1. ʻO ka 3-pae pathophysiology o 4-wiki lohi lolo koko koko¶

Pehea e ʻike ʻia ai ke koko o ka lolo ma hope o 3 a 5 mau pule * ma hope o ka scan CT maʻamau?

flowchart TD
    A["Lā 1: Puʻu poʻo liʻiliʻi a hāʻule paha ma luna o ka ʻūhā/pū (Whiplash Acceleration)"] --> B["Haehae Micro i loko o Taut Bridging Vein Crossing Atrophied Subdural Space"]
    B --> C["Nā lā 1 a hiki i ka 5: Tiny Venous Ooze (He lahilahi loa ke ʻike ʻia ma ka lā-1 CT a kū pōkole paha)"]
    C --> D["Nā lā 7 a hiki i ka 21: Hoʻokaʻawale ʻia ka Fibrin Clot i loko o ka wai protein concentrated + Neomembrane Inflammatory Forms a puni ka hōʻiliʻili."]
    D --> E["Nā pule 2 a hiki i 6: Nā Capillaries Leaky Fragile i loko o ka Neomembrane Micro-Bleed mau loa (Ke alakaʻi ʻia e nā Anticoagulants & Osmotic Fluid Pull)"]
    E --> F["Ua hiki i ka nui koʻikoʻi (80 a i ka 150 mL): nā neʻe ʻana o ka lolo ma waena o ka laina -> holo koke, hiamoe, huikau, a i ʻole nāwaliwali e like me ka stroke."]

1. Stage 1 - The Silent Micro-Tear (Days 1 to 5): ʻO ka ʻūhū liʻiliʻi a i ʻole ke poʻo poʻo hikiwawe e waimaka ai i kahi aʻa kaulahao liʻiliʻi. I loko o ka lolo kahiko me ke ākea subdural manawale'a, e kahe ana kahi ki'i'oni'oni lahilahi o ke koko venous ma ka convexity o ka lolo.
2. ** ʻĀpana 2 - Membrane Encapsulation and Liquefaction (La 7 a hiki i 21):** I ka lua a me ke kolu o nā pule, e hoʻāʻo ke kino e pale i ke koko kahiko ma o ka ulu ʻana i kahi capsule vascular lahilahi (neomembrane) a puni, aʻo nā enzymes e hoʻoheheʻe i ke koko ʻeleʻele i loko o kahi wai mānoanoa, ʻaila-ʻaila-like (**hygroma / chronic hematoma).
3. Stage 3 - Hoʻomau hou ʻana i ka Capillary Re-Bleeding (Weeks 2 a 6): ** Ua hoʻopiha ʻia ka neomembrane hou me nā capillaries microscopic ultra-fragile, leaky. No ka lawe ʻana o ke kanaka makua i ka ** Eliquis, Xarelto, warfarin, a i ʻole Plavix, ʻo ia mau capillaries membrane leaky e hoʻokahe hou i ke koko ʻulaʻula hou i loko o ka lua i kēlā me kēia lā. No nā pule 3 mua, hoʻokipa ka lolo i ka ʻeke ulu me ka ʻeha ʻole. A laila, ma ka lā 21 a i ʻole ka lā 35, hiki ka ʻeke i ka 80 a hiki i ka 150 milliliters, hoʻopau i nā lumi i koe a pau i loko o ka iwi poʻo, a hoʻokuke i ka lolo ma ka ʻaoʻao (midline shift).

2. ʻO ka "Great Neurological Imitator": 6 mau hōʻailona maʻalahi o kahi Hematoma Subdural Chronic¶

Kāhea ka poʻe neurologist i ka Chronic Subdural Hematoma "The Great Imitator" no ka mea ʻaʻole hiki ke hāʻule nui i Hollywood i ka wā mua. Akā, kuhi hewa pinepine nā lālā o ka ʻohana a me nā kauka mālama mua iā ia ma ke ʻano he ** "ʻoi aʻe ka maʻi o Alzheimer," "ke kaumaha," "ʻelemakule," a i ʻole "mini-stroke."**

E makaʻala i kēia 6 mau hōʻailona hōʻailona maʻamau ma waena o 3 lā a me 6 pule ma hope o ka hāʻule ʻana a i ʻole ka puʻu:

1. ** "Gait Drift" hou a i ʻole ka hoʻohālua ʻole ʻia (pinepine ka #1 mua loa):**
2. Hoʻomaka ka poʻe ʻelemakule e huli iki i kekahi ʻaoʻao ma lalo o ke alaloa, e hoʻoluliluli i ko lākou mau wāwae, hopu i ko lākou manamana wāwae, a i ʻole pono e paʻa i nā paia e hele ai i ka lumi ʻauʻau. No ka mea e noho ana ka hematoma subdural ma luna o ke kaʻa kaʻa o luna o ka lolo (e hoʻomalu ana i ka wāwae a me ke kumu), ʻike pinepine ʻia ka apraxia wāwae maʻalahi a me ke koena i nā lā ma mua o ka nāwaliwali o ka lima a i ʻole ka loli ʻana o ka ʻōlelo.
3. ** Ke hoʻololi nei i ka hiamoe o ka lā a me ka "Hora maikaʻi / ʻino" Lethargy:**
4. Ma ka hola 09:00, ʻike ʻia ka ʻelemakule a kamaʻilio, akā ma ka hola 13:00 e kunou ana lākou ma luna o ko lākou noho i ke kamaʻilio ʻana, paʻakikī ke makaʻala, a i ʻole ke nānā pono ʻole. ** ʻO ka makaʻala holoʻokoʻa ** kahi hōʻailona o ka piʻi ʻana o ke kaomi intracranial mai kahi ʻohi wai subdural.
5. Hoʻololi i ke ʻano o ke kanaka, manaʻo ʻole, a i ʻole "Rapid-Onset Dementia":
6. Ke holomua nei ka maʻi o Alzheimer ma mua o makahiki, ʻaʻole ma mua o 2 pule. Inā hiki i kekahi kanaka makua hiki ke ʻaʻahu iā ia iho, hoʻohana i ka TV mamao, a mālama i ke kamaʻilio maʻamau i 3 pule aku nei, ua huikau koke, huhū, manaʻo ʻole, a ʻaʻole hoʻomau i ka mimi i kēia pule, manaʻo ʻoe he Chronic Subdural Hematoma (a i ʻole maʻi leo; ʻike. huikau hikiwawe i ka poʻe ʻelemakule: silent UTI, urosepsis vs. stroke).
7. ** ʻEha Poʻo Maʻemaʻe, ʻEleʻele, ʻAʻohe Paʻa (A i ʻole Paʻi ʻana i ka Lae i nā poʻe ʻelemakule ʻaʻole waha):**
8. Ma kahi o 50 pākēneka o ka poʻe ʻelemakule me ka subdural hematoma maʻamau e hōʻike ana i ka ʻeha a me ka ʻeha o ke poʻo e ʻoi aʻe ka ʻino i ka wā e moe palahalaha ai a ʻāʻī paha, aʻo ka 50 pākēneka ʻē aʻe he zero headache no ka mea ʻo ka lolo atrophy blunts dural stretch receptors.
9. Nawaliwali Hoʻokahi ʻaoʻao (Hemiparesis) a i ʻole Pronator Drift:
10. E noi i ke kanaka makua e paʻa pololei i nā lima ʻelua i mua o lāua me nā poho lima e huli ana i luna no 10 kekona me ka pani ʻana o ko lākou mau maka: inā huli mālie kekahi lima i loko a neʻe i lalo (pronator drift), a i ʻole e hoʻomaka lākou e hoʻokuʻu i kā lākou kīʻaha kope a i ʻole ka huki ʻana i hoʻokahi slipper, e hele koke i ka ER.
11. Hoʻomaha ka ʻimi ʻana i nā huaʻōlelo, ka ʻōlelo ʻino, a i ʻole ka hopu ʻana i ka manaʻo:
12. Inā paʻi ka hematoma ma ka ʻaoʻao ʻōlelo hemisphere hema, hiki i ke kanaka makua ke paʻakikī i ka ʻimi ʻana i nā huaʻōlelo maʻamau, nā syllables slur, a i ʻole ka ʻike ʻana i ka wili puʻupuʻu o ka lima a i ʻole ke kihi o ka waha.

Hōʻike 2: ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi Kūʻē Kūʻē kūʻē i ka Pelvic Fracture ma hope o ka hāʻule ʻana o ke kanaka makua.¶

Ke hāʻule ka ʻelemakule ma luna o nā mea hoʻokahe koko, ʻaʻole ʻo ke poʻo wale nō ka wahi e hoʻopōʻino ai i ke ola. ʻO ka haʻi ʻūhā (haʻi femur proximal) a i ʻole ** ʻeha apo pelvic** i loko o kahi kanaka makua anticoagulated he pilikia orthopedic a hemodynamic.

1. E ʻike i nā hōʻailona maʻamau o ka haʻi ʻana o ka ʻūhā ma ka papahele:
2. Wāwae Pōkole a Hoʻololi ʻia i waho: E nānā i nā wāwae ʻelua o ke kanaka makua ʻoiai e moe ana lāua ma ko lāua kua: inā e lele ʻia kekahi wāwae i waho i ka papahele ma kahi kihi 45 a 90 degere a ʻo kēlā wāwae he 2 a 5 mau kenimika (1 a 2 ʻīniha) ʻoi aku ka pōkole ma mua o kekahi wāwae.
3. ** ʻEha o ka ʻūhā a i ʻole ka ʻūhā mua ma ke ʻano o ka hoʻololi ʻana i ka ʻūhā:** ʻOiai me ka haki ʻana o ka ʻūhā "impacted" a i ʻole ka lauoho lauoho kahi e nānā pololei ai ka wāwae, e ʻike ka ʻelemakule i ka ʻeha ʻoi loa ma ka ʻāʻī i ka wā e hoʻāʻo ai e hāpai i ko lākou kuʻekuʻe wāwae mai ka papahele a i ʻole ke kaumaha.
4. ** Occult Hip a i ʻole Pubic Ramus Fracture (I ka wā maʻamau ka X-Ray mua):** Ma kahi o 5 a 10 ka nui o ka poʻe ʻelemakule osteoporotic i hāʻule a ʻaʻole hiki ke amo i ke kaumaha ma ko lākou wāwae me ka ʻeha ʻole o ka ʻāʻī, ʻike maʻamau ka X-ray palahalaha mua i ka ER no ka mea ʻaʻole i hoʻoneʻe ʻia ka laina haʻi (occult femoral neck fracture). Inā ʻaʻole hiki i ke kanaka makua ke hele ma hope o ka hāʻule ʻana me ka X-ray hip ʻino, pono nā alakaʻi lapaʻau i kahi ** hōʻailona Hip MRI a i ʻole CT scan ** ma mua o ka hoʻāʻo ʻana iā lākou e amo i ke kaumaha.
5. Hana ʻia ke koko i loko o nā mea hoʻokahe koko:
6. Loaʻa i ka femur a me ke pelvis kahi hāʻawi koko vascular nui. Hiki ke hookahe ke koko 1,000 a i 2,000 milliliters (2 a 4 pints) o ke koko kahi haʻihaʻi ʻāʻī intertrochanteric a i ʻole haʻi pelvic sacral i ka mea maʻi e lawe ana iā Eliquis, Xarelto, a i ʻole warfarin i ke koko me ka ʻike ʻole ʻia o ka ʻili o ka ʻili. wikiwiki ka nawaliwali pulse, dizziness, emi koko koko).
7. No ke aha ka hoʻoponopono ʻana i ka hoʻoponopono mua ʻana i loko o 24 a 48 mau hola e hoʻopakele ai i nā ola:
8. ʻO nā alakaʻi orthopedic Clinical (AAOS a me NICE CG124) e hōʻoia i ka hoʻoponopono ʻana i kahi haki ʻūhā ʻelemakule i loko o 24 a i 48 mau hola o ka hōʻea ʻana i ka haukapila e ʻoki i ka make ʻana o 30 mau lā, fatal pulmonary embolism, pneumonia, a me delirium i ka hapalua.
9. Ma ka hele koke ʻana i ka ER a me ka paʻa ʻana i ke ʻano hou o ka mea hoʻokahe koko, hiki i nā hui anesthesia a me nā hui trauma orthopedic ke ana i nā pae lāʻau, hoʻoponopono i ka hoʻihoʻi i manaʻo ʻia a i ʻole ka manawa i ka puka holoi holoi DOAC 24-hola, a hana i ke kaʻina me ka ʻole o ka kali.

He aha kāu e hana ai oiai e kali ana ma ka papahele no ka ambulance (911 / 112 / 999)¶

Inā hāʻule kekahi kanaka makua anticoagulated ma luna o ka tile paʻa a i ʻole ka papahele lāʻau a manaʻo ʻoe he poʻo a i ʻole ʻeha ʻūhā:

• E hoʻomoe paʻa i ke kanaka makua a i ʻole ma ke kūlana pololei i loaʻa: Mai huki iā lākou i luna ma ko lākou mau lima a mai ʻae iā lākou e hoʻāʻo e "hele" i ka lumi moe. ʻO ka huki pololei ʻana i kahi kanaka makua anticoagulated ma hope o ka hāʻule ʻana, hiki ke hoʻololi i ka ʻāʻī o ka ʻāʻī o ka wahine (e hoʻololi i kahi hoʻoponopono 3-screw pin maʻalahi i kahi pani āpau āpau) a i ʻole e hoʻoulu i kahi ʻeleʻele syncopal inā ua hoʻohaʻahaʻa ke koko i loko o ke koko.
• E hoʻomalu i ka ʻoki poʻo i ʻike ʻia me ke kaomi paʻa pololei: ʻO ka ʻili poʻo kekahi o nā ʻiʻo vascular nui loa i loko o ke kino o ke kanaka, a ʻo ka 3-centimeter (1.2-inihi) maʻi poʻo ma luna o Eliquis a i ʻole warfarin hiki ke hoʻokahe i ke koko he 500 mililita ma ka papahele i 15 mau minuke. E pelu i ke kāwele ʻauʻau maʻemaʻe a i ʻole ka paʻi lole maʻemaʻe i loko o kahi ʻāpana mānoanoa a kaomi paʻa a hoʻomau pololei i lalo i ka ʻeha o ke poʻo e kahe ana ke koko (koe ke ʻike ʻoe i ka haʻi ʻana o ka iwi poʻo palupalu ma lalo, a laila e hoʻopili i ke kaomi hoʻopaʻa apo ma nā ʻaoʻao).
• E pale i ka hypothermia o ka papahele (Rhabdomyolysis and Coagulopathy Protection): ʻO ke anuanu o ke kino (hypothermia ma lalo o 35 degere Celsius / 95 degere Fahrenheit) hoʻopale i nā enzyme hoʻopaʻa koko kanaka (ka triad make o ka trauma coagulopathy), ʻoi aku ka pōʻino o ke koko. E hoʻopaʻa i nā pākeʻe wela a puni a ma lalo o nā poʻohiwi a me ka lama o ke kanaka makua me ka ʻōwili ʻole ʻana i ko lākou ʻūhā haki, a hoʻohuli i ka thermostat o ka lumi i ka wā e hele ana nā mea lapaʻau.

Nā helu ulia pōpilikia āpana a me nā protocols oihana¶

E hoʻohana i kēia mau helu ulia pōpilikia a me nā kaʻina hoʻomaʻamaʻa hoʻomaʻamaʻa ʻāina i ka wā e hāʻule ai a poʻo paha kekahi kanaka ʻelemakule ma nā mea hoʻokahe koko.

• ** ʻAmelika Hui Pū ʻIa a me Kanada:**
• Ambulance Emergency & Trauma Triage: Kāhea 911. Ma lalo o CDC Field Triage Guidelines for Injured Patients, ʻo ka poʻe ʻelemakule (\(\ge\)65 makahiki) e lawe ana i nā anticoagulants me ke poʻo poʻo a i ʻole i manaʻo ʻia ʻo ka ʻūhā ʻāhā e hālāwai me nā koina hoʻāʻo trauma kiʻekiʻe no ka lawe ʻana i kahi haukapila me **24/7 CT kiʻi a me ka hiki neurosurgical/orthopedic **.
• Alakaʻi Reversal Anticoagulation: Ua hahai nā keʻena ulia pōpilikia ** ʻO American College of Emergency Physicians (ACEP) Policy Clinical on Mild Traumatic Brain Injury** and American Heart Association (AHA) / Neurocritical Care Society Guidelines for Reversal of Antithrombotics in Intracranial Hemorrhage.
• United Kingdom:
• Pūkia: Kāhea 999 (a i ʻole 111 inā maopopo ʻole loa e pili ana i kahi ʻoki poʻo liʻiliʻi loa; no ka ʻeha o ke poʻo ma luna o nā mea hoʻoheheʻe koko e pono i kahi loiloi o ka Oihana Hoʻopilikia).
• NICE Clinical Mandate (NG232): Ma lalo o National Institute for Health and Care Excellence (NICE) Guideline NG232 (He poʻo ʻeha: loiloi a me ka hoʻoponopono mua ʻana), kēlā me kēia mea maʻi ma ka lāʻau anticoagulant (warfarin a i ʻole DOAC) a i ʻole ka lāʻau antiplatelet (koe ʻole ka aspirin monotherapy) i loaʻa i kahi ʻeha poʻo ** pono e loaʻa i kahi ʻeha poʻo i loko o 8 mau hola ** i ka CT scan. Loaʻa ka hōʻailona neurological), ʻoiai me ka nele o ka ʻike a me ka ʻole amnesia.
• Uni ʻEulopa:
• Pūkia: Kāhea 112. Ke hahai nei nā kikowaena trauma ʻEulopa i Scandinavian Neurotrauma Committee (SNC) a me ** European Stroke Organization (ESO)** nā alakaʻi e kauoha ana i ke poʻo koke CT kiʻi a me ka PCC / Andexanet / Idarucizumab reversal no anticoagulated head trauma.
• Australia a me Aotearoa:
• Pūkia: Kāhea 000 ma Australia a i ʻole 111 ma Aotearoa. Ma lalo o ka Australian & New Zealand Guideline for Mild to Moderate Head Injuries (PREDICT) a me NSW / Queensland Health Adult Trauma Guidelines, ʻo nā poʻe ʻelemakule a pau e pili ana i nā anticoagulants a i ʻole clopidogrel/ticagrelor e koi i ka nānā pono ʻana iā ED a me ke poʻo CT imaging ma hope o ka hahau poʻo.
• India a me Asia-Pākīpika:
• Pūkia: Kāhea 112 (a i ʻole 108 ambulance) ma India; lawe pololei i ka halemai kula kiʻekiʻe i hoʻolako ʻia me kahi CT scanner 24-hola a me ka ʻāpana neurosurgery.

6-Week ma hope o ka hāʻule ʻana o ka home no ka mālama ʻana¶

Inā ua hoʻomaʻemaʻe ʻia kou makua ma nā mea hoʻokahe koko i loko o ka Oihana Hoʻopilikia me ka lā-1 Head CT scan maikaʻi ʻole a hoʻouna ʻia i ka home, paʻi a mālama i kēia 6-Week Delayed Subdural Watch Checklist:

• 1. E hoʻopaʻa inoa i ka lā pololei o ka hāʻule ʻana ma ka kalena refrigerator a me Mark "Week 2, Week 4, and Week 6": Poina ka hapa nui o nā ʻohana i kahi hāʻule liʻiliʻi ma hope o 3 mau lā. ʻO ka mākaʻikaʻi ʻana i kahi puka makani 6-wiki ma ka kalena e hōʻoia inā hoʻomaka kou makua e hiamoe a paʻa ʻole paha i hoʻokahi mahina mai kēia manawa, hoʻopili koke ʻoe i ka hōʻailona i ka hāʻule a haʻi i ke kauka ER.
• 2. Hana i ka "30-Second Morning Walk & Hand-Drift Check" i kēlā me kēia lā: E nānā i ka hele ʻana o kou makua i ka papaʻaina kakahiaka i kēlā me kēia kakahiaka (e nānā ana i ka ʻaoʻao ʻaoʻao hou a i ʻole ka huki wāwae) a nānā inā hoʻohana like lākou i nā lima ʻelua.
• 3. E noi aku i ke Kauka Hoʻokaʻawale ʻana a i ʻole Kauka mālama mua ma mua o ka hoʻomaka hou ʻana i nā mea hoʻokahe koko ma hope o ke kahe ʻana: Inā ʻike ʻia ke koko liʻiliʻi liʻiliʻi, mai hoʻomaka hou iā Eliquis, Xarelto, warfarin, a i ʻole aspirin a hiki i ka ʻae ʻana o ka neurosurgery a me ka cardiology i ka lā e hoʻomaka hou ai ma muli o ka hoʻomau hou ʻana o CT.
• 4. Hoʻoponopono i nā mea hōʻeha ʻeha a me nā mea hoʻohui a pau: Wehe i nā ibuprofen, naproxen, aspirin, ginkgo biloba, ʻaila iʻa nui, a me nā capsules vitamin E mai ka mea hoʻonohonoho pila, no ka mea, hoʻohui lākou i ka pilikia o ke koko me nā lāʻau anticoagulants. E hoʻohana i ka acetaminophen / paracetamol (Tylenol) i loko o nā palena o ke akepaʻa palekana (maʻamau \(\le\)2,000 a i 3,000 mg/lā i nā poʻe ʻelemakule) inā ʻae ʻia e ko lākou kauka no nā ʻeha ma hope o ka hāʻule ʻana.
• 5. E hoʻopau i ka pōʻino o ke kaiapuni i kēia lā: E ʻohi i nā moena kiola, e wili i nā kaula uila, e hoʻokomo i nā kukui pō ma ke ala o ke keʻena moe a i ka lumi ʻauʻau, a e hōʻoia ʻaʻole e hāʻule ke koko o ke kanaka makua ke kū i luna (orthostatic hypotension).

Nīnau pinepine¶

Pono anei koʻu makua e hele i ke Keʻena Emergency no ka nānā ʻana i ke poʻo CT inā hoʻopaʻa lākou i ko lākou poʻo ma luna o Eliquis a i ʻole warfarin akā maikaʻi loa?¶

ʻAe, i kēlā me kēia manawa. ʻO nā alakaʻi lāʻau lapaʻau kūikawā ma ʻAmelika Hui Pū ʻIa, UK (NICE NG232), Kanada, a me Australia e kauoha i kahi ʻano like ʻole o ke poʻo CT scan no kekahi ʻelemakule e lawe ana i kahi anticoagulant (Eliquis, Xarelto, Pradaxa, warfarin) a i ʻole antiplatelet ikaika (Plavix, Brilinta) i pa i ko lākou poʻo, ʻoiai inā ʻaʻole lākou i nalowale i ka ʻike. Hōʻike nā haʻawina he 6 a 10 ka nui o nā poʻe kahiko anticoagulated e nānā a kamaʻilio maʻamau ma hope o ka paʻi ʻana o ke poʻo liʻiliʻi ua loaʻa ke koko ikaika i ʻike ʻia ma CT.

Pehea e hōʻike ʻia ai ke koko o ka lolo ma hope o 4 mau pule ma hope o ka hāʻule ʻana inā he maʻamau ka ER Head CT scan i ka lā o ka hāʻule?¶

ʻO ka lā-1 Head CT scan wale nō e hoʻoholo i ke kahe koko wikiwiki a me ke kiʻekiʻe i ka lā o ka ʻeha. I nā poʻe ʻelemakule, ʻo ka emi ʻana o ka lolo maoli e hohola i nā aʻa kaulahao palupalu e hele ana i ke ākea subdural. Hiki i kahi puʻu liʻiliʻi a hāʻule paha ke haʻihaʻi i ka haʻihaʻi microscopic i kekahi o kēia mau veins haʻahaʻa haʻahaʻa; ma luna o 2 a hiki i 6 pule, hana ke kino i kahi membrane puʻupuʻu lahilahi a puni ka ʻohi wai liʻiliʻi, a ʻo nā capillaries leaky i loko o ia membrane e hoʻomau hou i ke koko ma lalo o ka mana o nā mea hoʻokaʻawale koko a hiki i ka ulu ʻana o ka subdural hematoma maʻi i mea e hoʻopiʻi ai i ka lolo.

Hiki i kahi kanaka makua ke hoʻomohala i kahi Hematoma Subdural mai ka hāʻule ʻana ma kahi i pae ai ma ko lākou ʻāʻī a i ʻole ka ʻūhā me ka ʻole o ke kuʻi ʻana i ko lākou poʻo i ka papahele?¶

ʻAe. Hoʻomaʻamaʻa pinepine nā Neurosurgeons i ka Chronic Subdural Hematomas i nā poʻe ʻelemakule anticoagulated ʻaʻole i pā ko lākou poʻo i ka honua. Ke pahee a pae ikaika ma ka iwi huelo, ka puhaka, a me ke kua paha o ka lolo, no ka hoopau ana i ka lolo ma hope o ka iwi po'o no kekona kekona (he ikaika shearing whiplash inertial), a ua oi aku ka lawa e hiki ai ke hoopa aku i ke aaa pili i ka makahiki.

Pono anei au e hāʻawi i koʻu makua i kā lākou lāʻau ahiahi ʻo Eliquis, Xarelto, a i ʻole warfarin ma hope koke o ko lākou hāʻule ʻana a kuʻi i ko lākou poʻo?¶

ʻAʻole. Inā loaʻa i ka poʻo a hāʻule nui paha kekahi kanaka ʻelemakule ma ka hoʻokahe koko, e hoʻopaʻa i kā lākou lāʻau anticoagulant a i ʻole antiplatelet a hiki i ka loiloi ʻia ʻana i loko o ka Oihana Hoʻopiʻi a ʻaʻole i hoʻopaʻa ʻia ke koko o ke koko. ʻO ka ʻai ʻana i kahi maʻa ʻē aʻe o ka mea ʻoi aku ke koko i ka wā e kahe ikaika ana kahi aʻa kaulahao i loko o ka iwi poʻo e hoʻolalelale i ka hemorrhage a ʻoi aku ka paʻakikī o ka hoʻohuli ʻana i ka haukapila.

Pehea wau e ʻike ai i ka ʻokoʻa ma waena o kahi Hematoma Subdural Chronic a me ka holomua maʻamau o ka dementia?¶

ʻO nā neurodegenerative dementias e like me ka maʻi o Alzheimer e holomua mālie ana i nā mahina a me nā makahiki, ʻoiai kahi Chronic Subdural Hematoma e hoʻokau i kahi haʻahaʻa subacute i ka hana i nā lā a i kekahi mau pule. Inā loaʻa kahi kanaka makua i ka hele wāwae hou ʻole, hele wāwae ʻaoʻao, ʻaʻe i ka hiamoe ʻana o ke ao (no ka ʻū ʻana i ka waena o ka huaʻōlelo), ʻaʻole i hoʻopaʻa ʻia ka mimi hou, a i ʻole nāwaliwali o ka lima a i ʻole ka wāwae ma kahi ʻaoʻao ma kahi o 1 a 6 mau pule, mai hoʻopiʻi iā ia i ka dementia baseline a hiki i ka hoʻoponopono ʻole ʻana o ka Head CT scan i hoʻokuʻu i kahi hematoma.

He aha ka lāʻau ʻeha e palekana ke hāʻawi ʻia i kahi ʻelemakule ma nā mea hoʻokahe koko i ʻeha ma hope o ka hāʻule liʻiliʻi (i ka wā i hoʻokaʻawale ʻia ke koko o ka lolo)?¶

Ke hoʻomaʻemaʻe ke kauka i ke koko o ka lolo a i ʻole ka haʻihaʻi ʻana, ʻo ka acetaminophen (paracetamol / Tylenol) ka mea maʻamau ka mea hoʻomaha ʻeha ma luna o ka counter no nā poʻe maʻi me nā anticoagulants (e noho ana ma lalo o 2,000 a 3,000 milligrams ka huina o 24 mau hola i ka poʻe ʻelemakule me ka hana maʻamau maʻamau). Mai hāʻawi i ka aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), meloxicam, diclofenac, a i ʻole bismuth subsalicylate (Pepto-Bismol), no ka mea, hoʻopilikia kēia mau lāʻau i ka platelet clotting a hoʻoulu i ke koko o ka ʻōpū a me ka intracranial i ka wā e hui pū ai me nā mea hoʻokahe koko.

Nā alakaʻi pili¶

• Hāʻule ka poʻe ʻelemakule i ka wā hiki ʻole ke kū
• ʻEha poʻo a me ke kōkua mua
• ʻO ka huikau koke i ka poʻe ʻelemakule: silent UTI, urosepsis vs. stroke
• ʻO ka Polypharmacy, ka nui o ka lāʻau lapaʻau, ka hala ʻole, a me nā hewa hoʻonohonoho pila

Nā kumu a me ke alakaʻi kūhelu¶

• American College of Emergency Physicians (ACEP): * Ke kulekele pili kino: nā pilikia koʻikoʻi i ka hoʻokele ʻana i nā maʻi makua e hōʻike ana i ka ʻoihana pilikia me ka maʻi ʻeha o ka lolo (Anticoagulation a me Antiplatelet Mandatory CT Criteria) *.
• National Institute for Health and Care Excellence (NICE, United Kingdom): Guideline NG232: Poʻo ʻeha: Assessment and Early Management (Anticoagulant and Antiplatelet Head CT Timelines).
• ʻAmelika Hui Pū ʻIa o ʻAmelika Hui Pū ʻIa (ACS) Trauma Quality Improvement Program (TQIP): Nā Kūlana Hoʻomaʻamaʻa maikaʻi loa ma Geriatric Trauma Management a me Anticoagulation Reversal.
• Neurocritical Care Society and Society of Critical Care Medicine (SCCM): Alakaʻi no ka hoʻihoʻi ʻana o nā Antithrombotics i ka Intracranial Hemorrhage (Andexanet Alfa, Idarucizumab, a me 4-Factor PCC Protocols).
• National Institute on Aging (NIA) a me nā Centers for Disease Control and Prevention (CDC): STEADI (Stopping Elderly Accidents, Deaths & Injuries) Older Adult Fall and Traumatic Brain Injury Prevention.