Umutwe w'abakuze ku miti igabanya amaraso: Gucererwa kw'amaraso y'inyuma y'amayinga inyuma y'ugugwa gutoyi¶

Amamiliyoni y’abantu bakuze bafata imiti igabanya amaraso canke imiti igabanya amaraso buri musi kugira ngo ntibafatwe n’indwara y’umutima, indwara y’amahaha, canke indwara y’umutima, harimwo apixaban (Eliquis), rivaroxaban (Xarelto)n, radabiga) (Savaysa), warfarine (Coumadin), imiti y’ibitera indwara y’ibihaha, imiti y’ibitera indwara y’ibihaha, n’imiti y’ibitera indwara y’ibihaha ku musi. Iyo umuntu akuze ari ku miti imwe muri iyo ari yo yose anyerera ku mfuruka, akagwa akavunika igihimba c’irondoka, canke agatera umutwe gusa ku muryango w’igikoni canke ku rugi rw’imodoka, umuryango akenshi urahumeka iyo umusaza atazi, ata maraso ava mu mutwe, kandi akaruhuka. Ukwo kwiyumvamwo umutekano w’ikinyoma ni kimwe mu mitego yica cane mu buvuzi bw’ibihe vyihutirwa bw’abageze mu zabukuru.

Mu muntu akuze afata imiti igabanya amaraso, amaraso ava mu mutwe akurikiza ibihe bibiri bitandukanye, bishobora gutuma umuntu apfa: ugusohoka amaraso mu mutwe bikomeye canke bitevye mu masaha 6 gushika kuri 48 ya mbere, CANKE ugusohoka amaraso buhoro buhoro mu gihanga c’umutwe (c SD2lent) 6 weeks inyuma y’ugutera umutwe mutoyi kwibagirwa canke kugwa hasi gushika aho bifatanya ubwonko bigaca bishushanya indwara y’umutima canke indwara yo kwihebura yihuta. Iyo umuntu akuze ari ku miti igabanya amaraso akubitwa n’umutwe canke akagwa, canke akagira ububabare bushasha, akagira ibitotsi, akagira umutwe, akavuga nabi, canke akagira amaguru agendagenda ku ruhande rumwe imisi canke amayinga inyuma y’aho aguye, hamagara inomero y’ivyihutirwa yo mu karere iwanyu (911 muri Leta Zunze Ubumwe za Amerika no muri Kanada, 112 mu bihugu vyose vy’Ubumwe bw’Uburaya, 999 mu Bwongereza; Raba inomero z'ivyihutirwa) ubwo nyene. Ku bijanye n’ivyihutirwa bijanye n’abageze mu zabukuru, raba abasaza baragwa iyo badashobora guhagarara, gukomereka mu mutwe, na imiti myinshi, gufata imiti birenze urugero, imiti yabuze, n'amakosa yo gutunganya imiti.

Ivyo ubikore ubu¶

1. Genda ku bitaro biri hafi kugira ngo ukore CT Scan y’umutwe idakoreshwa n’ibindi bihimba igihe cose umuntu akuze afata umuti ugabanya amaraso canke umuti ugabanya amaraso akubita umutwe, naho yoba atigeze agira umwijima kandi yumva ko ari ibisanzwe 100 kw’ijana. Amabwirizwa y’ubuvuzi ACENGCS urgent na TNIIP32) CT scan y’umutwe ku umurwayi uwo ari we wese afise anticoagulant akurikije ugukomeretswa mu mutwe ata kuraba ingene igipfunsi cabonetse ari gito canke ingene amanota yabo yo mu Glasgow Coma Scale ari asanzwe.
2. Fata imiti ikurikira yategekanijwe ya Eliquis, Xarelto, Pradaxa, warfarin, canke Plavix gushika umuganga wo mu gisata c’Ivyihutirwa asubiyemwo CT scan y’Umutwe. Ntukigere utanga umuti wo kugabanya amaraso ku mugoroba canke mu gitondo ubwo nyene umaze kugwa canke gukubitwa n’umutwe imbere y’uko amaraso asohoka mu bwonko. Zana amacupa y’ibipimo nyavyo muri ER maze ubwire umuforoma w’ivy’ugupima isaha nyayo y’isaha dose ya nyuma yamizwe.
3. Ntukigere utanga imiti yitwa aspirine, ibuprofen (Advil/Motrin), naproxen (Aleve), canke Goody’s/BC Powder kubera umutwe canke ububabare bwo mu gikiriza inyuma yo kugwa. Imiti igabanya ububabare (NSAIDs) n’imiti igabanya ububabare bw’amaraso bigabanya umuvuduko w’amaraso kandi bikagwiza umuvuduko w’amaraso.
4. Kwikeka ko "Delayed Chronic Subdural Hematoma" iyo umuntu akuze afise ukugenda gushasha kudakomeye, intege nke z'amaguru zitaboneka, gusinzira ku murango, guhinduka kw'ubuntu, canke ububabare bw'umutwe buteye ubwoba inyuma y'indwi 1 gushika ku 6 z'ugugwa kwose. Naho CT scan ya mbere y'umutwe wa ER ku musi w'ugugwa kwabo yari per000 y'ugugwa kwabo ( directement ariko bashikiwe n’igikombe c’inkoni gitunguranye kubera ko caguye ku rubavu canke ku matako yabo), imitsi isohoka mu kibanza co munsi y’urukoba ishobora gutwara imisi 14 gushika ku 42 kugira ngo ubwonko bushire. Saba gusubiramwo CT scan y’umutwe idafise ubudasa ubwo nyene.
5. Nimba umukuru yaguye adashobora kwikorera uburemere ku kuguru kumwe, canke ikirenge kimwe kihindukiye hanze (kihindukiye hanze) kikaba kigaragara ko ari kigufi kuruta ikindi, mubigumye hasi maze muhamagare 911 (112 canke 999) ku bijanye n’ugucika kw’itako. Ntukigere uterura umuntu akuze afise igihimba c’irondoka kivunitse mu ntebe canke mu ntebe y’imodoka: izosi ry’igihimba c’irondoka ry’amababa canke ibice vy’amagufa y’igihimba c’irondoka birashobora guca imitsi y’amaraso ikikuje maze bikava amaraso litiro 1 gushika ku 1,5 imbere mu itako iyo umuntu yimuriwe mu buryo butabereye.
6. Bwira abajejwe gupima ER ko umurwayi ari ku muti wo gukingira amaraso kugira ngo bashireho uburyo bwo gukora "Code Trauma / Anticoagulated Head Strike". Vuga izina nyaryo ry'umuti kugira ngo ivuriro ry'ibitaro rishobore gutegura umuti wo gusubiza amaraso mu mutsi (nk'akarorero Andexxar / PX/elFactor Praxbind ku miti ya Pradaxa, canke Vitamine K + Kcentra ku miti ya warfarin) iyo CT yerekanye ko ubwonko buva amaraso.

Igiti c'ingingo: Gutoranya umukuze afise ubumuga bwo gukingira amaraso inyuma yo kugwa canke gutera umutwe¶

flowchart TD
    A["Umuntu akuze afata imiti igabanya amaraso (Eliquis, Xarelto, Warfarin, Plavix) aragwa canke akagwa mu mutwe"] --> B{"Mbega iyo nkuru y’ugugwa yabaye UYU MUSI (Igice c’Igihugu) canke IMISI/INDWI IHEZE (Igice c’Igihe Gitevye)?"}
    B -->|"Vyabaye uno musi / mu masaha 48"| C{"Hari Ibimenyetso vy’Ibendera Ritukura: Gutakaza ubwenge, gukorora, kumeneka umutwe cane, gutera urujijo, amaso adangana, canke ubumuga bwo mu gikiriza?"}
    C -->|"Ego: Amabendera atukura arahari"| D["Hamagara 911 / 112 / 999 Ubwo nyene: Guma uhagaze, ufate urugero rukurikira rwo gutuma amaraso agenda neza, witegurire ER Umutwe CT + Umuntu wo Guhindura"]
    C -->|"Oya: Bisa n'ibisanzwe 100%, nta bimenyetso"| E["N'UYU MUSI MUJE MU BITARIRO kugira ngo mukore CT Scan y'umutwe idafise ubudasa"]
    E --> F{"Ni igiki CT y’umutwe wa ER yerekana?"}
    F -->|"Ivyiza ku maraso menshi"| G["Ubwo nyene ICU ivugwa n'abaganga b'imitsi + IV guhindura imiti igabanya amaraso (Andexxa / Kcentra / Praxbind)"]
    F -->|"Ivyiza (CT y'intango isobanutse)"| H["Gukurikirana idirisha ry'ububabare budakira ry'indwi 6: Gukurikirana ukugenda, ugusinzira, canke urujijo rushasha"]
    B -->|"Vyabaye imisi 3 gushika mu ndwi 6 ziheze"| I{"Mbega uwo mukuru yoba yerekana ukudashikama kw’ingendo NSHASHA mu buryo buteye ubwoba, ugusinzira, uguhinduka kw’urujijo, ukuvuga nabi canke ukurwara umutwe?"}
    I -->|"Ego: Naho CT ya mbere mu ndwi ziheze yari igaragara neza"| J["Genda mu bitaro ER Ubwo nyene usabe gusubiramwo CT y'umutwe idakoreshwa n'ibindi kugira ngo ukureho Hematoma idakira yo munsi y'umutwe"]
    I -->|"Nta bimenyetso"| K["Bandanya kwirinda kugwa no gusuzuma imitsi buri ndwi gushika mu ndwi ya 6"]

Icigwa ca 1 (Amasaha 0 gushika kuri 48): Ico kibazo co kuva amaraso mu bwonko n’uguhindura vyihutirwa imiti igabanya amaraso¶

Iyo umuntu akuze afata imiti igabanya amaraso akubita umutwe uno musi, abaganga b’ibihe vyihutirwa barabanza guhagarika umutima ku bijanye n’amaraso akomeye yo mu mutwe, amaraso yo munsi y’umubiri, canke ugukomeretswa mu mutwe. Mu bushakashatsi bwakozwe ku bakuze bafise imiti igabanya amaraso, baza mu bitaro vyihutirwa bari maso cane bafise amanota meza cane y’urugero rwa Glasgow Coma Scale rwa 15 (kuvuga neza, nta ntege nke z’amaso, nta n’umwe yibagirwa) inyuma y’aho baguye hasi, 6 gushika ku 10 kw’ijana baramaze kuronka ubumuga bwo mu mutwe bukora, Hemorcranial he**mor he 0,6 gushika kuri 2,5 kw’ijana bashobora gusohoka amaraso menshi atevye hagati y’amasaha 6 na 24 aheze.

Kugereranya imiti igabanya amaraso, ingorane zo kuva amaraso, n’imiti yo gusubiza inyuma ibitaro vyihutirwa¶

Imisi yose uzane urutonde rw’imiti y’umukuze canke amacupa y’ibipimo vy’imiti ku Gisata c’Ivyihutirwa. Igitigiri nyaco c’ivyo bikoresho bigabanya amaraso ni co kigena ingene ibitaro bihagarika amaraso yo mu bwonko ashobora gutuma apfa canke bikategura umurwayi kugira ngo abagwe vyihutirwa canke ngo abazwe mu mfuruka y’itako:

Icigwa ca 2 (Imisi ya 3 gushika ku ndwi ya 6): Kumenya indwara y’amaraso idakira (cSDH)¶

N'igihe umuntu akuze aja muri ER ku musi w'ugugwa, akagira CT scan y'umutwe idafise ubudasa, akabwira "Inkuru nziza, CT scan ni ibisanzwe rwose, urashobora gutaha," akaga NTIKARAHEZE.

Nkako, gushika kuri 25 gushika kuri 35 kw’ijana vy’abakuze bavuwe ko bafise indwara y’umutima nini yitwa Chronic Subdural Hematoma, boba bafise CT scan y’umutwe isanzwe ku musi baguyeko canke ntibashobora no kwibuka ko bakubise umutwe wabo kubera ko igipfunsi ca mbere (canke igikombe c’inkoni gitunguranye co gutsitara) cari.

1. Intambwe 3 z'ubuvuzi bw'amaraso mu bwonko atevye indwi 4¶

Ni gute amaraso yo mu bwonko ashobora kugaragara inyuma y’indwi 3 gushika kuri 5 inyuma y’ugukora CT scan isanzwe?

flowchart TD
    A["Umusi wa 1: Gutera umutwe mutoyi canke kugwa ku matako (Ukwihuta kw’ibipfunsi)"] --> B["Micro-Tear mu Taut Bridging Umutsi Ujabuka Atrophied Subdural Ikibanza"]
    B --> C["Imisi ya 1 gushika ku ya 5: Utugingo ngengabuzima dutoduto (Turake cane ku buryo utashobora kubona ku musi wa mbere CT canke tugahagarara gatoyi)"]
    C --> D["Imisi ya 7 gushika ku ya 21: Fibrin Clot Imenagurika Ikaba Amazi y’Ivyiyumviro vy’Ivyiyumviro + Ivyuma vy’Umururumba Bitera Neomembrane Ikikuje Ikoraniro"]
    D --> E["Indwi 2 gushika ku 6: Amaraso y’amaraso ashobora gusenyuka mu nzira y’amaraso agenda arasohoka (arongowe n’imiti igabanya amaraso n’amazi atera amaraso)"]
    E --> F["Igitigiri gikomeye cashitseko (80 gushika kuri 150 mL): Ubwonko burahinduka -> Guhungabana mu buryo butunguranye, Gusinzira, Gutera urujijo, canke Intege nke zimeze nk'iz'indwara y'umutima"]

1. Intambwe ya 1 - Amarira makeyi acereje (Imisi ya 1 gushika ku ya 5): Igipfunsi gitoyi canke ugutera umutwe bukwi na bukwi biratabura umutsi mutoyi w’ibarabara. Mu bwonko bushaje bufise umwanya munini wo munsi y’ubwonko, amaraso makeyi cane ava mu mitsi y’ubwonko arasohoka mu nzira y’ubwonko.
2. Intambwe ya 2 - Gupfuka urukoba no guhindura amazi (Imisi ya 7 gushika ku ya 21): Mu ndwi ya kabiri n’iya gatatu, umubiri ugerageza gukingira amaraso ashaje mu gukura uruzitiro rw’imitsi y’umubiri (neomembrane) rukikuje, mu gihe enzymes zihindura amaraso y’umubiri w’umwirabura /mali-il (mali-il hematoma idakira**).
3. Intambwe ya 3 - Gusubira gusohoka amaraso mu mitsi y’amaraso (Indwi 2 gushika ku 6): Igihimba gishasha c’umubiri gifise amaraso y’imitsi y’amaraso (neomembrane) yuzuye amaraso y’imitsi y’amaraso ashobora gusenyuka cane kandi ashobora gusohoka. Kubera ko uwo mukuru ariko arafata Eliquis, Xarelto, warfarin, canke Plavix, izo nzira z’amaraso zivuza ziguma zisubira gusohora amaraso mashasha atukura mu mwobo umusi ku musi. Mu ndwi 3 za mbere, ubwonko bucitse bushobora kwakira umufuko uriko urakura ata kubabara. Hanyuma, ku musi wa 21 canke wa 35, iyo saho ishika kuri militiro 80 gushika kuri 150, igaheza igaheza ivyumba vyose bisigaye imbere mu gihanga, igasunika ubwonko mu ruhande (midline shift).

2. "Umwigana Mukuru w'Imitsi": Ibimenyetso 6 bitaboneka vy'Ikivyimba c'Imitsi y'Imitsi¶

Abahinga mu vy'imitsi bita Chronic Subdural Hematoma "Umwigana Mukuru" kuko gake cane itera Hollywood gusenyuka biteye ubwoba mu ntango. Ahubwo, abagize umuryango n'abaganga ba mbere baravyifatamwo nabi ngo "indwara ya Alzheimer ikomeje gukomera," "uguhagarika umutima," "ubusaza," canke "indwara y'umutima ntoyi."

Raba ibi bimenyetso 6 vy'imburi ahantu hose hagati ya imisi 3 n'indwi 6 inyuma y'ugugwa canke gutera:

1. "Gait Drift" nshasha canke Gutsitara Bitasobanuwe (Akenshi ni Ikimenyetso ca mbere #1):
2. Uwo mukuru atangura guhindukira gatoyi aja ku ruhande rumwe aja mu nzira, akavyura ibirenge, akafata urutoke, canke akakenera kwifatanya n’inkuta kugira ngo agende aja mu bwogero. Kubera ko hematoma yo munsi y’ubwonko yicara hejuru y’umurongo wo hejuru w’ubwonko (uwugenzura ukuguru n’umubiri), ukuguru kudakora neza mu buryo butaboneka be n’ukubura uburinganire akenshi bigaragara imisi mikeyi imbere y’uko ukuboko gucika intege canke imvugo ihinduka.
3. Ugusinzira ku murango guhindukahinduka n'Ugucika intege "Isaha nziza / Isaha mbi":
4. Ku isaha ya 09:00 uwo mukuru asa n’uwukeye kandi azi kuvuga, ariko ku isaha ya 13:00 baba bariko barazunguza umutwe mu ntebe yabo mu gihe bariko barayaga, bigoye kuguma bari maso, canke baraba amaso ata co bazi. Uguhinduka kw’amaso ni ikimenyetso c’ugutera imbere kw’umuvuduko wo mu mutwe uva ku nzira y’amazi iri munsi y’umutwe.
5. Ihinduka ry'ubuntu, ukutagira ico ukora, canke "Indwara yo kwihebura yihuta":
6. Indwara ya Alzheimer y’ukuri itera imbere mu imyaka, ntiyigera irenga indwi 2. Nimba umukuze yari gushobora kwiyambara, gukoresha remote ya televiziyo, no kugira ikiyago gisanzwe mu ndwi 3 ziheze, aca agira ubwoba bukwi na bukwi, arashavura, ataco yitwararika, canke akabura amazi muri iki ciyumviro, wike ko afise Chronic Subdural Hematoma (canke infection silencieuse; raba urujijo rutunguranye mu bakuze: UTI icereje, urosepsis n'indwara y'umutima).
7. Umutwe udakomeye, udatera ubwoba, uhoraho (Canke gutera/gutera mu ruhanga mu bakuze batavuga):
8. Nk’ibice 50 kw’ijana vy’abantu bakuze bafise hematoma idakira yo mu bwonko bavuga ko bafise umutwe ubabaza cane, ukaba utera cane iyo baryamye canke ukorora, mu gihe abandi 50 kw’ijana bafise ububabare bw’umutwe kubera ko ububabare bwo mu bwonko butera ububabare bw’umubiri.
9. Intege nke zidasanzwe z'uruhande rumwe (Hemiparesis) canke uguhungabana kw'umubiri:
10. Saba umukuru afate amaboko yompi agororotse imbere yabo, ibiganza vyiwe biraba hejuru mu masegonda 10 amaso afunze: iyo ukuboko kumwe guhindukiye buhoro buhoro imbere maze kugendagenda hasi (pronator drift), canke iyo batanguye gutera igikombe cabo c’ikawa canke gukurura inkweto imwe, genda mu bitaro vy’abagwayi ubwo nyene.
11. Imirongo yo kurondera amajambo, imvugo idatomoye, canke gufata ingingo:
12. Iyo hematoma ikandagiye ku gice c’ururimi c’ibubamfu, uwo muntu akuze yoshobora kugorwa no kuronka amajambo asanzwe, inyuguti zidasobanutse, canke akagira ukuboko kumwe canke imfuruka y’akanwa guhungabana mu buryo bugufi.

Ivyabaye 2: Gucagura igihimba c'irondoka n'uguca ibice kw'igihimba c'irondoka inyuma y'ugugwa kw'abakuze¶

Iyo umuntu akuze ari ku miti igabanya amaraso aguye, umutwe si wo wonyene ushobora kuva amaraso. Ukuvunika kw’itako (uguvunika kw’igihimba c’irondoka co hafi) canke uguvunika kw’impeta y’igihimba c’irondoka ku muntu akuze afise anticoagulant ni ikintu gikomeye c’amagufa n’amaraso:

1. Menya Ibimenyetso Vya kera vy'Ukuvunika kw'Itako Hasi:
2. Ikirenge kigufi kandi gihindukiye hanze: Raba ibirenge vyose bibiri vy’umukuru igihe baryamye ku mugongo: iyo ikirenge kimwe giteretse hanze kija hasi mu mfuruka ya degre 45- gushika kuri 90 kandi ico kirenge kikaba kimeze nk’amasentimetero 2 gushika kuri 5 (inci 1 gushika kuri 2 izindi) ni kigufi kuruta igufa ry’itako ry’imbere canke ry’inyuma ry’itako vyavunitse.
3. Ububabare bwo mu rubavu canke rw'imbere ku rubavu rwose: Naho yoba afise "impacted" canke hairline hip fracture aho ikirenge kigaragara ko kigororotse, umukuze azogira ububabare bukomeye cane mu rubavu igihe agerageza guterura igitsintsiri ciwe hasi canke kwikorera uburemere.
4. Igice c’itako canke c’igihimba c’irondoka (Igihe X-Ray ya mbere ari isanzwe): Mu bice 5 gushika kuri 10 kw’ijana vy’abakuze bafise ubumuga bw’amagufa bagwa badashobora kwikorera uburemere ku kuguru kwabo ata bubabare bwo mu rubavu, igicapo c’itako c’intango gisanzwe mu bitaro vy’abarwayi bisa n’ibisanzwe kubera ko umurongo w’amagufa udasanzwe (ne**o feck). Iyo umuntu akuze adashobora kugenda amaze kugwa naho afise igipimo c’itako kitari ciza, amabwirizwa y’ubuvuzi asaba MRI canke CT scan y’itako vyihutirwa imbere y’uko abareka ngo bagerageze kwikorera uburemere.
5. Ingorane zo kuva amaraso imbere mu mubiri ku bikoresho bigabanya amaraso:
6. Igihimba c’irondoka n’igihimba c’irondoka birafise amaraso menshi cane. Igihe umurwayi afata imiti Eliquis, Xarelto canke warfarin, iyo umuntu avunitse igihimba c’irondoka canke igihimba c’irondoka, arashobora kuva amaraso imililitiro 1.000 gushika ku 2.000 (amapinte 2 gushika ku 4) y’amaraso ata co avuze mu bice vy’itako canke mu gice c’inyuma c’itako, hypovolemic shock (urukoba rutukura, umutima utera intege nke, gusinzira, umuvuduko w’amaraso ugabanuka).
7. Kubera iki kubagwa hakiri kare mu masaha 24 gushika kuri 48 bikiza ubuzima:
8. Amabwirizwa y’ubuvuzi bw’amagufa (AAOS na NICE CG124) yerekana ko gusanasana igihimba c’irondoka c’umusaza mu masaha 24 gushika kuri 48 umuntu ashitse mu bitaro bigabanya urupfu rw’imisi 30, indwara y’amahaha yica, indwara y’amahaha, n’ugutahura ibintu mu bice bibiri.
9. Mu kuja mu bitaro vya ER ubwo nyene no gufata urugero rukurikira rw’imiti igabanya amaraso, imigwi y’abaganga batera ububabare bw’amagufa irashobora gupima urugero rw’imiti, gutanga uguhindura canke gufata umwanya w’amasaha 24 yo gukaraba DOAC, no kubaga ata nkomanzi ata guteba.

Ivyo wokora mu gihe urindiriye hasi imodoka itwara abarwayi (911 / 112 / 999)¶

Iyo umukuze afise imiti igabanya amaraso yaguye ku giti gikomeye canke hasi ku giti maze ukeka ko yakubiswe mu mutwe canke ko yavunitse igihimba c’irondoka:

• Guma umukuru aryamye canke mu kibanza nyaco abonye: Ntukigere umukwegera hejuru mu maboko kandi ntukigere ubareka ngo bagerageze "kubigenda" baje mu cumba co kuraramwo. Gukwega umuntu akuze afise anticoagulant ahagaze inyuma y’ugugwa birashobora gukuraho ukuvunika kw’izosi ry’igihimba c’irondoka (guhindura ugusanura kworoshe kw’ibipfunsi 3 mu gusubirira igihimba c’irondoka cose) canke gutuma umuntu agira ububabare bw’umubiri (syncopal blackout) iyo amaraso yo mu mutima yagabanyije umuvuduko w’amaraso yabo.
• Gugenzura igikomere cose kiboneka co mu mutwe ukoresheje umuvuduko ukomeye: Urukoba rw’umutwe ni rumwe mu mitsi myinshi mu mubiri w’umuntu, kandi urukoba rw’umutwe rufise uburebure bwa santimetero 3 (1,2-inch) rwacitse kuri Eliquis canke warfarin rushobora gusohora amaraso militiro 500 hasi mu minota 15. Nimushire igitambaro co kwoga canke igitambaro co mu mutwe gisukuye mu gice c’umubiri gikomeye maze mugikande bikomeye kandi bikomeze mugororotse ku gikomere co mu mutwe kiva amaraso (kiretse wumvise igihimba c’umutwe kivunitse, giteye nk’igiponji, gicitse intege munsi, muri ivyo rero, ushireko umukazo w’impeta yoroshe ku ruhande).
• Kwirinda ubushuhe bwo hasi (Rhabdomyolyse na Coagulopathy Gukingira): Ubushuhe bwo mu mubiri bukonje (ubushuhe buri munsi ya degre 35 za Celsius / degre 95 za Fahrenheit) buraremaza intungamubiri zitera amaraso y’umuntu (umwami w’ubutatu butera ububabare bw’amaraso cane Tuka amaburengeti asusurutse hirya no hino no munsi y’ibitugu n’umubiri w’uwo muvyeyi ataco uzunguruka mu rubavu rwabo rwavunitse, hanyuma ushire hejuru igikoresho co gupima ubushuhe bwo mu cumba mu gihe abaganga bari mu nzira.

Inomero z'ivyihutirwa zo mu karere n'amategeko y'ibigo¶

Koresha izi nimero z’ivyihutirwa be n’amategeko y’igihugu yerekeye ihungabana iyo umuntu akuze ari ku miti igabanya amaraso aguye canke akubitwa n’umutwe:

• Leta Zunze Ubumwe za Amerika na Canada:
• Imodoka y'abagwayi n'abakomeretse: Hamagara 911. Mu Ingingo ngenderwako za CDC zo gutoranya abarwayi bakomeretse, abakuze (\(\ge\)65 years) bafata imiti igabanya amaraso iyo bakubiswe mu mutwe canke bakekwa ko bavunitse mu rubavu, barahuye n’ingingo ngenderwako zo gutoranya abakomeretse bafise ingorane nyinshi kugira ngo bajanwe mu bitaro bafise 24/7 CT imaging n’ubushobozi bwo kubaga ubwonko/amagufap.
• Impanuro zo guhindura imiti igabanya amaraso: Ibisata vy’ubuvuzi vyihutirwa bikurikiza Itegeko ry’ubuvuzi ry’ishure ryisumbuye ry’abaganga b’ivyihutirwa ryo muri Amerika (ACEP) ku bijanye n’ugukomeretswa kw’ubwonko gutoyi na Ishirahamwe ry’umutima ryo muri Amerika (AHA) / Ishirahamwe ry’ubuvuzi bw’imitsi y’ubwonko ry’uguhindura imiti igabanya ububabare bw’amaraso
• Ubwami bw'Ubwongereza:
• Ivyihutirwa: Hamagara 999 (canke 111 gusa iyo utazi neza rwose ivyerekeye igikomere gito cane kitari co mu mutwe; ugukomeretswa kwose kwo mu mutwe ku miti igabanya amaraso bisaba gusuzumwa n’Igisata c’Ivyihutirwa).
• Itegeko ry’ubuvuzi rya NICE (NG232): Mu Ikigo c’Igihugu c’Ubuzima n’Ukwitwararika (NICE) Ingingo ngenderwako NG232 (Igikomerekezo co mu mutwe: gusuzuma no kuvura hakiri kare), umurwayi wese ari ku miti igabanya amaraso (warfarin canke DOACs) canke ubuvuzi bwo gukingira amaraso nk’umuti igikomere kitegerezwa gukorwa CT scan y’Umutwe mu masaha 8 y’igikomere (canke mu masaha 1 nimba hari ikimenyetso c’ubumuga bw’imitsi), mbere n’aho ata kimenyetso co gutakaza ubwenge n’ukwibagirwa.
• Ubumwe bw'Uburaya:
• Ivyihutirwa: Hamagara 112. Ibigo vy’i Buraya bijejwe ivy’ihungabana bikurikiza Komite y’i Scandinavie y’ihungabana ry’imitsi (SNC) na Ishirahamwe ry’i Buraya ryitaho ivy’ihungabana ry’umutima (ESO) amabwirizwa asaba ko umuntu ahita afata amashusho y’umutwe n’uguhindura PCC/Andexanet/Idarucizumab ku bijanye n’ihungabana ry’umutwe ridatera amaraso.
• Ostraliya na Nouvelle-Zélande:
• Ivyihutirwa: Hamagara 000 muri Australiya canke 111 muri Nouvelle-Zélande. Mu Itegeko rya Australiya na Nouvelle-Zélande ku bikomere vyo mu mutwe bitobito canke bikomeye (PREDICT) na Itegeko ry’Ikomere ry’Ubuzima ry’Abakuze ryo muri NSW / Queensland, abakuze bose bari ku miti igabanya amaraso canke clopidogrel/ticagrelor basaba ko bafata ED n’ugufata amashusho y’umutwe inyuma y’ivyo vyose.
• Ubuhindi na Aziya-Pasifike:
• Ivyihutirwa: Hamagara 112 (canke 108 ambulance) mu Buhindi; n’ugutwara umuntu ataco akora mu bitaro vy’amashure yisumbuye bifise igikoresho co gupima amasaha 24 n’igikoresho co kubaga ubwonko.

Urutonde rw'igenzura ry'indwi 6 inyuma y'ugugwa kw'abarera abana¶

Niba umuvyeyi wawe ari ku miti igabanya amaraso yaciwe mu gisata c’Ivyihutirwa afise CT scan y’umutwe y’umunsi wa mbere ataco imaze, aca yoherezwa muhira, acapura canke ubike uru urutonde rw’ivy’ugusuzuma ivy’umutwe vy’indwi 6:

• 1. Niwandike itariki nyayo y'ugugwa ku kirangamisi ca frigo maze ushireko ikimenyetso "Indwi ya 2, indwi ya 4, n'indwi ya 6": Imiryango myinshi iribagirwa ugugwa gutoyi inyuma y'imisi 3. Gushira ikimenyetso ku idirisha ry’indwi 6 ku kirangamisi bituma umuvyeyi wawe atanguye gukora nk’uwusinziriye canke adahagaze neza haciye ukwezi kumwe, uhita uhuza ico kimenyetso n’ugugwa maze ukabibwira umuganga wo mu bitaro vy’ibitaro.
• 2. Kora "30-Second Morning Walk & Hand-Drift Check" Buri Musi: Raba ingene umuvyeyi wawe agenda aja ku meza y'ifunguro rya mu gitondo buri gitondo (ugenzure ko ata n'imwe ihinduka mu ruhande canke ikwega ibirenge) maze urabe nimba akoresha ibiganza vyose mu buryo buhuye.
• 3. Baza Umuganga w’Umutima canke Umuganga w’Imbere yo Gusubira Gukoresha Imiti Igabanya Amaraso Inyuma y’Ukuva Amaraso: Niba hari amaraso makeyi yo mu mutwe, ntukigere usubira gukoresha Eliquis, Xarelto, warfarin, canke aspirin gushika abaganga b’imitsi n’abaganga b’umutima bemeranije itariki nyayo yo gusubira gukoresha imiti ishingiye ku gusubiramwo CT .
• 4. Igenzura ry’Imiti Yose Igabanya Ububabare n’Iyongera: Kura ibuprofen yose, naproxen, aspirine, ginkgo biloba, amavuta y’ifi afise imiti myinshi, n’imiti ya vitamine E mu gikoresho co gutegura imiti, kuko bitera ingorane zo kuva amaraso hamwe n’imiti yo gukingira amaraso. Koresha acetaminophen / paracetamol (Tylenol) mu rugero rw’imiti y’igitigu (mu bisanzwe \(\le\)2.000 gushika ku 3.000 mg/umunsi ku bakuze) iyo yemejwe n’umuganga wabo ku bikomere vy’inyuma y’ugugwa.
• 5. Kuraho akaga ko kugwa mu bidukikije uno musi: Tora amatapi yo gutera, ushire imigozi y’amashanyarazi, ushire amatara y’ijoro ku nzira iva mu cumba co kuraramwo uja mu cumba co kwogeramwo, kandi usuzume ko umuvuduko w’amaraso w’umukuze udagabanuka iyo ahagaze (orthostatic hypotension).

Ibibazo bikunda kubazwa¶

Mbega vy’ukuri umuvyeyi wanje arakeneye kuja mu cumba c’ubuvuzi bw’ivyihutirwa kugira ngo bamukoreshe CT scan y’umutwe iyo bateye umutwe ku miti yitwa Eliquis canke warfarin ariko bakaba bameze neza rwose?¶

Ego cane, igihe cose. Amabwirizwa y’ubuvuzi bw’ibihe vyihutirwa muri Leta Zunze Ubumwe za Amerika, Ubwongereza (NICE NG232), Kanada, na Ostraliya asaba ko umuntu wese akuze afata umuti wo gukingira amaraso (Eliquis, Xarelto, Pradaxa, warfarin) canke umuti wo gukingira amaraso (Plavix, Brilinta) akora igipimo c’umutwe ataco akora, iyo afise ubumuga bwo mu mutwe. ibimenyetso. Ivyigwa vyerekana ko 6 gushika ku 10 kw’ijana vy’abakuze bafata imiti igabanya amaraso, basa n’abavuga neza neza inyuma y’aho bakubiswe gatoyi mu mutwe, baba bamaze gusohoka amaraso mu bwonko akora cane aboneka ku bipimo vya CT.

Ni gute amaraso yo mu bwonko yoshobora kugaragara inyuma y’indwi 4 umuntu aguye nimba ER Head CT scan ku musi aguye yari isanzwe rwose?¶

Igipima c’umutwe co ku musi wa mbere kirashobora gusa gukuraho amaraso yihuta kandi afise umuvuduko mwinshi ku musi umuntu yakomeretse. Mu bantu bakuze, ugucika intege kw’ubwonko kurambura imitsi y’umubiri ishobora gusenyuka ijabuka ikibanza co munsi y’umubiri. Ugutera canke ugugwa gutoyi birashobora gutuma umwe muri iyo mitsi y’umuvuduko mutoyi utabuka; mu ndwi 2 gushika ku 6, umubiri uragira uruzitiro rworoshe rw’imitsi rukikuje ako gace gatoyi k’amazi, maze imitsi y’amaraso ivuza imbere muri ako gace iguma isubira gusohoka amaraso iyo ikoresheje imiti igabanya amaraso gushika aho iyo hematoma idakira yo munsi y’umubiri ikura cane ku buryo ishobora gufatanya ubwonko.

Mbega umuntu akuze yoshobora kugira Subdural Hematoma avuye mu kugwa aho yaguye ku matako canke ku gikiriza ataco akubise umutwe hasi vy’ukuri?¶

Egome. Abaganga babaga imitsi barakunda kuvura indwara y’amaraso yitwa Chronic Subdural Hematomas ku bantu bakuze bafise imitsi igabanya amaraso, imitwe yabo ntiyigeze ikora hasi. Iyo umuntu akuze anyerera maze akagwa cane ku igufa ry’umurizo, ku rubavu canke ku mugongo, iyo nzira y’ubukazi butunguranye ituma ubwonko buguma inyuma y’igihanga mu kiringo c’isegonda rimwe (inguvu z’ugukemura z’inkoni zidakora), ivyo bikaba bihagije cane kugira ngo umuntu ashobore guca umutsi w’umubiri ukomeye kandi urambuye kubera imyaka.

Noba noha umuvyeyi wanje imiti yabo yo ku mugoroba yitwa Eliquis, Xarelto canke warfarin bakimara kugwa bagatera umutwe?¶

Oya, iyo umuntu akuze ari ku miti igabanya amaraso akubiswe mu mutwe canke akagwa cane, nufate imiti yiwe ikurikira itegekanijwe y’imiti igabanya amaraso canke igabanya amaraso gushika basuzumye mu Gisata c’Ivyihutirwa kandi CT scan y’Umutwe ikabona ko ata maraso ava mu mutwe. Kumira iyindi miti igabanya amaraso mu gihe umutsi ufatanya amaraso uriko urasohoka imbere mu gihanga, bizotuma amaraso yihuta gusohoka kandi bizotuma gusubira mu bitaro bigorana cane.

Nomenya gute itandukaniro riri hagati y’indwara y’amaraso idakira n’ugutera imbere kw’indwara yo kwihebura mu buryo busanzwe?¶

Indwara y’ugusenyuka kw’imitsi nk’iya Alzheimer itera imbere buhoro buhoro mu mezi n’imyaka, mu gihe Chronic Subdural Hematoma ituma umuntu adakora neza mu misi canke mu ndwi nkeyi. Iyo umuntu akuze afise ubugoyagoye bushasha bwo kugenda butashikamye, akagenda mu ruhande, akagira ingorane yo gusinzira ku murango (gutera umutwe hagati mu nteruro), akagira ubugoyagoye bushasha bwo kunywa amasobe, canke ubugoyagoye bushasha bwo ku ruhande rumwe canke ku kuguru mu kiringo c’indwi 1 gushika ku 6, ntukigere ubishira ku ndwara yo kwihebura gushika aho umuntu akuze afise ubumuga bwo mu mutwe. amaraso.

Ni uwuhe muti w’ububabare ushobora guha umuntu akuze ari ku miti igabanya amaraso afise ububabare amaze kugwa gatoyi (igihe amaraso yo mu bwonko amaze gukurwaho)?¶

Umuganga amaze gukuraho amaraso canke ukuvunika kw’ubwonko, umuti witwa acetaminophen (paracetamol / Tylenol) ni wo muti wo gukuraho ububabare ku barwayi bafata imiti igabanya ububabare (uguma munsi ya miligarama 2.000 gushika ku 3.000 z’amaraso yose hamwe ku masaha 24 y’ubuzima busanzwe). Ntukigere utanga imiti yitwa aspirine, ibuprofen (Advil, Motrin), naproxen (Aleve), meloxicam, diclofenac canke bismuth subsalicylate (Pepto-Bismol), kuko iyo miti ituma utugingo ngengabuzima tudakora neza kandi igatuma amaraso ava cane mu nda no mu mutwe iyo ifatanijwe n’ibindi bihimba vy’umubiri.

Inyobora zifitaniye isano¶

• Abageze mu zabukuru baragwa iyo badashobora guhagarara
• Ibikomere vyo mu mutwe n'uguhungabana kw'umutima
• Urujijo rutunguranye mu bakuze: UTI icereje, urosepsis n'indwara y'umutima
• Polypharmacy, gufata imiti birenze urugero, gutakaza imiti, n'amakosa yo gutunganya imiti

Amasoko n'ubuyobozi buzwi¶

• Ishure ry’abaganga b’ivyihutirwa ryo muri Amerika (ACEP): Itegeko ry’ubuvuzi: Ibibazo bihambaye mu bijanye no kuvura abarwayi bakuze baje mu gisata c’ubuvuzi bw’ivyihutirwa bafise ububabare buke bwo mu bwonko (Ivyiyumviro vy’ugukingira amaraso n’ugukingira amaraso mu bwonko).
• Ikigo c’Igihugu c’Ubuzima n’Ukwitwararika (NICE, Ubwongereza): Ingingo ngenderwako NG232: Gukomeretsa mu mutwe: Gusuzuma no kuvura hakiri kare (Igihe co gupima umutwe n’imiti igabanya amaraso).
• Porogarama yo gutera imbere mu bijanye n’ihungabana (TQIP) y’Ishure ry’Abaganga ry’Amerika (ACS): Ingingo ngenderwako nziza mu bijanye no gufasha abarwayi b’abageze mu zabukuru no guhindura imiti igabanya amaraso.
• Ishirahamwe ry’ubuvuzi bw’imitsi n’ishirahamwe ry’ubuvuzi bw’imitsi (SCCM): Ingingo ngenderwako zo guhindura imiti igabanya amaraso mu mutwe (Andexanet Alfa, Idarucizumab, n’amasezerano ya PCC y’ibintu 4).
• Ikigo c’igihugu kijejwe gukura (NIA) n’ibigo bijejwe kugenzura no kwirinda indwara (CDC): STEADI (Guhagarika impanuka, urupfu n’ibikomere vy’abageze mu zabukuru) Gukingira abageze mu zabukuru ugugwa n’ibikomere vyo mu bwonko.