Umutwe Mukuru Kumeneka Kumaraso: Gutinda Ibyumweru Byakera Subdural Hematoma Nyuma yicyumweru gito¶

Abantu babarirwa muri za miriyoni bakuze bafata imiti igabanya ubukana cyangwa imiti igabanya ubukana buri munsi kugira ngo birinde indwara ya fibrillation yo mu nda, embolisme yo mu bihaha, cyangwa imitsi ya coronary, harimo ** apixaban (Eliquis) **, ** rivaroxaban (Xarelto) **, ** dabigatran (Pradaxa) **, ** edoxaban (Savaysa) ** clopidogrel (Plavix) **, ** ticagrelor (Brilinta) **, na buri munsi ** aspirine **. Iyo umuntu mukuru ukuze kuriyi miti iyo ari yo yose anyerera ku itapi, akagwa kandi akavunika ikibuno, cyangwa akubita umutwe gusa ku muryango w’igikoni cyakinguwe cyangwa ku muryango w’imodoka, umuryango ukunze guhumeka neza niba mukuru adataye ubwenge, nta mutwe wamaraso waciwe, kandi ukora ibintu bisanzwe rwose nimugoroba. Iyo myumvire itari yo yumutekano nimwe mumitego yica mubuvuzi bwihutirwa.

Ku muntu mukuru ukuze ufata ibinini byamaraso, kuva amaraso ava mumitsi akurikiza ibihe bibiri bitandukanye, byangiza ubuzima: ** bikabije cyangwa byatinze bikomeretsa ihahamuka ryamaraso ** mumasaha 6 kugeza 48 yambere, CYANGWA ** buhoro buhoro buhoro buhoro buhoro buhoro (cSDH) ** bwaguka bucece imbere yumuhanga kugeza kumutwe wibyibushye bikabije kugeza kumutwe wumutwe wibagiwe kugeza kumutwe wumutwe wibagiwe kugeza kumutwe wumutwe wibagiwe kugeza kumutwe wumutwe wibagiwe kugeza kumutwe wumutwe wibagiwe kugeza kumutwe wumutwe wibagiwe kugeza kumutwe wumutwe wibagiwe kugeza kumutwe wumutwe wibagiwe kugeza kumutwe wumutwe wibagiwe kugeza kumutwe wibyibushye cyangwa bikabije. guta umutwe. Niba umuntu mukuru ukuze kumeneka yamaraso arwaye umutwe cyangwa kugwa, cyangwa akagira urujijo rushya, gusinzira, kubabara umutwe, kuvuga nabi, cyangwa ukuguru kumwe kuruhande iminsi cyangwa ibyumweru nyuma yo kugwa, hamagara numero yawe yihutirwa (911 muri Amerika no muri Kanada, 112 hirya no hino mu muryango w’ubumwe bw’ibihugu by’Uburayi, 999 mu Bwongereza; reba nimero yihutirwa) ako kanya. Kubijyanye nibihe byihutirwa, reba abageze mu zabukuru kugwa gukira iyo badashoboye kwihagararaho, ibikomere byo mu mutwe, na polifarmacy, imiti irenze urugero, dosiye zabuze, hamwe namakosa ategura ibinini.

Kora ubu¶

1. ** Jya mu ishami ryihutirwa ryibitaro byegereye kugirango uhite utandukana na Head CT Scan igihe cyose umuntu mukuru ukuze afata imiti igabanya ubukana cyangwa antiplatelet yakubise umutwe, kabone niyo yaba atigeze yirabura kandi akumva ko ari ibisanzwe 100%. ni.
2. ** Fata igipimo gikurikiraho cya Eliquis, Xarelto, Pradaxa, warfarin, cyangwa Plavix kugeza igihe umuganga w’ishami ryihutirwa asuzumye Head CT scan. Zana amacupa yibinini neza muri ER hanyuma ubwire umuforomo wa triage ** isaha nyayo yisaha ** igipimo cyanyuma cyamizwe.
3. ** Ntuzigere utanga aspirine, ibuprofen (Impanuro / Motrin), naproxen (Aleve), cyangwa Powder ya Goody's / BC kubabara umutwe nyuma yo kugwa cyangwa kubabara mu kibuno.
4. ** Gukeka "Gutinda kwa Chronique Subdural Hematoma" niba mukuru akuze afite kugenda mushya udahagaze neza, intege nke zamaguru zamaguru, gusinzira kumanywa, guhindura imiterere, cyangwa kubabara umutwe mubi nyuma yicyumweru 1 kugeza kuri 6 nyuma yo kugwa. Iminsi 14 kugeza 42 yo guhagarika ubwonko. Saba ** gusubiramo bidatandukanye Umutwe CT scan ** ako kanya.
5. ** Niba mukuru yaguye kandi adashobora kwihanganira uburemere ku kuguru kamwe, cyangwa ukuguru kumwe guhindukiye hanze (kuzunguruka hanze) kandi kugaragara ko ari kugufi kurenza ukundi, komeza ube hasi hanyuma uhamagare 911 (112 cyangwa 999) kubakekwaho kuvunika ikibuno.
6. ** Bwira intebe ya ER ako kanya ko umurwayi ari kuri Anticoagulant bityo bagatera protocole ya "Code Trauma / Anticoagulated Head Strike". warfarin) niba CT scan yerekana amaraso akora neza.

Igiti cyo gufata umwanzuro: Gutwara umusaza anticoagulée nyuma yo kugwa cyangwa guta umutwe¶

flowchart TD
    A["Abakuze bakuze kumena amaraso (Eliquis, Xarelto, Warfarin, Plavix) Yababajwe Kugwa cyangwa Umutwe"] --> B{"Kugwa kwabaye UYU MUNSI (Icyiciro gikaze) cyangwa IMINSI / ICYUMWERU GISHYA (Icyiciro cyatinze)?"}
    B -->|"Bibaye Uyu munsi / Mu masaha 48"| C{"Ibimenyetso bitukura byose: Gutakaza ubwenge, kuruka, kubabara umutwe bikabije, urujijo, abanyeshuri batangana, cyangwa ubumuga bwo mu kibuno?"}
    C -->|"Yego: Ibendera ritukura rirahari"| D["Hamagara 911/112/99"]
    C -->|"Oya: Reba 100% bisanzwe, ibimenyetso bya zeru"| E["BIRACYAJYA MU BITARO ER UYU MUNSI W'INGENZI ZITEGANYIJWE Umutwe CT Scan"]
    E --> F{"Niki Intangiriro ya ER Umutwe CT Yerekana?"}
    F -->|"Ibyiza byo kuva amaraso"| G["Ako kanya ICU Neurosurgical Consult + IV Anticoagulant Guhindura (Andexxa / Kcentra / Praxbind)"]
    F -->|"Ibibi (Clear Itangiriro CT)"| H["Gukurikirana ibyumweru 6 Byadindije Chronic Subdural Window: Reba kugendagenda, gusinzira, cyangwa urujijo rushya"]
    B -->|"Bibaye iminsi 3 kugeza ibyumweru 6 bishize"| I{"Ese abakuru berekana uburyo bushya bwo kugenda budahungabana, gusinzira, guhindagurika urujijo, kuvuga nabi, cyangwa kubabara umutwe?"}
    I -->|"Yego: Nubwo Intangiriro ya CT Icyumweru gishize yari isobanutse"| J["Jya mu bitaro ER Ako kanya hanyuma usabe gusubiramo umutwe utandukanye na CT kugirango ukureho Hematoma idakira."]
    I -->|"Nta bimenyetso"| K["Komeza gahunda yo kwirinda kugwa no kugenzura buri cyumweru ibyumweru"]

Icyiciro cya 1 (Amasaha 0 kugeza 48): Ubwonko bukabije bwo kuva amaraso hamwe no kwihutira kurwanya anticoagulant¶

Iyo umuntu mukuru ukuze afata ibinure byamaraso bikubise mumutwe uyumunsi, abaganga byihutirwa bahangayikishijwe mbere na ** acute subdural hematoma **, ** subarachnoid hemorhage **, cyangwa ** intraparenchymal contusion **. Mu bushakashatsi bw’amavuriro y’abasaza barwanya antikagile berekana ishami ryihutirwa bakangutse bafite amanota meza ya Glasgow Coma Scale amanota 15 (kuvuga bisanzwe, intege nke zeru, zeru amnesia) nyuma yo kugwa kurwego rwubutaka, ** 6 kugeza 10 ku ijana basanzwe bafite amaraso ava mumyanya ndangagitsina agaragara kumutwe CT **, naho ubundi ** 0,6 kugeza 2,5% bikura amaraso yatinze hagati ya 6 na 24.

Ugereranije kunanura amaraso, ibyago byo kuva amaraso, hamwe nibitaro byihutirwa bihindura antidote¶

Buri gihe uzane urutonde rwimiti cyangwa amacupa yibinini kubushinzwe ubutabazi. Icyiciro nyacyo cyo kunanura amaraso gitegeka uburyo ibitaro bihagarika amaraso yangiza ubuzima bwubwonko cyangwa agategura umurwayi kubagwa byihutirwa cyangwa kuvunika burr-hole:

Icyiciro cya 2 (Iminsi 3 kugeza Icyumweru cya 6): Kumenya Hematoma Yatinze Yigihe kirekire (cSDH)¶

Ndetse iyo umuntu mukuru akuze yagiye kuri ER kumunsi wo kugwa, akabona scan ya Head CT itandukanye, hanyuma akabwirwa * "Amakuru meza, scan ya CT nibisanzwe rwose, urashobora gutaha," * ** akaga ntikarenze **.

Mubyukuri, abagera kuri ** 25 kugeza 35% byabasaza basuzumwe na nini ya Chronic Subdural Hematoma ** yaba ifite ** bisanzwe bisanzwe Head CT scan ** kumunsi wo kugwa kwabo cyangwa ntibashobora no kwibuka gukubita umutwe kuberako igituba cyambere (cyangwa ikibindi gitunguranye gitunguranye kiva mukigenda) cyari gito cyane.

1. Ibyiciro 3 bya pathophysiologiya yibyumweru 4 byatinze ubwonko¶

Nigute amaraso ava mu bwonko ashobora kugaragara ibyumweru 3 kugeza kuri 5 * nyuma * ya CT isanzwe?

flowchart TD
    A["Umunsi wa 1: Umutwe muto cyangwa kugwa ku kibuno / Ikibuno (Kwihuta kwa Whiplash)"] --> B["Micro-Amarira muri Taut Bridging Veine Yambukiranya Atrophied Subdural Umwanya"]
    B --> C["Umunsi wa 1 kugeza 5"]
    C --> D["Iminsi 7 kugeza 21"]
    D --> E["Icyumweru cya 2 kugeza ku cya 6: Fagile Leaky Capillaries muri Neomembrane Micro-Bleed ikomeza (Iyobowe na Anticoagulants & Osmotic Fluid Pull)"]
    E --> F["Misa ikomeye yageze (80 kugeza 150 mL): Guhindura Ubwonko Hagati -> Gutungurwa gutunguranye, Gusinzira, Urujijo, cyangwa Intege nke nkintege nke"]

1. ** Icyiciro cya 1 - Micro-Amarira acecetse (Iminsi 1 kugeza 5): ** Igituba gito cyangwa umutwe utunguranye umutwe-amarira ararira umutsi muto. Mu bwonko bukuze bufite umwanya munini wa subdural, firime yoroheje yamaraso yimitsi iva mubwonko bwubwonko.
2. ** Icyiciro cya 2 - Membrane Encapsulation and Liquefaction (Umunsi wa 7 kugeza 21): ** Mugihe cyicyumweru cya kabiri nicyagatatu, umubiri ugerageza gukingira amaraso ashaje ukura capsule yoroheje yimitsi (** neomembrane ) irizengurutse, mugihe enzymes ziva mumaraso yuzuye umwijima mumazi menshi, amavuta-amavuta ( hygroma **).
3. ** Icyiciro cya 3 - Gukomeza kuva amaraso (Icyumweru cya 2 kugeza ku cya 6): ** Neomembrane iherutse gushingwa yuzuyemo capillaries ultra-fragile, yamenetse. Kubera ko mukuru arimo gufata ** Eliquis, Xarelto, warfarin, cyangwa Plavix , izo capillaries ziva muri membrane zidahwema kongera kumena amaraso mashya atukura mumyanya yumunsi umunsi kuwundi. Mugihe cibyumweru 3 byambere, ubwonko bwagabanutse bwakira isakoshi ikura nta bubabare. Noneho, kumunsi wa 21 cyangwa kumunsi wa 35, isakoshi igera kuri mililitiro 80 kugeza kuri 150, ikananiza ibyumba byose bisigaye imbere ya gihanga, kandi igasunika ubwonko kuruhande ( shift midline **).

2¶

Inzobere mu bumenyi bw'imitsi zita Chronic Subdural Hematoma ** "Umunyigana Ukomeye" ** kuko bidakunze gutera gusenyuka gukabije kwa Hollywood. Ahubwo, abagize umuryango n'abaganga babanza bakunze kubisuzuma nabi nka ** "bikabije Alzheimer," "depression," "ubusaza," cyangwa "mini-stroke." **

Reba kuri ibi bimenyetso ** 6 byo kuburira ** ahantu hose hagati ya ** iminsi 3 nibyumweru 6 ** nyuma yo kugwa cyangwa kugwa:

1. ** Gishya "Gait Drift" cyangwa Gutsitara Bidasobanutse (Akenshi Ikimenyetso cya mbere # 1): **
2. Umusaza atangira guhindukirira gato kuruhande rumwe hepfo ya koridoro, guhindagura ibirenge, gufata amano, cyangwa gukenera gufata ku rukuta kugirango agende mu bwiherero. Kuberako hemdoma ya subdural yicaye hejuru ya moteri yo hejuru yubwonko (igenzura ukuguru nigiti), apraxia yoroheje yamaguru hamwe no gutakaza umunzani bikunze kugaragara iminsi mike mbere yuko intege nke zamaboko cyangwa imvugo ihinduka.
3. ** Guhindura ibitotsi byo ku manywa na "Isaha Nziza / Isaha mbi" Ubunebwe: **
4. Ku isaha ya saa 09h00, mukuru asa nkaho ari mwiza kandi uhinduka, ariko saa 13h00 barunama ku ntebe yabo mugihe cyo kuganira, biragoye gukomeza kuba maso, cyangwa kureba nabi. ** Guhindagurika kuba maso ** ni ikimenyetso cyerekana umuvuduko ukabije wimbere uva mubikusanyirizo byamazi.
5. ** Guhindura Imiterere Yumuntu, Kutitaho ibintu, cyangwa "Kwihuta-Gutangira Kwiheba": **
6. Indwara yukuri ya Alzheimer itera imbere mumyaka ** **, ntabwo irenga ibyumweru 2. Niba umuntu mukuru ushobora kwambara, gukoresha televiziyo ya kure, hanyuma akagirana ikiganiro gisanzwe hashize ibyumweru 3 arangaye bitunguranye, arakaye, atitabira ubutumwa, cyangwa adafite inkari muri iki cyumweru, ukekako ** Chronic Subdural Hematoma ** (cyangwa kwandura bucece; reba; urujijo rutunguranye mubakuru: guceceka UTI, urosepsis na stroke).
7. ** Ububabare bworoheje, butuje, buhoraho Umutwe (Cyangwa Gukubita Uruhanga / Gukubita mu Bakuru Batavuga): **
8. Hafi ya 50 ku ijana byabantu bakuru bakuze bafite indwara ya hematoma idakira, bavuga ko umutwe utuje, ubabaza umutwe bikarushaho kuryama iyo uryamye cyangwa ukorora, mugihe abandi 50 ku ijana bafite ** zeru umutwe ** kubera ko ubwonko bwubwonko budahuza igihe kirekire.
9. ** Intege nke Zuruhande rumwe (Hemiparesis) cyangwa Drift ya Pronator: **
10. Saba mukuru gufata amaboko yombi agororotse imbere yabo afite imikindo ireba hejuru yamasegonda 10 amaso afunze: niba ikiganza kimwe gihindutse imbere hanyuma kikamanuka epfo (** pronator drift **), cyangwa niba batangiye guta igikombe cyikawa cyangwa gukurura kunyerera, jya kuri ER ako kanya.
11. ** Kuruhuka Kubona Ijambo, Kutavuga, cyangwa Gufata Byibanze: **
12. Niba hematoma ikanda ku gice cy’ibumoso cy’ururimi cortex, mukuru arashobora guhatanira kubona amagambo asanzwe, injyana ya slur, cyangwa akagira injyana ngufi ihinnye yikiganza kimwe cyangwa imfuruka yumunwa.

Urugero rwa 2: Kuvunika ikibuno cya Anticoagulated na Pelvic kuvunika nyuma yo kugwa mukuru¶

Iyo umuntu mukuru ukuze kumeneka yamaraso aguye, umutwe ntabwo aribwo bwonyine bwangiza ubuzima. Kuvunika ikibuno cya ** (kuvunika kwa femorale)

1. ** Menya ibimenyetso bya kera byavunitse ikibuno hasi: **
2. ** Amaguru magufi kandi azunguruka hanze: ** Reba ibirenge byombi byumukuru mugihe aryamye ku mugongo: niba ikirenge kimwe cyerekejwe hanze kigana hasi kuri dogere 45- kugeza kuri 90 kandi ukuguru kugasa na santimetero 2 kugeza kuri 5 (santimetero 1 kugeza kuri 2) mugufi ugereranije nandi maguru, ijosi ryumugore cyangwa igufwa ryikibuno cyavunitse.
3. ** Kubabara kw'ibibero cyangwa Ibibero by'imbere ku kuzenguruka kw'ibibuno byose: ** Ndetse hamwe no kuvunika "gukubitwa" cyangwa kuvunika umusatsi aho ikirenge gisa neza, umusaza azagira ububabare bukabije bwimbitse mu kibuno mugihe agerageza gukuramo agatsinsino hasi cyangwa uburemere.
4. ** Occult Hip cyangwa Pubic Ramus Yavunitse (Iyo Intangiriro ya X-Ray Nibisanzwe): ** Mugihe kigera kuri 5 kugeza 10% byabasaza osteoporotic bagwa kandi badashobora kwihanganira ukuguru kwabo nta bubabare bwo mu kibero, ikibuno cyambere kibanza X-ray muri ER gisa nkibisanzwe kuko umurongo wavunitse utimuwe (** kuvunika ijosi ryumugore **). Niba mukuru adashobora kugenda nyuma yo kugwa nubwo X-ray itari nziza, amabwiriza yubuvuzi arasaba ** byihutirwa Hip MRI cyangwa CT scan ** mbere yo kubareka bagerageza kubyibuha.
5. ** Ibyihishe Amaraso Yimbere Yimbere Kubitera Amaraso: **
6. Igitsina gore nigitereko gifite amaraso menshi. Kuvunika ikibuno cya intertrochanteric cyangwa ramus ya pubic cyangwa ivunika rya sacral pelvic kumurwayi ufata Eliquis, Xarelto, cyangwa warfarin ashobora kuva amaraso mililitiro 1.000 kugeza 2000 (amapine 2 kugeza kuri 4) yamaraso ** acecetse mubice byimbitse byibibero cyangwa retroperitoneum nta gitonyanga cyamaraso kigaragara ku ruhu, umuvuduko ukabije wa ** pulvo, igitutu).
7. ** Kuki Gusana hakiri kare mu masaha 24 kugeza 48 bikiza ubuzima: **
8. Amabwiriza ya orthopedic yubuvuzi (AAOS na NICE CG124) yerekana ko gusana kuvunika ikibuno cyumukecuru mugihe cyamasaha 24 kugeza 48 nyuma yo kugera mubitaro ** bigabanya imfu ziminsi 30, embolisme yica ibihaha, umusonga, na delirium mo kabiri.
9. Mugihe ugiye muri ER ako kanya na ** ufashe igipimo gikurikira cyo kunanura amaraso **, amatsinda ya anesthesia na orthopedic ihahamuka arashobora gupima urugero rwibiyobyabwenge, agatanga ihinduka ryihuse cyangwa umwanya wamadirishya yo gukaraba amasaha 24, hanyuma akabagwa neza bidatinze.

Icyo wakora mugihe utegereje hasi kuri ambulance (911 / 112 / 999)¶

Niba umusaza anticoagulée yaguye hejuru ya tile cyangwa igiti hanyuma ukeka ko gukubita umutwe cyangwa kuvunika ikibuno:

• ** Komeza mukuru uryamye neza cyangwa mumwanya nyawo wabonetse: ** Ntuzigere ubakurura amaboko kandi ntuzigere ubareka ngo bagerageze "kubigenda" kugeza mubyumba. Gukuramo anticoagulée mukuru neza nyuma yo kugwa birashobora kuvanaho kuvunika ijosi ryigitsina gore (guhindura byoroheje 3-gusana pin gusana muburyo bwo gusimbuza ikibuno) cyangwa gutera umwijima wa syncopal niba kuva amaraso imbere byagabanije umuvuduko wamaraso.
• ** Igenzura ibisebe byose bigaragara mumutwe hamwe nigitutu gikaze: ** Umutwe nimwe mumitsi yimitsi myinshi mumubiri wumuntu, kandi igihanga cya santimetero 3 (santimetero 1,2) cyacitse kuri Eliquis cyangwa warfarin gishobora kuva amaraso mililitiro 500 mumaraso muminota 15. Gwizamo igitambaro cyogejwe cyangwa isuku ya sterile mukibanza kinini hanyuma ukande ** ushikamye kandi ubudahwema ** uhita umanuka hejuru y igikomere cyumutwe wamaraso (keretse niba wumva kuvunika igihanga cyoroshye, cyoroshye, cyihebye munsi yacyo, muricyo gihe ushyireho igitutu cyoroheje cyizengurutse impande zose).
• ** Irinde hypothermia hasi (Rhabdomyolysis na Coagulopathie Kurinda): ** Ubushyuhe bwumubiri ukonje (** hypothermia munsi ya dogere selisiyusi 35 / dogere 95 Fahrenheit ) ihagarika imisemburo yamaraso yumuntu ( inyabutatu yica ihahamuka coagulopathie **), bigatuma kunanuka kwamaraso birushaho kuba bibi. Fata ibiringiti bishyushye hirya no munsi yigitugu cyumukuru hamwe numubiri utiriwe uzunguza ikibuno cyacitse, hanyuma uzamure icyumba thermostat mugihe inkeragutabara ziri munzira.

Inomero zihutirwa zo mukarere hamwe na protocole yikigo¶

Koresha iyo mibare yihutirwa hamwe na protocole yigihugu ihahamuka mugihe umuntu mukuru ukuze kumeneka yamaraso aguye cyangwa akubiswe umutwe:

• ** Amerika na Kanada: **
• ** Ambulance yihutirwa & Ihahamuka: ** Hamagara 911. Munsi ya ** CDC Amabwiriza yo Gutwara abarwayi bakomeretse **, abakuze ($ ge $ 65 ans) bafata anticoagulants bakubita umutwe cyangwa bakekwaho kuvunika ikibuno byujuje ibyangombwa byinshi byo guhahamuka kugirango bajyane mubitaro bifite amashusho ya ** 24/7 CT hamwe nubushobozi bwa neurosurgical / orthopedic **.
• ** Amabwiriza yo Guhindura Anticoagulation: ** Amashami yihutirwa akurikiza ** Ishuri Rikuru ry’abaganga b’abaganga byihutirwa (ACEP) Politiki y’ubuvuzi ku bijyanye no gukomeretsa ubwonko bworoheje bw’ubwonko ** na ** Ishyirahamwe ry’umutima ry’Abanyamerika (AHA) / Amabwiriza y’Ubuvuzi bwa Neurocritical Care Amabwiriza yo Guhindura Antithrombotique mu maraso ava mu nda **.
• ** Ubwongereza: **
• ** Ibihe byihutirwa: ** Hamagara 999 (cyangwa 111 gusa niba bidashidikanywaho rwose kubyerekeye uduce duto cyane tutari umutwe; ** igikomere cyose mumutwe kumena amaraso bisaba isuzuma ryishami ryihutirwa **).
• ** Manda ya NICE Clinical (NG232): ** Munsi ya ** Ikigo cyigihugu gishinzwe ubuzima n’ubuvuzi bwiza (NICE) Amabwiriza NG232 (* Gukomeretsa mu mutwe: gusuzuma no gucunga hakiri kare *) **, umurwayi uwo ari we wese wivuza anticagulant (warfarin cyangwa DOACs) cyangwa kuvura antiplatelet (ukuyemo ikibazo cya aspirine monotherapie) akomeretse mu mutwe mu isaha ya ** ubungubu), ndetse no gutakaza zeru ubwenge na zeru amnesia.
• ** Umuryango w’ubumwe bw’ibihugu by’i Burayi: **
• ** Ibihe byihutirwa: ** Hamagara 112. Ibigo by’ihungabana by’i Burayi bikurikiza ** Komite ya Neurotrauma ya Scandinaviya (SNC) ** na ** Amabwiriza y’umuryango w’ibihugu by’Uburayi (ESO) ** ategeka amabwiriza ako kanya CT yerekana amashusho na PCC / Andexanet / Idarucizumab guhindukira kubera ihungabana ry’umutwe.
• ** Ositaraliya na Nouvelle-Zélande: **
• ** Ibihe byihutirwa: ** Hamagara 000 muri Ositaraliya cyangwa 111 muri Nouvelle-Zélande. Ukurikije umurongo ngenderwaho wa ** Australiya & Nouvelle-Zélande kubijyanye no gukomeretsa byoroheje mu mutwe (PREDICT) ** na ** NSW / Queensland Health Adult Trauma Amabwiriza **, abantu bakuru bose bakuze kuri anticoagulants cyangwa clopidogrel / ticagrelor bisaba gukurikiranwa na ED no kwerekana amashusho ya CT nyuma yo gukubita umutwe.
• ** Ubuhinde na Aziya-Pasifika: **
• ** Ibihe byihutirwa: ** Hamagara 112 (cyangwa 108 ambulance) mu Buhinde; ubwikorezi butaziguye mubitaro bya kaminuza bifite ibikoresho byamasaha 24 ya CT scaneri hamwe nubuvuzi bwa neurosurgie.

6-Icyumweru nyuma yo kugwa murugo kugenzura urutonde rwabarezi¶

Niba umubyeyi wawe kumena amaraso yahanaguwe mubushinzwe ubutabazi akoresheje umunsi mubi-1 Head CT scan hanyuma ukohereza murugo, icapa cyangwa ubike iyi ** Urutonde rwibyumweru 6 Byatinze Subdural Reba Urutonde **:

• ** 1. Andika itariki nyayo yo kugwa kuri Kalendari ya firigo hanyuma ushireho "Icyumweru cya 2, Icyumweru cya 4, nicyumweru cya 6": ** Imiryango myinshi yibagirwa kugwa gake nyuma yiminsi 3. Gushira akamenyetso kumadirishya yibyumweru 6 kuri kalendari byemeza neza ko niba umubyeyi wawe atangiye gukora ibitotsi cyangwa bidahagaze ukwezi uhereye ubu, uhita uhuza ibimenyetso kugwa no kubwira muganga wa ER.
• ** 2. Kora "30-Second Second Morning Walk & Hand-Drift Check" Buri munsi: ** Reba uko umubyeyi wawe agenda kumeza ya mugitondo buri gitondo (kugenzura niba hari impande zose zometse kuruhande cyangwa gukurura ibirenge) hanyuma urebe niba bakoresha amaboko yombi muburyo bumwe.
• ** 3. Baza umuganga w’umutima cyangwa umuganga wibanze mbere yo gutangira kumena amaraso nyuma yo kuva amaraso: ** Niba hari amaraso mato mato mato yabonetse, ntuzigere utangira Eliquis, Xarelto, warfarin, cyangwa aspirine kugeza igihe neurosurgie na cardiologie byemeranijweho itariki yo gutangira ishingiye kubisubiramo bya CT.
• ** 4. Kugenzura Byose Kurwanya Ububabare hamwe ninyongera: ** Kuraho ibuprofen, naproxen, aspirine, ginkgo biloba, amavuta y’amafi menshi, hamwe na vitamine E ya capsules kubategura ibinini, kuko byongera ibyago byo kuva amaraso hamwe na anticagulants zandikiwe. Koresha ** acetaminofeni / paracetamol (Tylenol) ** mugihe ntarengwa cyumwijima-mwinshi (mubisanzwe $ le $ 2000 kugeza 3000 mg / kumunsi kubantu bakuze) niba byemejwe na muganga wabo kubikomeretsa nyuma yo kugwa.
• ** 5. Kuraho Ibiza Byangiza Ibidukikije Uyu munsi: ** Fata itapi irekuye, utere umugozi w'amashanyarazi, ushyire amatara ya nijoro kumuhanda uryamamo kugeza mu bwiherero, kandi urebe ko umuvuduko wamaraso wumukuru utagabanuka iyo uhagaze (** hypotension ya orthostatike **).

Ibibazo bikunze kubazwa¶

Ese koko umubyeyi wanjye akeneye kujya mucyumba cyihutirwa kugirango asuzume Head CT niba bakubise umutwe kuri Eliquis cyangwa warfarin ariko bakumva bameze neza?¶

Yego, buri gihe. Amabwiriza y’ubuvuzi bwihutirwa muri Amerika, Ubwongereza (NICE NG232), Kanada, na Ositaraliya ategeka ko Head CT itandukana itandukanye n’umuntu mukuru ukuze ufata imiti igabanya ubukana (Eliquis, Xarelto, Pradaxa, warfarin) cyangwa antiplatelet ikomeye (Plavix, Brilinta) ikubita umutwe, nubwo itigeze itakaza ubwenge kandi ifite ibimenyetso bya zeru. Ubushakashatsi bwerekana ko 6 kugeza 10 ku ijana byabantu bakuru bakuze bareba kandi bakavuga bisanzwe nyuma yo gukubita umutwe muto bimaze kuva amaraso mu bwonko bukora bigaragara kuri CT.

Nigute amaraso yubwonko ashobora kwerekana ibyumweru 4 nyuma yo kugwa niba ER Head CT scan kumunsi wo kugwa byari bisanzwe rwose?¶

Umunsi-1 Umutwe CT gusikana gusa birinda umuvuduko ukabije, umuvuduko ukabije wamaraso kumunsi wimvune. Ku bantu bakuze, ubwonko busanzwe bwo kugabanuka burambura imitsi yoroheje yikiraro yambukiranya umwanya muto. Gucika intege cyangwa kugwa birashobora gutera amarira ya microscopique muri imwe muri iyo mitsi ifite umuvuduko muke; mu byumweru birenga 2 kugeza kuri 6, umubiri ukora ururenda ruto ruto ruzengurutse icyegeranyo gito cy'amazi, hamwe na capillaries ziva muri urwo ruhererekane zikomeza kuva amaraso zatewe no kunanura amaraso kugeza igihe hematoma idakira ikuze nini bihagije kugirango ihoshe ubwonko.

Umusaza arashobora gukura Subdural Hematoma kuva kugwa aho baguye kumatako cyangwa ikibuno badakubise umutwe hasi?¶

Yego. Neurosurgueon ikunze kuvura Hematoma Chronic Subdural Hematoma kubantu bakuze barwanya antikagile imitwe itigeze ikora ku butaka. Iyo umusaza anyerera kandi akagwa cyane kumurizo wumurizo, ikibuno, cyangwa mugongo, umuvuduko ukabije wurugomo utera ubwonko gusubira inyuma ya gihanga kumasegonda abiri yo gutandukana (imbaraga zogosha inertial whiplash shearing), ibyo bikaba birenze bihagije gufata imitsi yikiraro, irambuye imyaka mumwanya muto.

Nkwiye guha umubyeyi wanjye umugoroba wabo wa Eliquis, Xarelto, cyangwa warfarin bakimara kugwa bakubita umutwe?¶

Oya. Niba umuntu mukuru ukuze kumena amaraso arwaye umutwe cyangwa kugwa bikabije, fata igipimo gikurikiraho cyimiti igabanya ubukana cyangwa imiti igabanya ubukana kugeza igihe bazasuzumirwa mu ishami ryihutirwa kandi scan ya CT yanze ko amaraso ava munda. Kumira urundi rugero rwamaraso yoroheje mugihe umutsi wikiraro urimo usohoka imbere muri gihanga bizihutisha kuva amaraso kandi bigatuma ibitaro bihinduka cyane.

Nigute navuga itandukaniro riri hagati ya Hematoma Chronic Subdural na progaramu isanzwe yo guta umutwe?¶

Indwara ya Neurodegenerative nka Indwara ya Alzheimer itera imbere buhoro buhoro amezi n'imyaka, mugihe Hematoma Chronic Subdural Hematoma itera subacute kumanuka mumikorere muminsi cyangwa ibyumweru bike. Niba umusaza akuze afite urugendo rushya rutajegajega, kuruhande rwo kugenda, guhindagurika gusinzira kumanywa (kwinangira interuro hagati), kutagira inkari nshya, cyangwa kunanirwa ukuboko kuruhande rumwe cyangwa ukuguru kwakaguru mugihe cyicyumweru 1 kugeza kuri 6, ntuzigere ubishinja guta umutwe wibanze kugeza igihe isuzuma ritandukanye na Head CT scan ryanze kuvura indwara ya hematoma.

Nuwuhe muti wububabare ushobora guha umuntu mukuru ukuze kumeneka wamaraso ubabara nyuma yo kugwa gake (iyo ubwonko bumaze kuva amaraso)?¶

Muganga amaze guhanagura umusaza kuva amaraso mu bwonko cyangwa kuvunika, asetaminofeni isanzwe (paracetamol / Tylenol) muri rusange ni yo igabanya ububabare bukabije bw’abarwayi kuri anticagulants (kuguma munsi ya miligarama 2000 kugeza 3.000 zose hamwe mu masaha 24 kubantu bakuze bafite imikorere yumwijima isanzwe). Ntuzigere utanga aspirine, ibuprofen (Impanuro, Motrin), naproxen (Aleve), meloxicam, diclofenac, cyangwa bismuth subsalicylate (Pepto-Bismol), kuko iyi miti ibangamira imitsi ya platine kandi igatera amaraso akomeye ya gastrointestinal na intracranial iyo ihujwe no kunanura amaraso.

Kuyobora¶

• Abakuze kugwa gukira mugihe udashoboye kwihagararaho
• Gukomeretsa mumutwe no guhungabana ubufasha bwambere
• Urujijo rutunguranye mubakuru: guceceka UTI, urosepsis na stroke
• Polifarmacy, imiti irenze urugero, dosiye zabuze, hamwe namakosa ategura ibinini

Inkomoko nubuyobozi¶

• Ishuri rikuru ry’abaganga bo muri Amerika ryihutirwa (ACEP): * Politiki y’ubuvuzi: Ibibazo bikomeye mu micungire y’abarwayi bakuze berekana ishami ryihutirwa bafite ibikomere byoroheje by’ubwonko bw’ubwonko (Anticoagulation na Antiplatelet Mandatory CT Criteria) *.
• Ikigo cy'igihugu gishinzwe ubuzima no kwita ku ndashyikirwa (NICE, Ubwongereza): * Amabwiriza NG232: Gukomeretsa mu mutwe: Isuzuma no gucunga hakiri kare (Anticoagulant na Antiplatelet Head CT Igihe) *.
• Ishuri rikuru ry’abaganga bo muri Amerika (ACS) Gahunda yo Kuzamura Ihahamuka (TQIP): * Amabwiriza meza yimyitozo ngororamubiri mu micungire y’ihungabana no kurwanya Anticoagulation *.
• Sosiyete Sivile ya Neurocritical hamwe na Sosiyete ishinzwe ubuvuzi bukomeye (SCCM): * Amabwiriza yo guhindura Antithrombotique mu maraso ava mu nda (Andexanet Alfa, Idarucizumab, na Porotokole ya PC-4).
• Ikigo cy'igihugu gishinzwe gusaza (NIA) hamwe n’ibigo bishinzwe kurwanya no gukumira indwara (CDC): * STEADI (Guhagarika Impanuka zashaje, Urupfu & Gukomeretsa) Abakuze bakuze Kugwa no gukumira ibikomere byubwonko *.