Musoro Mukuru Bump paRopa Thinners: Yakanonoka Chronic Subdural Hematoma Mavhiki Mushure mekudonha Kuduku¶

Mamiriyoni evakuru vakura vanotora mishonga yemuromo anticoagulants kana antiplatelet mishonga zuva rega rega kudzivirira atrial fibrillation sitiroko, pulmonary embolisms, kana coronary stent clots, kusanganisira ** apixaban (Eliquis) , ** rivaroxaban (Xarelto) , ** dabigatran * (Pravaxaedsay) * dabigatran * (Pravaxaedsay) * dabigatran (Pravaxaedsay) * apixaban (Eliquis) ** ** warfarin (Coumadin) **, ** clopidogrel (Plavix) **, ** ticagrelor (Brilinta) **, uye zuva nezuva ** aspirin **. Kana munhu mukuru ari pamupi wemishonga iyi anotsvedza paragi, anodonha otyoka hudyu, kana kungorovera musoro pagonhi rekabhati remukicheni rakashama kana padhoo remota, mhuri inowanzofemera pamusoro kana mukuru akasafenda, asina kubuda ropa romusoro, uye anoita zvinhu zvakakwana manheru ose. Iyo yenhema pfungwa yekuchengetedzeka ndiyo imwe yemisungo yakaipisisa mumushonga we geriatric emergency.

Mumunhu mukuru anotora zvinoderedza ropa, kubuda ropa mukati kunotevera nguva mbiri dzakasiyana, dzinoisa upenyu panjodzi: acute kana kunonoka kushungurudza intracranial hemorrhage* mukati memaawa matanhatu kusvika makumi mana nemasere ekutanga, KANA kuyerera zvishoma nezvishoma Chronic Subdural Hematoma (cSDH) iyo inokura chinyararire kwemavhiki maviri**** bundu remusoro kana pasi-level kudonha kudzamara yadzvanya uropi uye kutevedzera sitiroko kana kukurumidza dementia. Kana munhu mukuru pazvicherwa zveropa achirwara nekurohwa nemusoro kana kudonha, kana kutanga kuvhiringika kutsva, kukotsira, kutemwa nemusoro, kutaura kwakashata, kana gumbo rimwe divi mazuva kana mavhiki mushure mekudonha, fonera nhamba yako yekukurumidzira.911 muUnited States neCanada, 112 muEuropean Union, 999 muUnited Kingdom; maona nhamba dze emergency) pakarepo. Nezvekukurumidzira kwakabatana, ona vakwegura vanodonha kupora kana vasingakwanisi kumira, kukuvara mumusoro,uye polypharmacy, kuwandisa kwemishonga, kupotsa doses, uye zvikanganiso zvemurongi wemapiritsi.

Ita izvi ikozvino¶

1. Enda kuchipatara chiri pedyo neDhipatimendi reEmergency Dhipatimendi reHead CT Scan nguva dzose apo mukuru anotora anticoagulant kana antiplatelet drug akarova musoro wavo, kunyange vasina kumbobvira vasviba uye vanonzwa 100 muzana zvakajairwa. Clinical trauma guidelines (ACEP, NICE NG232, uye ACTS TQIP) inorayira murwere kuti aongorore musoro wekukurumidzira zvisinei nekuti bundu rakaonekwa sei idiki kana kuti yakajairika sei yavo Glasgow Coma Scale mamaki.
2. *Bata chirongwa chinotevera chakarongwa cheEliquis, Xarelto, Pradaxa, warfarin, kana Plavix kusvikira chiremba weEmergency Department aongorora Head CT scan. * Usambofa wapa manheru kana mangwanani mapiritsi anoderedza ropa pakarepo mushure mekudonha kana kurova musoro kusati kwabuda ropa rave rakagadziriswa neCT imaging. Uya nemabhodhoro emapiritsi chaiwo kuER uye uudze mukoti wechitatu ** nguva chaiyo yewachi ** iyo yekupedzisira dose yakamedzwa.
3. Usambofa wakapa aspirin, ibuprofen (Advil/Motrin), naproxen (Aleve), kana Goody's/BC Powder nokuda kwekurwadziwa kwemusoro mushure mekudonha kana kurwadza kwehudyu. Non-steroidal anti-inflammatory drugs (NSAIDs) uye aspirin inodzima maplatelet eropa uye kuwedzera kukurumidza kwekubuda ropa mucranial kunouraya mumunhu ane anticoagulated.
4. ** Fungidzira "Delayed Chronic Subdural Hematoma" kana mukuru achiita hutsva husina kusimba kufamba, kushaya simba kwegumbo, kurara kwemasikati, kuchinja kweunhu, kana kusuruvara kwemusoro 1 kusvika kumavhiki e6 mushure mokunge CHESE kuwa. venous inoyerera munzvimbo yepasi inogona kutora mazuva gumi nemana kusvika makumi mana nemaviri kudzvanya uropi. Dana ** dzokorora isiri-kusiyanisa Musoro CT scan ** nekukurumidza.
5. ** Kana mukuru akadonha uye asingakwanisi kutakura uremu pagumbo rimwe, kana tsoka imwe yakatendeudzirwa kunze (yakatenderedzwa kunze) uye ichiita ipfupi pane imwe, vachengete vachiri pasi uye ufonere. 911 (112 kana 999) kune anofungidzirwa kuti Hip Fracture.** Usambofa wakasimudza munhu mukuru ane chirwere chehudyu akatyoka pachigaro kana chigaro chemumotokari: mutsipa wefemoral wakakombama kana kuti zvimedu zvebhonzo zve intertrochanteric zvinogona kukuvadza tsinga dzeropa uye kubuda ropa 1 kusvika ku1.5 litres eropa mukati mechidya kana rikafambiswa zvisina kunaka.
6. Taurira ER triage desk nekukasika kuti murwere ari paAnticoagulant saka vanotanga "Code Trauma / Anticoagulated Head Strike" protocol. Taura zita chairo remushonga kuitira kuti pharmacy yechipatara igadzirire chaiyo intravenous reversal agent (yakadai seAndexxa / 4-Factor PCC yePraxax, PXarax yePraxas, PXara kana Eliquinds, PXara kana Eliquind Vitamin K + Kcentra yewarfarin) kana CT scan ichiratidza kubuda ropa muuropi.

Muti wesarudzo: Kutevedzwa kwevakuru vane anticoagulated mushure mekudonha kana musoro¶

flowchart TD
    A["Vakuru Vakuru paRopa Vatete (Eliquis, Xarelto, Warfarin, Plavix) Anotambura Kudonha kana Musoro Bump."] --> B{"Kudonha kwakaitika NHASI (Acute Phase) kana MAZUVA/VHIKI AKAPFUURA (Delayed Phase)?"}
    B -->|"Zvaitika Nhasi / Mukati 48 Maawa"| C{"Chero Red Flag Signs: Kurasikirwa nekuziva, kurutsa, musoro wakakomba, kuvhiringidzika, vadzidzi vasina kuenzana, kana kuremara kwehudyu?"}
    C -->|"Hongu: Red Flags Present"| D["Fonera 911 / 112/999 Pakarepo: Ramba wakanyarara, bata rinotevera-rinoonda ropa dosi, gadzirira ER Head CT + Reversal Agent."]
    C -->|"Kwete: Inotaridzika 100% yakajairika, zero zviratidzo"| E["ZVICHIRI KUENDA KUCHIPATARA ER NHASI for Mandatory Baseline Non-Contrast Head CT Scan"]
    E --> F{"Chii chinoratidzirwa neYekutanga ER Musoro CT?"}
    F -->|"Positive for Acute Bleed"| G["Pakarepo ICU Neurosurgical Consult + IV Anticoagulant Reversal (Andexxa / Kcentra / Praxbind)"]
    F -->|"Negative (Clear Initial CT)"| H["Monitor ye6-Vhiki Yakanonoka Kunonoka Subdural Window: Tarisa kune gait drift, kurara, kana kunyongana kutsva."]
    B -->|"Zvakaitika Mazuva matatu kusvika Masvondo matanhatu Apfuura"| I{"Mukuru ari kuratidza ITSVA yakavanzika gait kusagadzikana, kurara, kushanduka-shanduka kuvhiringidzika, kutaura kusinganzwisisike, kana kutemwa nemusoro?"}
    I -->|"Ehe: Kunyangwe kana Yekutanga CT Mavhiki Apfuura Aive Akajeka"| J["Enda kuChipatara ER Pakarepo uye Ude Kudzokorora Kusina Kusiyanisa Musoro CT Kutonga Kunze Chisingaperi Subdural Hematoma"]
    I -->|"Hapana zviratidzo"| K["Ramba uchiita maitiro ekudzivirira-kudonha uye vhiki nevhiki neurological cheki kuburikidza neSvondo 6"]

Chikamu 1 (Maawa 0 kusvika 48): Acute uropi hwekubuda ropa njodzi uye emergency anticoagulant reversal¶

Kana munhu mukuru anotora mishonga yeropa akarova musoro nhasi, vanachiremba vanokurumidza kunetseka kutanga nezve ** acute subdural hematoma **, ** subarachnoid hemorrhage **, kana ** intraparenchymal contusion **. Muzvidzidzo zvekiriniki zvevakwegura vane anticoagulated vanouya kudhipatimendi rekukurumidzira vakasvinura neGlasgow Coma Scale yakakwana yegumi nemashanu (kutaura zvakajairika, zero focal weakness, zero amnesia) mushure mekudonha kwepasi, ** 6 kusvika 10 muzana yatova nekushanda kweropa intracranial hemorrhage inoonekwa paMusoro CT **, uye imwe inononoka 2.5 uye 6. 24 maawa gare gare **.

Kuenzanisa zvinoderedza ropa, njodzi dzekubuda ropa, uye mishonga yekukurumidzira yekudzosera chipatara¶

Nguva dzose unza runyoro rwemishonga yevakuru kana mabhodhoro emapiritsi kuDhipatimendi reEmergency. Iyo chaiyo kirasi yeropa rakatetepa rinoraira kuti chipatara chinomisa sei huropi hunotyisidzira kubuda ropa kana kugadzirira murwere kune emergency hip-fracture kana burr-hole kuvhiyiwa:

Chikamu 2 (Mazuva 3 kusvika Vhiki 6): Kuziva Yakanonoka Chronic Subdural Hematoma (cSDH)¶

Kunyangwe kana munhu mukuru aenda kuER pazuva rekudonha, anowana isina-contrast Head CT scan, oudzwa kuti "Nhau dzakanaka, CT scan yakajairika, unogona kuenda kumba," **ngozi HAIPERI **.

Kutaura zvazviri, kusvika ku ** 25 kusvika ku35 muzana yevakuru vakaonekwa kuti vane Chronic Subdural Hematoma hombe ** vangave vaine ** yakajairika yekutanga Head CT scan ** pazuva rekudonha kwavo kana vasingatomboyeuke kurova musoro wavo nekuti bumpu rekutanga (kana kamwe kamwe whiplash jar kubva pakugumburwa) raive diki.

1. Iyo 3-nhanho pathophysiology ye4-vhiki inononoka uropi kubuda ropa¶

Huropi hunogona sei kubuda ropa mavhiki matatu kusvika mashanu mushure me yakajairika CT scan?

flowchart TD
    A["Zuva 1: Musoro Mudiki Bump kana Kudonha paHip / Buttocks (Whiplash Acceleration)"] --> B["Micro-Kubvarura muTaut Bridging Vein Kuyambuka Atrophied Subdural Space"]
    B --> C["Mazuva 1 kusvika 5: Tiny Venous Ooze (Yakanyanya kutetepa kuti uone paZuva-1 CT kana kumira zvishoma)"]
    C --> D["Mazuva 7 kusvika 21: Fibrin Clot Inoputsika muYakanyura Protein Liquid + Inflammatory Neomembrane Forms Around Collection."]
    D --> E["Vhiki 2 kusvika ku6: Fragile Leaky Capillaries muNeomembrane Micro-Bleed Zvichienderera (Inofambiswa neAnticoagulants & Osmotic Fluid Dhonza)"]
    E --> F["Misa Yakakosha Yakasvika (80 kusvika 150 mL): Brain Midline Shifts -> Sudden Gait Drift, Kurara, Kuvhiringika, kana Stroke-Sekuneta"]

1. Danho 1 - The Silent Micro-Tear (Mazuva 1 kusvika 5): Kabundu kadiki kana kuerekana kudzungudza musoro kunobvarura katsinga kadiki. Muhuropi hwechikuru hune rupo subdural space, firimu rakatetepa reropa retsinga rinoyerera richitevedza kutenderera kwehuropi.
2. ** Nhanho 2 - Membrane Encapsulation uye Liquefaction (Mazuva 7 kusvika 21):** Mumavhiki echipiri neretatu, muviri unoedza kuvhara ropa rekare nekukura ganda rakatetepa revascular (**neomembrane **) rakaripoteredza, nepo ma enzymes anonyungudutsa ropa rakagwamba rakasviba kuita gobvu, motor-oil-like ma chronic / hematohygroma fluid (*) .
3. Danho rechitatu - Kuramba Kuchibuda ropa reCapillary (Vhiki 2 kusvika ku6): Neomembrane ichangobva kuumbwa yakazara ne-ultra-fragile, leaky microscopic capillaries. Nekuda kwekuti mukuru ari kutora Eliquis, Xarelto, warfarin, kana Plavix, macapillaries aya anobvinza anoramba achibuda ropa dzvuku idzva mugomba zuva nezuva. Kwemavhiki matatu ekutanga, huropi hwakanyunguduka hunogadzika saga rinokura pasina kurwadziwa. Zvadaro, paZuva 21 kana Zuva 35, sac inosvika ** 80 kusvika 150 milliliters , inopedza nzvimbo yose yakasara mukati medehenya, uye inosundira uropi kumativi ( midline shift **).

2. Iyo "Great Neurological Imitator": 6 zviratidzo zvisinganzwisisiki zveChronic Subdural Hematoma¶

Neurologists vanodana Chronic Subdural Hematoma "Mutevedzeri Mukuru" nokuti haawanzokonzera kuparara kunoshamisa kweHollywood pakutanga. Pane kudaro, nhengo dzemhuri uye vanachiremba vekutanga vanowanzozvifungira zvisirizvo se ** "kuwedzera kweAlzheimer," "kuora mwoyo," "kukwegura," kana "mini-stroke." **

Tarisa uone idzi 6 zviratidzo zvekunyevera zvekare ** chero kupi pakati pe ** mazuva matatu nemavhiki matanhatu mushure mekudonha kana kuputika:

1. Itsva "Gait Drift" kana Kugumburwa Kusingatsananguriki (Kazhinji chiratidzo #1 Chekutanga):
2. Mukuru anotanga kutsveyamira zvishoma kune rimwe divi pasi pemukoto, achikwenya tsoka, kubata zvigunwe zvavo, kana kuda kubatirira pamadziro kuti afambe achienda kuchimbuzi. Nekuti subdural hematoma inogara pamusoro pemutsetse wemota weuropi (unodzora gumbo nehunde), apraxia yegumbo risinganzwisisike uye kurasikirwa kwechiyero kunowanzoonekwa mazuva ruoko rusati rwapera simba kana shanduko yekutaura.
3. ** Kuchinja Kurara Kwemasikati uye "Nguva Yakanaka / Yakaipa Nguva" Lethargy: **
4. Na 09:00 mukuru anoita seanopenya uye ari kutaura, asi na13:00 vanenge vachigutsurira pachigaro chavo panguva yekukurukurirana, zvakaoma kuti varambe vakamuka, kana kutarisa vasina chinhu. Fluctuating alertness mucherechedzo wekukwira kwe intracranial pressure kubva ku liquid subdural collection.
5. Subacute Personality Shanduko, Kusava nehanya, kana "Rapid-Onset Dementia":
6. Hosha yechokwadi yeAlzheimer inoenderera mberi nemakore, isingambopfuuri mavhiki maviri. Kana mukuru aikwanisa kuzvipfekedza, oshandisa terevhizheni iri kure, uye obata nhaurirano yakajairwa mavhiki matatu apfuura akangoerekana avhiringika, kushatirwa, kusava nehanya, kana kusaita weti svondo rino, anofungidzira ** Chronic Subdural Hematoma ** (kana chinyararire utachiona; ona kuvhiringidzika kamwe kamwe muvakuru: UTI yakanyarara, urosepsis vs. stroke)
7. Musoro wakapfava, wakadzikama, Unoramba Uchirwadza (Kana Kubata Huma/Kukwesha muVakuru Vasingataure):
8. Inenge 50 muzana yevakwegura vane chirwere chisingaperi che hematoma vanorondedzera kusuruvara, kurwadza kwemusoro kunowedzera kana wakarara pasi kana kukosora, asi imwe 50 muzana ine ** zero headache ** nokuti brain atrophy blunts dural stretch receptors.
9. ** Hunyoro-Kune Rutivi Husina Kusimba (Hemiparesis) kana Pronator Drift: **
10. Kumbira mukuru kuti abate maoko ose ari maviri pamberi pavo nemichindwe yakatarisa kumusoro kwemasekondi gumi nemaziso avo akavharwa: kana ruoko rumwe ruchidzokera mukati zvishoma nezvishoma uye ruchidzika pasi (** pronator drift **), kana kuti kana vakatanga kudonhedza kapu yavo yekofi kana kukwevera imwe slipper, enda kuna ER pakarepo.
11. Kumbomira-Kutsvaga Mazwi, Matauriro Asinganzwisisike, kana Kubata Kwakananga:
12. Kana hematoma ikatsikirira kuruboshwe hemisphere mutauro cortex, mukuru anogona kunetseka kuwana mashoko akajairika, slur syllables, kana ruzivo pfupi rhythmic twitching ruoko rumwe kana kona yemuromo.

Chiitiko 2: Anticoagulated Hip Fracture vs. Pelvic Kutyoka mushure mekudonha kwevakuru¶

Kana munhu akura ari pazvicherwa ropa achidonha, musoro hausi iwo wega unotyisa hupenyu hwekubuda ropa. A kutyoka kwehudyu (kutyoka kwefemu) kana kutyoka mhete yepelvic mumunhu mukuru ane anticoagulated is orthopedic and hemodynamic emergency:

1. Ziva Zviratidzo Zvechinyakare zveHip Kutyoka Pauriri:
2. Gumbo rakapfupikiswa uye rakatenderedzwa Nekunze: Tarisa tsoka dzese dzevakuru padzakarara nemanhede: kana tsoka imwe yakapepetwa ichienda pasi ne45- kusvika 90-degree angle uye gumbo iro rinotarisa 2 kusvika 5 centimeters (1 kusvika 2 inches) kupfupika pane rimwe gumbo, iyo femoral fracture yehudyu.
3. Groin kana Anterior Chidya Marwadzo pane Chero Hip Rotation: Kunyange ne "yakakanganiswa" kana hairline kutsemuka kwehudyu uko tsoka inotarisa yakatwasuka, mukuru achanzwa kurwadziwa kwakanyanya kwakadzika mukati meiyo groin crease pavanenge vachiedza kusimudza chitsitsinho chavo kubva pasi kana kutakura uremu.
4. Occult Hip kana Pubic Ramus Fracture (Apo Yekutanga X-Ray Yakajairika): Kusvika ku5 kusvika ku10 muzana ye osteoporotic vakwegura vanowira uye vasingakwanisi kutakura uremu pamakumbo avo pasina kurwadziwa kwegoro, iyo yekutanga flat flat hudyu X-ray muER inoratidzika seyakajairika nokuti mutsara wekuputsika hausi-displaced femo (**ock). Kana mukuru asingakwanisi kufamba mushure mekudonha pasinei nehudyu yakaipa X-ray, mirayiridzo yekliniki inoda ** emergency Hip MRI kana CT scan ** vasati vavabvumira kuedza kutakura uremu.
5. Njodzi Yakavanzika Yemukati Yekubuda Ropa paVanoteta Ropa:
6. Iyo femur uye pelvis ine hombe yevascular ropa. An intertrochanteric hip fracture kana pubic ramus kana sacral pelvic fracture mumurwere anotora Eliquis, Xarelto, kana warfarin inogona kubuda ropa ** 1,000 kusvika 2,000 milliliters (2 kusvika 4 pints) yeropa ** chinyararire mumakamuri akadzika echidya kana kuti ganda retropovolemic rinooneka ** retropovolemic ganda rinooneka. kuvhunduka** (ganda rakacheneruka, kukurumidza kupera simba, dzungu, kudonha kweBP).
7. Nei Kugadziriswa Kwekutanga Kuvhiya Mukati Ma24 kusvika 48 Maawa Kunoponesa Upenyu:
8. Clinical orthopedic guidelines (AAOS uye NICE CG124) inoratidza kuti kugadzirisa kutsemuka kwehudyu vakwegura mukati ** 24 kusvika maawa 48 ekusvika kuchipatara ** kunoderedza kufa kwemazuva makumi matatu, kuuraya pulmonary embolism, pneumonia, uye delirium muhafu.
9. Nekuenda kuER nekukasira uye **uchibata dhigirii rinotevera reropa rakatetepa **, zvikwata zveanesthesia uye orthopaedic trauma zvinogona kuyera mazinga ezvinodhaka, kutonga zvakanangwa reversal kana nguva 24-awa DOAC washout hwindo, uye kuvhiya zvakachengeteka pasina kunonoka.

Zvekuita uchimirira pasi kune ambulensi (911 / 112 / 999)¶

Kana mukuru ane anticoagulated akawira pane yakaoma tile kana huni pasi uye iwe unofungidzira kurohwa kwemusoro kana kutsemuka kwehudyu:

• ** Chengetedza mukuru akarara akarara kana kuti panzvimbo chaiyo yawanikwa:** Usambovasimudza nemaoko avo uye usambovabvumira kuedza "kufamba nayo" kuenda kuimba yekurara. Kudhonza munhu mukuru akamira akamira akamira mushure mekudonha kunogona kushandura kutsemuka kwemutsipa wemukadzi (kushandura nyore 3-screw pin kugadzirisa mune yakazara hudyu inotsiva) kana kukonzeresa kudzima kwesyncopal kana kubuda kwemukati kwakaderedza BP yavo.
• Dzora chero kuchekwa kweganda remusoro kunoonekwa nekumanikidza kwakasimba kwakananga: Musoro wemusoro ndechimwe chetsinga dzetsinga dzakanyanya mumuviri wemunhu, uye 3-centimita (1.2-inch) ganda remusoro rakatsemurwa paEliquis kana warfarin rinogona kubuda ropa 500 milliliters eropa pasi mumaminetsi gumi nemashanu. Peta tauro rekugezesa rakachena kana kuti gauze gauze padhi muskweya gobvu woidzvanya ** zvakasimba uye uchienderera mberi** yakananga pasi paronda remumusoro riri kubuda ropa (kunze kwekunge uchinzwa dehenya rakapfava, rakapfava, rakapfava nechepasi, ipapo shandisa ring-pedding pressure yakapfava kumucheto).
• Kudzivirira pasi hypothermia (Rhabdomyolysis uye Coagulopathy Dziviriro): Kutonhora kwemuviri wekushisa (hypothermia iri pasi pe35 degrees Celsius / 95 degrees Fahrenheit) inoremadza maenzayimu anovhara ropa (the lethal triad of trauma coagulopathy), zvichiita kuti mishonga yeropa iwedzere kuva nengozi. Pfekedza magumbeze anodziya uchitenderedza nepasi pemapendekete emukuru uye torso pasina kutenderedza hudyu yavo yakatyoka, uye simudza thermostat yemukamuri apo vabatsiri vari munzira.

Nhamba dzenharaunda dzechimbichimbi uye zvirongwa zveagency¶

Shandisa idzi nhamba dzekukurumidzira uye yenyika kliniki trauma protocol kana munhu mukuru pane vatete ropa achidonha kana kurova musoro:

• United States neCanada:
• Emergency Ambulance & Trauma Triage: Call 911. Pasi pe **CDC Field Triage Guidelines yeVarwere Vakakuvara **, vakuru vakuru (\(\ge\)65 years) vanotora anticoagulants nemusoro kana kufungidzirwa kutyoka kwehudyu vanosangana nepamusoro-soro yenjodzi triage maitiro ekuendeswa kuchipatara ne 24/7 CT imaging uye neurosurgical/orthopedic capability.
• **Anticoagulation Reversal Guidance: ** Madhipatimendi eEmergency anotevera ** American College of Emergency Physicians (ACEP) Clinical Policy paMild Traumatic Brain Injury ** uye ** American Heart Association (AHA) / Neurocritical Care Society Guidelines for Reversal of Antithrombotics in Intracranial Hemorrhage **.
• United Kingdom:
• Emergency: Call 999 (kana 111 chete kana usina chokwadi zvachose nezve diki-diki isiri-musoro scrape; ** chero kukuvadzwa kwemusoro kune vanyoro veropa kunoda kuongororwa kweDhipatimendi reEmergency **).
• ** NICE Clinical Mandate (NG232): ** Pasi pe ** National Institute for Health and Care Excellence (NICE) Guideline NG232 (* Kukuvadzwa kwemusoro: kuongorora uye kutungamira kwekutanga *) **, chero murwere ane anticoagulant kurapwa (warfarin kana DOACs) kana antiplatelet kurapwa (kunze kweAspirin aspirin yemaawa emumusoro) inochengetedza kukuvara kwemusoro * CT inogamuchira kukuvara kwe8 mumusoro. (kana ** mukati meawa 1 ** kana chero chiratidzo chetsinga chiripo), kunyangwe ne zero kurasikirwa nekuziva uye zero amnesia.
• European Union:
• Emergency: Call 112. European trauma centers inotevera ** Scandinavian Neurotrauma Committee (SNC) ** uye ** European Stroke Organization (ESO) ** mirayiridzo inorayira pakarepo musoro CT imaging uye PCC/Andexanet/Idarucizumab reversal for anticoagulated head trauma.
• Australia neNew Zealand:
• Emergency: Call 000 muAustralia kana 111 muNew Zealand. Pasi pe **Australian & New Zealand Guideline yeMild to Moderate Head Injuries (PREDICT) ** uye **NSW / Queensland Health Adult Trauma Guidelines **, vose vakwegura vakwegura pa anticoagulants kana clopidogrel / ticagrelor vanoda zvinosungirwa ED kutarisa uye musoro CT imaging mushure mekurova chero musoro.
• India neAsia-Pacific:
• Emergency: Call 112 (kana 108 ambulensi) muIndia; kutakura zvakananga kuchipatara chepamusoro chine 24-awa CT scanner uye neurosurgery unit.

6-Vhiki mushure mekudonha kwemba yekutarisa yekutarisa kune vanochengeta¶

Kana mubereki wako ari pazvinoderedza ropa akacheneswa muDhipatimendi reEmergency neDay-1 Head CT scan uye akatumirwa kumba, pirinda kana chengeta iyi 6-Vhiki Yakanonoka Subdural Watch Checklist:

• 1. Nyora Zuva Rekudonha Pakarenda yeFiriji uye Maka "Vhiki 2, Vhiki 4, uye Svondo 6": Mhuri zhinji dzinokanganwa kuwa kudiki mushure memazuva matatu. Kumaka hwindo remavhiki matanhatu pakarenda kunoita kuti kana mubereki wako atange kuita akarara kana kusagadzikana mwedzi kubva ikozvino, unobva wabatanidza chiratidzo nekudonha uye taurira ER chiremba.
• 2. Ita "30-Second Morning Walk & Hand-Drift Check" Mazuva Ose: Tarisa mafambiro anoita mubereki wako kutafura yemangwanani mangwanani ega ega (achitarisa chero mutsva wepadivi kana kukweva tsoka) uye tarisa kana vachishandisa maoko ese ari maviri akaenzana.
• 3. Bvunza Anonyorera Cardiologist kana Chiremba wePrimary Care Usati Watangazve Vatete Veropa Mushure mekubuda ropa: Kana chero kudiki kudiki kubuda ropa kwakaonekwa, usambotangazve Eliquis, Xarelto, warfarin, kana aspirin kusvika neurosurgery necardiology yabvumirana pazuva chairo rekutanga zvichibva pakudzokorora kugadzikana kweCT.
• 4. Ongorora All Over-the-Counter Pain Relievers and Supplements: Bvisa zvese ibuprofen, naproxen, aspirin, ginkgo biloba, mafuta ehove ane dozi yakawanda, uye macapsules evhitamini E kubva kumurongi wemapiritsi, sezvo anowedzera njodzi yekubuda ropa pamwe chete nemishonga inodzivirira kubuda ropa. Shandisa ** acetaminophen / paracetamol (Tylenol) ** mukati memiganhu yakachengeteka yechiropa-dose (kazhinji $ le $ 2,000 kusvika 3,000 mg / zuva muvakuru vakwegura) kana yakabvumirwa nachiremba wavo nokuda kwekukuvadzwa kwemashure.
• 5. Bvisa Njodzi Yekudonha Kwenzvimbo Nhasi: Simudza maragi ekukanda akaregedzeka, tambo dzemagetsi, isa marambi ehusiku munzira yekurara-kuenda-yekugezera, uye ratidza kuti BP haidzike kana akamira (orthostatic hypotension).

Mibvunzo inowanzo bvunzwa¶

Mubereki wangu anoda chaizvo kuenda kuEmergency Room yeHead CT scan kana vakarovera musoro wavo paEliquis kana warfarin asi vachinzwa zvakanaka?¶

Hongu, nguva dzose. Mirayiridzo yemishonga yekukurumidzira yekiriniki muUnited States, UK (NICE NG232), Canada, neAustralia inorayira isiri-yakasiyana Head CT scan kune chero akura anotora anticoagulant (Eliquis, Xarelto, Pradaxa, warfarin) kana yakasimba antiplatelet (Plavix, Brilinta) inorova misoro yavo, kunyangwe kana vasina kurasikirwa nezviratidzo zvezero. Zvidzidzo zvinoratidza kuti 6 kusvika 10 muzana yevakwegura vane anticoagulated vanotarisa uye vanotaura zvakakwana zvachose mushure mekurova kwemusoro mudiki vatove nehuropi hunoshanda hunobuda ropa hunoonekwa paCT.

Huropi hunogona sei kubuda ropa mavhiki mana mushure mekudonha kana iyo ER Head CT scan pazuva rekudonha yaive yakajairika?¶

Zuva-1 Musoro CT scan inongotonga kunze kwekukurumidza, kwepamusoro-kudzvinyirira kubuda ropa pazuva rekukuvara. Muvakuru vakuru, huropi hwepanyama shrinkage hunotambanudza tsinga dzisina kusimba dzekuvhara dzichiyambuka nzvimbo yepasi. Kuputika kudiki kana kudonha kunogona kukonzera kubvaruka kusingaonekwi mune imwe yeiyi tsinga dzepasi-pasi; kwemavhiki maviri kusvika ku6, muviri unoumba tsinga yetsinga yakatetepa yakatenderedza kuunganidzwa kwemvura diki, uye macapillaries ari mukati me membrane anoramba achibuda ropa pasi pesimba reropa rakatetepa kusvikira chisingaperi subdural hematoma yakura zvakakwana kumanikidza uropi.

Ko mukuru anogona kugadzira Subdural Hematoma kubva pakudonha kwavakamhara pamagaro kana muhudyu vasina kunyatsorova musoro pasi?¶

Ehe. Neurosurgeons vanowanzobata Chronic Subdural Hematomas mune anticoagulated vakuru vakuru vane misoro isina kumbobata pasi. Kana mukuru anotsvedza uye akadzika zvakaoma pamuswe wavo, muhudyu, kana kumashure, kukurumidza kuderera kwechisimba kunoita kuti uropi husambe kuseri kwedehenya kwesekondi yakakamukana (inertial whiplash shearing force), iyo inopfuura zvakakwana kubvuta taut, zera-yakatambanudzwa bridging tsinga munzvimbo yepasi.

Ndinofanira kupa mubereki wangu dosi ravo remanheru reEliquis, Xarelto, kana warfarin vachangobva kudonha nekurovera misoro yavo?¶

Kwete. Kana munhu akura ane ropa rakapfava achitambura nekurohwa nemusoro kana kudonha kwakanyanya, bata dhigirii inotevera yakarongwa yemishonga yavo yeanticoagulant kana antiplatelet kusvikira vaongororwa muDhipatimendi reEmergency uye Head CT scan yakaratidza kubuda ropa kwemukati. Kumedza imwe dhamu yeropa rakatetepa apo tsinga inovhara ichiita kubuda mukati medehenya kunomhanyisa kubuda kweropa uye kuita kuti kuchinjika kwechipatara kuome zvakanyanya.

Ndinoudza sei mutsauko pakati peChronic Subdural Hematoma uye kufambira mberi kwakajairwa kwedementia?¶

Neurodegenerative dementias senge chirwere cheAlzheimer chinofambira mberi zvishoma nezvishoma nemwedzi nemakore, nepo Chronic Subdural Hematoma inokonzera subacute danho-pasi mukushanda kwemazuva kusvika kumavhiki mashoma. Kana mukuru akatanga kufamba kutsva kusina kusimba, kufamba-famba mumativi, kurara kwemasikati (kugutsurira kubva pakati pemutsara), kusagadzikana kutsva kweweti, kana kushaya simba kweruwoko rwedivi rimwe kana gumbo mukati mevhiki 1 kusvika ku6, usambopa mhosva pane yekutanga dementia kutozosvikira isina-kusiyanisa Head CT scan yatonga subhematoma.

Ndeupi mushonga wemarwadzo wakachengeteka kupa munhu mukuru wevanhu vanoderedza ropa ari kurwadziwa mushure mekudonha kuduku (kana uropi hunobuda ropa)?¶

Pane imwe nguva chiremba abvisa mukuru wehuropi kubuda ropa kana kuputsika, plain acetaminophen (paracetamol / Tylenol) inowanzova yakachengeteka kupfuura-the-counter pain reliever kune varwere vane anticoagulants (kugara pasi pe2,000 kusvika ku3,000 milligrams pamaawa 24 muvakuru vakuru vane chiropa chemazuva ose). Usambofa wakapa aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), meloxicam, diclofenac, kana bismuth subsalicylate (Pepto-Bismol), sezvo mishonga iyi inokanganisa kugwamba kweplatelet uye ichikonzera kubuda ropa kwakanyanya kwemudumbu uye intracranial kana yasanganiswa neropa.

Mazano anoenderana¶

• Vakwegura vanodonha kupora kana vasingakwanisi kumira
• Kukuvara mumusoro uye concussion first aid
• Kuvhiringidzika kamwe kamwe muvakuru: UTI yakanyarara, urosepsis vs. stroke
• Polypharmacy, kuwandisa kwemishonga, kupotsa dosi, uye zvikanganiso zvemurongi wemapiritsi

Nzvimbo uye nhungamiro yepamutemo¶

• American College of Emergency Physicians (ACEP): *Clinical Policy: Matambudziko Akakosha Mukutungamira kweVarwere Vakuru Vanopa kuDhipatimendi Rechimbichimbi NeMild Traumatic Brain Injury (Anticoagulation uye Antiplatelet Mandatory CT Criteria) *.
• National Institute for Health and Care Excellence (NICE, United Kingdom): * Nhungamiro NG232: Kukuvadza Musoro: Kuongorora uye Kutungamirirwa Kwekutanga (Anticoagulant uye Antiplatelet Head CT Timelines) *.
• American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP): *Best Practices Guidelines muGeriatric Trauma Management uye Anticoagulation Reversal *.
• Neurocritical Care Society uye Society of Critical Care Medicine (SCCM): *Nhungamiro yeReversal yeAntithrombotics muIntracranial Hemorrhage (Andexanet Alfa, Idarucizumab, uye 4-Factor PCC Protocols) *.
• National Institute on Aging (NIA) uye Centers for Disease Control and Prevention (CDC): * STEADI (Kumisa Tsaona Dzakwegura, Rufu & Kukuvara) Vakuru Vakwegura Vanowira uye Kushungurudza Brain Injury Prevention *.