DOMATES Doğu Marmara Acil Tıp Seminerlerinin 29.11.2014 tarihli toplantısı sunumudur. Evsahibi: Marmara Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı marmaraaciltip.org domatesli.wordpress.com acilci.net

1. Minör Kafa Travması
Yatış ?
İzlem?
Taburculuk?
Doç Dr Özlem GÜNEYSEL
Dr Lütfi Kırdar Kartal EAH
Acil Tıp Kliniği

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GKS

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4. GKS
14-15 : Mild
9-13 : Moderate
3- 8 : Severe
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5. Minör Kafa
Travması
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7. The following patients should have a head CT performed:
• Patients with loss of consciousness or
posttraumatic amnesia AND:
• Headache OR
• Vomiting OR
• Age>60 OR
• Drug/alcohol intoxication OR
• Short-term memory deficits OR
• Evidence of trauma above the clavicles
OR
• Posttraumatic seizure OR
• GCS<15 OR
• Focal neurological deficit OR
• ^Coagulopathy
Patients without loss of consciousness or
posttraumatic amnesia AND
• Severe headache OR
• Vomiting OR
• Age>65 OR
• GCS<15 OR
• Physical signs of a basilar skull fracture OR
• Focal neurological deficit OR
• ^Coagulopathy OR
• ^^Dangerous Mechanism
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8. • Retrospektif
• 3338 CT çekilen
• Warfarin kullanan 82
hasta
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11. [Ann Emerg Med 2012;59:451-455.]
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16. How Long Should Patients Be Observed?
EFNS guidelines: they suggest hospital admission and an observation of greater than or equal
to 24 hours.
How Best to Manage Warfarin Around the Time of Injury?
In our opinion, there are 3 possibilities:
(1) the anticoagulation therapy should be stopped in all these patients, with
particular attention to patients with a mechanical heart valve, atrial fibrillation,
or venous thromboembolism at high risk for thromboembolism;
(2) the anticoagulation therapy should be withdrawn only if patients show
neurologic deterioration; and
(3) the anticoagulation therapy should be reversed on account of a markedly
elevated international normalized ratio.
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18. Children
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20. Prospektif, gözlemsel
Nisan 2009- Ocak 2011
Hastalar 2 hf izlenmiş
Erken dönem İKKanama prevalansı ve gecikmiş (ilk BT sonrası 2 hf)
İKKanama kümülatif insidansı hesaplanmış
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21. 768 Warfarin ve 296 Klopidogrel kullanan
Her iki grupta da Aspirin (Klop > War)
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27. Sonuç:
• Bilinç Kaybı, amnezi veya GKS intrakraniyal
kanaması olmayanlarda belirleyici değildir;
• INR yükseldikçe (>3), risk artar;
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29. Minör Kafa
Travması
Antikoagülan /
Antiagregan
BT
Risk Faktörü
+ -
Yatış / 24 s izlem
Kontrol BT
Taburcu
-
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