Minör Kafa Travması

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Doç Dr Özlem GÜNEYSELDr Lütfi Kırdar Kartal EAH

Acil Tıp Kliniği

2

GKS

3

GKS

14-15 : Mild

9-13 : Moderate

3- 8 : Severe

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Minör Kafa

Travması

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• 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

The following patients should have a head CT performed:

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• Retrospektif

• 3338 CT çekilen

• Warfarin kullanan 82

hasta

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[Ann Emerg Med 2012;59:451-455.]

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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(2) the anticoagulation therapy should be withdrawn only if patients show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.16

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Children

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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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768 Warfarin ve 296 Klopidogrel kullanan

Her iki grupta da Aspirin (Klop > War)

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Sonuç:

• Bilinç Kaybı, amnezi veya GKS intrakraniyal

kanaması olmayanlarda belirleyici değildir;

• INR yükseldikçe (>3), risk artar;

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Minör Kafa

Travması

Antikoagülan /

Antiagregan

BT

Risk Faktörü

+ -

Yatış / 24 s izlem

Kontrol BT

Taburcu

-

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