Kafa travmalı hastalarda hastane öncesi yaklaşım ve acil serviste yönetim

Amaç: Kafa travması gelişmiş ülkelerde 45 yaş üstü mortalite ve morbiditenin en önemli nedenlerinden birisidir. Trafik kazalarına bağlı ölümlerin % 75’inde ve tüm multitravmalı hastaların % 80’inde kafa travması izlenir. Bu yazıda olay mahallinde ve acil servislerde görev yapan acil hekimlerinin kafa travmalı hastalarda izlemesi gereken en uygun acil yaklaşım bilgileri özetlenmiştir. Ana Bulgular: Kafa travmalı bir hastada ilk müdahale travmanın olduğu yerde başlamalıdır, çünkü hipoksi, hipotansiyon ve ek yaralanmalar kafa travmasında morbidite ve mortaliteyi artırır. Acil servislerin kafa travmalı hastalardaki görevi travma mahallinde başlayan resusitasyonu devam ettirmek, sistemik ve serebral yaralanmaya bağlı oluşabilecek komplikasyonları önleyerek bu hastalarda tablonun daha da kötüleşmesini engellemektir. Sonuç: Ağır kafa travmalı hastaların % 50’si, ilk travma anında, transport esnasında veya posttravmatik erken dönemde acil serviste kaybedilir. Buna en çok hipotansiyon ve ikinci sıklıkta hipoksi gibi sekonder yaralanmaların ölüme sebep olduğu düşünülürse, bunların erken tanı ve tedavisinin ne kadar önemli olduğu anlaşılır.

Pre-hospital approach in patients with head trauma and management ın emergency department

Objective: Traumatic brain injury is one of the most important causes of morbidity and mortality in developed countries. Head trauma can be observed in 75% of the traffic accidental deaths and in 80% of all multitrauma patients. In this article we summarize the most appropriate treatment strategies followed by the emergency doctors in trauma place and in emergency departments (EDs). Main findings: The pre-hospital approach in a head trauma patient should be made where the trauma happened; because hypoxia, arterial hypotension and the additive injuries increase morbidity and mortality in head trauma. The duties of EDs are maintaining the resusitation began in trauma place, preventing the table become worse up to systemic and cerebral injury complications. Conclusion: 50% of the severe head trauma patients mortal as soon as trauma happen, transportation duration or post-traumatic early period in EDs. We can understand that how urgent it is to early diagnose and treat in head trauma patients when we consider the effects of secondary injuries of mortality firstly caused hypotension, secondly hypoxia.

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