KAFA TRAVMALARINA YAKLAfiIM: ‹LK G‹R‹fi‹M - Cerrahpaşa Tıp ...

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KAFA TRAVMALARINA YAKLAfiIM: ‹LK G‹R‹fi‹M - Cerrahpaşa Tıp ...

UZAN, M; KAYA, Z

gularda uygulan›rken kafaiçi bas›nç monitorizasyonu ise pulmoner ve hemodinamik

resüsitasyondan sonra GCS skoru 13 ve alt›nda olan olgularda tercih

edilmelidir. 36

Nörolojik tablosu bozulan hastalar›n de¤erlendirilmesi

Hastalar›n önemli bir ço¤unlu¤u, acil servise, gerçekten a¤›r intrakranyal

hasar› olmas›na ra¤men minör yaralanma bulgular› ile gelir. Bu konuda yap›-

lan bir çal›flmada 10 y›l içerisinde künt kafa travmal› olup, GCS skoru 15 olan

183 hastaya sonradan travmatik hematom sebebiyle müdahale edildi¤i bildirilmifltir.

21 Bu hastalar›n yaklafl›k %40’›n›n ilk de¤erlendirmelerinde herhangi

bir fluur kayb›, posttravmatik amnezi, bafl a¤r›s› veya kusmas›n›n olmad›¤›

saptanm›flt›r. Bu olgular›n fluurlar› tam olarak aç›k bile olsa %33’ünde fokal

nörolojik defisit varken, %19’unda kafa taban› k›r›¤›n›n klinik bulgular›,

%60’›nda da kafatas› k›r›¤›n›n radyografik bulgular› saptanm›flt›r.

A¤›r kafa travmal› hastalar›n %10-%32’sini acile baflvurusunda konuflan

ama sonradan kötüleflen hastalar oluflturmaktad›r. 13,18 A¤›r kafa travmal› hastalar

içinde cerrahi müdahale gerektiren kitle lezyonlar›n›n görülme s›kl›¤›

%40 olup, bu bulgu bize fluuru aç›k hastalar›n koma tablosuna girmesinin en

muhtemel sebebinin daha sonradan geliflen kitle lezyonlar›n›n oldu¤unu göstermektedir.

KAYNAKLAR

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