UZAN, M; KAYA, Z gularda

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 1. American College of Surgeons Committee on Trauma.Initial assessment and management.In:American College of Surgeons Committee on Trauma: Advanced Trauma Life Support Student Manual. Chicago: American College of Surgeons 1993:17-46. 2. American College of Surgeons Committee on Trauma.Shock.In :American College of Surgeons Committee on Trauma:Advanced Trauma Life Support Student Manual.Chicago: American College of Surgeons, 1993:75- 94. 3. Bouma GJ, Muizelaar JP, Choi SC, et al. Cerebral circulation and metabolism after severe traumatic brain injury: the elusive role of ischemia. J Neurosurg 1991; 75: 685-693. 4. Boyd CR, Corse KM, Cample RC: Emergency interhospital transport of the major traumatic patient: Air versus ground. J Trauma 1989; 29: 789-793. 5. Bullock ME,du Trevou MD,Van Dellen JR,et al.Prevention of death from head injury in Natal. S Afr Med J 1988;73:523- 527. 6. Chesnut RM, Marshall LF, Marshall SB. Medical managemant of intracranial pressure. In: Cooper PR ed. Head Injury, 3rd ed. Baltimore: Williams & Wilkins, 1993:225-246. 7. Chestnut RM, Marshall SB, Piek J,et al.Early and late systemic Hypotension as a frequent and fundamental source of cerebral ischemia following severe brain injury in the Traumatic Coma Data Bank. Acta Neurochir 1993;59: S121-S125. 8. Delaney KA, Goldfrank LR. Initial management of the multiply injured or intoxicated patients. In: Cooper PR ed. Head Injury, 3rd ed. Baltimore: Williams & Wilkins, 1993:43-63. 9. Esposito TJ, Sanddal ND, Hansen JD,at al. Analysis of preventable trauma deaths and inappropriate trauma care in a rural state. J Trauma 995; 39:955-962. 10.Gennarelli TA, Champion HR, Sacco WJ, et al.Mortallity of patients with head injury and extracranial injury treated in trauma centers.J Trauma 1989;29:1193-1202 complications. Br Med J 1986;292: 449. 12.Hamill JF, Bedford RF, Weaver DC, et al.Lidocaine before endotracheal intubation:intravenous or laryngotracheal? Anesthesiology 1981;55:578-581. 13. Jennett B,Teasdale G,Galbraight S,et al.Severe head injury in three countries. J Neurol Neurosurg Psychiatry 1977;40:291- 298. 72

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