RESUMO
The aim of the present study is to describe the clinical and epidemiological characteristics, complications and outcome of patients with haemophilia and acute head injury (AHI) at the emergency department (ED), and develop a protocol to prevent early and late complications. This is a retrospective cohort study including all patients with haemophilia and AHI admitted to the ED. We identified 26 patients with AHI. A computed tomography scan was carried out on all patients at admission, and again on two patients (with neurosurgical complications) 48 h later. The discharge diagnosis was as follows: 3.8% subdural haematoma, 3.8% cerebellar epidural haematoma and 92.3% uncomplicated AHI. We propose the following protocol: a computed tomography scan upon arrival and another within 48 h post-AHI, unless there is an absence of clinical symptoms. In addition, all patients must self-administer a clotting factor as soon as possible and be observed in the ED for at least 48 h.
Assuntos
Traumatismos Craniocerebrais/complicações , Hemofilia A/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Protocolos Clínicos , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/terapia , Serviço Hospitalar de Emergência , Abscesso Epidural/complicações , Feminino , Hematoma Subdural/complicações , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemRESUMO
La estimulación cerebral profunda (ECP) es una alternativa de manejo para los pacientescon distonía cervical, un síndrome de etiología múltiple, de presentación variada eincapacitante y refractario al manejo médico, que incluye la toxina botulínica. El artículopresenta el caso de una mujer de 56 años de edad con distonía cervical manifiesta conretrócolis e hiperextensión de columna dorsal, de cuatro años de evolución, consideradarefractaria al tratamiento y con indicación de ECP...
Deep brain stimulation (DBS) is a management alternative for patients with cervicaldystonia, syndrome of multiple etiology, presentation varied, disabling and refractoryto medical management, including botulinum toxin. A case of a 56 year old woman withcervical dystonia manifested by retrocollis and hyperextension dorsal spine of 4 yearsof evolution, considered resistant to treatment that is an indication of DBS is presented...
Assuntos
Radiocirurgia/reabilitação , Torcicolo/diagnóstico , Torcicolo/etiologia , Torcicolo/prevenção & controle , ColômbiaRESUMO
En la actualidad, los servicios de urgencias atienden pacientes con daño neurológicograve, especialmente por trauma craneoencefálico, en quienes durante la reanimacióninicial se logra la recuperación de la estabilidad hemodinámica, pero requieren intubacióntraqueal y soporte con ventilación mecánica, sin que con ello se logren recuperar lasfunciones cerebrales y de tallo, lo que lleva a la sospecha de muerte encefálica. No es útilque un paciente con alta probabilidad de certeza para este diagnóstico sea trasladado a unaunidad de cuidado intensivo, pero sí es necesario que los pacientes con este diagnóstico,potencialmente donantes de órganos, puedan ofrecer este último servicio altruista en suexistencia. Los médicos urgenciólogos deben hacer este diagnóstico cuando sea el casoy conocer el ámbito legal que lo rodea...
In currently, emergency services are faced with patients that have severe neurologicaldamage after traumatic brain injury, and especially in those that during the initial resuscitation is achieved hemodynamic stability,required intubation and mechanical ventilationsupport, and were unable to recovery functionalbrain, leading to the suspicion of brain death. Itis futile for those patients with a high probabilityof certainty of this diagnosis need to be hospitalizedto intensive care unit but, it is necessary forthose patients with a diagnosis of brain death,potential organ donor, can offer a last selflessservice in your existence. Emergency physiciansshould make this diagnosis when is appropriate,and know the legal field that surrounds it...