Abstract
Giriş: Pulmoner emboli, tanısı genellikle klinik şüpheye dayanan ve hayatı
tehdit eden bir hastalıktır. Epidural kanama kafa travması olan hastalarda
cerrahi ile kolayca tedavi edilebilen prognozu iyi bir klinik durumdur.
Olgu sunumu: 34 yaşında erkek hasta dispne ve senkop şikayetiyle başka
bir sağlık kuruluşuna başvurmuş ve yapılan değerlendirme sonrası epidural
kanama tanısıyla acil operasyona alınmıştı. Operasyon sonrası kontrol
altına alınamayan taşikardi ve nefes darlığı olması üzerine ileri tetkik için
kurumumuza sevk edilmişti. Elektrokardiografi, ekokardiyografi ve toraks
bilgisayarlı tomografi bulguları masif pulmoner emboli ile uyumluydu.
Epidural kanama operasyonu geçirmesi nedeniyle hastaya teşhis sonrası
trombolitik veya antikoagülan tedavi başlanamadı. Hastanın destek
tedavisine operasyon sonrası 72. saatte düşük molekül ağırlıklı heparin
ve 96. saatte varfarin eklendi. Takiplerinde klinik durumu düzelen hasta
yatışının 15. gününde taburcu edildi.
Sonuç: Hasta yönetiminde zamanla yarışan acil servis hekimi, yaşamı
tehdit edebilecek birden fazla patoloji ile aynı hastada karşılaşabileceğini
hatırından çıkarmamalıdır
Keywords
References
- Kostadima E, Zakynthinos E. Pulmonary embolism: pathophysiology, diagnosis, treatment. Hellenic J Cardiol. 2007;48:94-107.
- Becattini C, Agnelli G. Acute pulmonary embolism: risk stratification in the emergency department. Intern Emerg Med. 2007;2:119-29.
- Tallon JM, Ackroyd-Stolarz S, Karim SA, Clarke DB. The epidemiology of surgically treated acute subdural and epidural hematomas in patients with head injuries: a population-based study. Can J Surg. 2008;51:339-45.
- Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW. Surgical management of acute epidural hematomas. Neurosurgery 2006;58:7-15.
- Özdemir M, Ünlü A. Neurosurgical approaches in severe head injury. Turkiye Klinikleri J Surg Med Sci. 2007; 3:20-26.
- American College of Surgeons Committee on Trauma: Initial assessment and management. In: Advanced Life Support Program for Doctors, 7th ed. Chicago: American College of Surgeons; 2004.p.11-29.
- Kaufmann CR. Initial assessment and management. In: Moore EE, Feliciano DV, Mattox KL, eds. Trauma. 6th ed. New York: Mc Graw-Hill; 2007.p.169-171.
- Benditt DG, van Dijk JG, Sutton R, Wieling W, Lin JC, Sakaguchi S, Lu F. Syncope. Curr Probl Cardiol. 2004;29:152-229.
- Palla A, Petruzzelli S, Donnamaria V, Giuntini C: The role of suspicion in the diagnosis of pulmonary embolism. Chest 1995;107:21-24.
Abstract
Introduction: Pulmonary embolism is a life-threatening condition and its
diagnosis is generally based on clinical suspicion.
Case report: A 34-years-old male had been admitted to another hospital with
acute dyspnea and syncope. After initial evaluation he had immediately been
undergone an operation due to epidural hematoma and occipital fracture.
ECG, Echocardiogram and Thorax CT findings complied with pulmonary
embolism. Thrombolytic or anticoagulant medication could not be started
because of epidural hematoma operation. At postoperative 72 hours low
molecular weight heparin and at 96 hours warfarin was administered. He
discharged from hospital at day 15.
Conclusions: The emergency room physician who race with time in patient
management, has to keep in mind that physician could experience more than
one life-threatening pathology in the same patient.
Keywords
References
- Kostadima E, Zakynthinos E. Pulmonary embolism: pathophysiology, diagnosis, treatment. Hellenic J Cardiol. 2007;48:94-107.
- Becattini C, Agnelli G. Acute pulmonary embolism: risk stratification in the emergency department. Intern Emerg Med. 2007;2:119-29.
- Tallon JM, Ackroyd-Stolarz S, Karim SA, Clarke DB. The epidemiology of surgically treated acute subdural and epidural hematomas in patients with head injuries: a population-based study. Can J Surg. 2008;51:339-45.
- Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW. Surgical management of acute epidural hematomas. Neurosurgery 2006;58:7-15.
- Özdemir M, Ünlü A. Neurosurgical approaches in severe head injury. Turkiye Klinikleri J Surg Med Sci. 2007; 3:20-26.
- American College of Surgeons Committee on Trauma: Initial assessment and management. In: Advanced Life Support Program for Doctors, 7th ed. Chicago: American College of Surgeons; 2004.p.11-29.
- Kaufmann CR. Initial assessment and management. In: Moore EE, Feliciano DV, Mattox KL, eds. Trauma. 6th ed. New York: Mc Graw-Hill; 2007.p.169-171.
- Benditt DG, van Dijk JG, Sutton R, Wieling W, Lin JC, Sakaguchi S, Lu F. Syncope. Curr Probl Cardiol. 2004;29:152-229.
- Palla A, Petruzzelli S, Donnamaria V, Giuntini C: The role of suspicion in the diagnosis of pulmonary embolism. Chest 1995;107:21-24.
Details
| Other ID | JA87NT58MF |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | April 1, 2010 |
| Submission Date | April 1, 2010 |
| Published in Issue | Year 2010 Volume: 1 Issue: 2 |