TRAVMATİK EPİDURAL/SUBDURAL KANAMALI OLGUDA İNTRAOPERATİF GELİŞEN KARDİYAK ARREST YÖNETİMİ OLGU SUNUMU

Öz

Kafa travmaları akut gelişir, çoğu zaman cerrahi işlem gerektirebilir ve hayati tehlike oluşturabilir. Ameliyathanede ve girişimsel işlemlerin uygulandığı ortamlarda birçok sebebe bağlı kardiyak arrest görülebilir. Olguların hızlı ve uygun şekilde değerlendirilmesi ve yönetilmesi, geleneksel kardiyak arrest algoritmaları yanı sıra ihtiyaç duyulan farklı yöntemlerin tedaviye eklenmesi gerekir. Yüksekten kafa üstü düşme nedeni ile dış merkezden acil servise getirilen bilinci kapalı 29 Y, erkek hasta entübe olarak akut epidural/subdural hematom tanısıyla ameliyathaneye alındı. Cerrahi devam ederken EtCO2’te ani düşüş ve nabız trasesinin görülmemesi üzerine nabızsız elektriksel aktivite (NEA) kardiyak arrest (KA) ritmi teyit edildi 1 mg İV adrenalin verilerek kardiyopulmoner resüsitasyon (KPR) başlandı. KPR nin 16. dk’sında EtCO2 aniden yükseldi ardından nabız palpe edildi ve spontan dolaşım geri (SDGD) döndü. Cerrahi bitiminde olgu entübe ve inotropik ilaç desteği ile anestezi yoğun bakım ünitesine (AYBÜ) alındı. Bu olgu sunumu ile; entübe hastalarda EtCO2 takibinin kardiyak arrestin erken tanısında yol gösterici olduğunu, KPR kalitesi ile SDGD süresini erken haber verdiğini vurgulamak istedik.

Anahtar Kelimeler

• kardiyak arrest
• kpr algoritmaları
• EtCO2 monitörizasyonu
• epidural-subdural kanama

A CASE WITH TRAUMATIC EPIDURAL/SUBDURAL HEMORRHAGE INTRAOPERATIVE CARDIAC ARREST MANAGEMENT CASE REPORT

Öz

Head traumas are acute, often requiring surgical intervention, and can be life-threatening. Cardiac arrest can occur for a variety of reasons in the operating room and in interventional settings. Rapid and appropriate evaluation and management of these cases are essential, and treatment should incorporate alternative therapies as needed, in addition to traditional cardiac arrest algorithms. A 29-year-old male patient, unconscious and intubated, was brought to the emergency room from an external center due to a head-on fall from a height. He underwent acute epidural/subdural surgery. He was taken to the operating room with a diagnosis of hematoma. While the surgery was in progress, a sudden decrease in EtCO2 and no pulse were observed, and a pulseless electrical activity (PEA) cardiac arrest (CA) rhythm was confirmed. 1 mg of IV adrenaline was administered, and cardiopulmonary arrest was performed. Resuscitation (CPR) was initiated. At the 16th minute of CPR, EtCO2 suddenly rose, followed by a palpable pulse and return of spontaneous circulation (ROSC). At the end of the surgery, the patient was intubated and transferred to the anesthesia intensive care unit (ICU) with inotropic medication support. With this case report, we wanted to emphasize that EtCO2 monitoring in intubated patients is a guide in the early diagnosis of cardiac arrest and provides early information on CPR quality and ROSC duration.

Anahtar Kelimeler

• cardiac arrest
• CPR algorithms
• EtCO2 monitoring
• epidural-subdural bleeding

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