{"id":1503,"date":"2024-07-12T11:42:37","date_gmt":"2024-07-12T08:42:37","guid":{"rendered":"https:\/\/tatd.org.tr\/afet\/?p=1503"},"modified":"2024-07-12T11:42:39","modified_gmt":"2024-07-12T08:42:39","slug":"afetlerde-goruntuleme","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/afet\/afet-yazi-dizisi\/afetlerde-goruntuleme\/","title":{"rendered":"Afetlerde G\u00f6r\u00fcnt\u00fcleme"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">Sorular<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><em>Afet sonras\u0131 g\u00f6r\u00fcnt\u00fcleme sadece hastane garnizonu i\u00e7erisinde mi olmal\u0131?<\/em><\/li>\n\n\n\n<li><em>Hastane \u00f6ncesi d\u00f6nemde bir g\u00f6r\u00fcnt\u00fcleme yap\u0131labilir mi?<\/em><\/li>\n\n\n\n<li><em>Peki hasta hastane bah\u00e7esinden i\u00e7eri girdi\u011fi anda?<\/em><\/li>\n\n\n\n<li><em>Hangi g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemi, kime, nerede (hastane i\u00e7i\/d\u0131\u015f\u0131), kim taraf\u0131ndan yap\u0131lacak?<\/em><\/li>\n\n\n\n<li><em>Yap\u0131lan g\u00f6r\u00fcnt\u00fclemenin kime ait oldu\u011fu anla\u015f\u0131labilecek mi?<\/em><\/li>\n\n\n\n<li><em>Afetzedede g\u00f6r\u00fcnt\u00fclemeye engel bir durum var m\u0131?<\/em><\/li>\n\n\n\n<li><em>Bulgular hem g\u00f6rsel hem de yaz\u0131l\u0131 olarak kay\u0131t alt\u0131na al\u0131nabilecek mi?<\/em><\/li>\n\n\n\n<li><em>Herkes afetzede, \u00e7evre illerden ya da farkl\u0131 co\u011frafyalardan destek istenecek mi?<\/em><\/li>\n\n\n\n<li><em>Elektrik gerekecek mi? Jenerat\u00f6r ya da basit bir powerbank i\u015f g\u00f6rebilecek mi?<\/em><\/li>\n<\/ul>\n\n\n\n<p>Hadi \u015fimdi bu sorular\u0131n yan\u0131tlar\u0131n\u0131 vermeye \u00e7al\u0131\u015fal\u0131m &gt;&gt;&gt;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Giri\u015f<\/h2>\n\n\n\n<p>Acil servisteki n\u00f6betiniz esnas\u0131nda bilgisayarl\u0131 tomografinin (BT) bozuldu\u011funu d\u00fc\u015f\u00fcn\u00fcn. Bu durum bile zaten her g\u00fcn afet standartlar\u0131nda hasta bakmaya \u00e7al\u0131\u015ft\u0131\u011f\u0131m\u0131z acil servislerde bizim i\u00e7in ufak \u00e7apl\u0131 anksiyete olu\u015fturmaya yetmekte. Basit bir y\u0131ld\u0131r\u0131m d\u00fc\u015fmesi ya da bir siber sald\u0131r\u0131 sonucu hasarlanm\u0131\u015f BT cihaz\u0131n\u0131n rutin hasta hacminin dahi y\u00f6netilmesinde g\u00fc\u00e7l\u00fck olu\u015fturabildi\u011fi bildirilmi\u015ftir (1,2). Durum b\u00f6yle olunca bizim y\u00fcksek hacimli acil servis hasta pop\u00fclasyonumuzdaki halimiz daha da s\u0131k\u0131nt\u0131l\u0131 oluyor asl\u0131nda. S\u00f6z konusu ar\u0131za birka\u00e7 saat i\u00e7erisinde giderilecek belki; peki ya daha b\u00fcy\u00fck bir problem s\u00f6z konusu olursa; <strong><em>AFET<\/em><\/strong> <em>gibi<\/em>\u2026<\/p>\n\n\n\n<p>Afetler, yaralanma \u015fiddetinin ve yaral\u0131 say\u0131s\u0131n\u0131n pek \u00e7ok d\u00fczeyde yerel sa\u011fl\u0131k m\u00fcdahalesi kapasitesini a\u015ft\u0131\u011f\u0131 durumlard\u0131r. \u015eartlar\u0131n elveri\u015fli olmad\u0131\u011f\u0131 her durum bir nevi afet gibi d\u00fc\u015f\u00fcn\u00fclebilir asl\u0131nda. Do\u011fal yoldan, teknolojinin getirisiyle ya da insan eliyle meydana gelebilir bu afetler. Bu afet; bir deprem, bir sel, bir kas\u0131rga, bir sava\u015f durumu, bir siber sald\u0131r\u0131, bir radyasyon kazas\u0131, belki de bir pandemi olabilir ve hepsi g\u00f6r\u00fcnt\u00fclemeleri potansiyel olarak olumsuz \u015fekilde etkileyebilir (<strong>Fig\u00fcr 1<\/strong>). &nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img fetchpriority=\"high\" decoding=\"async\" width=\"531\" height=\"267\" src=\"https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim1.png\" alt=\"\" class=\"wp-image-1504\" srcset=\"https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim1.png 531w, https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim1-300x151.png 300w\" sizes=\"(max-width: 531px) 100vw, 531px\" \/><\/figure>\n\n\n\n<p><strong>Fig\u00fcr 1.<\/strong> Afetlerdeki g\u00f6r\u00fcnt\u00fclemeleri potansiyel olarak k\u00f6t\u00fc y\u00f6nde etkileyebilecek do\u011fal, teknolojik ve insan kaynakl\u0131 olaylar (1).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Zorluklar<\/h2>\n\n\n\n<p>Afetlerin ya da toplu yaralanma olaylar\u0131n\u0131n tan\u0131nmas\u0131, afetlere m\u00fcdahale ve kurtarma ekiplerine ait i\u015fleyi\u015finin bilinmesi, afet lojisti\u011fine h\u00e2kim olunmas\u0131, hastane afet plan\u0131ndan haberdar olunmas\u0131, afetzedelerin kimliklendirilmesi gibi b\u00fct\u00fcn durumlar hastane \u00f6ncesi d\u00f6nemde yap\u0131lmas\u0131 ya da yap\u0131lm\u0131\u015f olmas\u0131 gereken afet planlamas\u0131na ait konu ba\u015fl\u0131klar\u0131d\u0131r. Bu ba\u015fl\u0131klara ek ba\u015fka bir ba\u015fl\u0131k m\u0131 olur yoksa bu ba\u015fl\u0131klar\u0131n i\u00e7erisinde kendine ait bir yeri mi olur bilmem ama en \u00f6nemli ba\u015fl\u0131klardan biri de <strong><em><u>afet durumlar\u0131ndaki t\u0131bbi g\u00f6r\u00fcnt\u00fclemelerin planlanmas\u0131<\/u><\/em><\/strong> \u00fczerine olmal\u0131d\u0131r. Karma\u015f\u0131k altyap\u0131 gereksinimleri; aciliyet arzeden ve fazlaca g\u00f6r\u00fcnt\u00fcleme ihtiyac\u0131n\u0131n has\u0131l olabilece\u011fi afet durumlar\u0131nda, radyoloji \u00fcnitelerinin sistem ar\u0131zalar\u0131na kar\u015f\u0131 savunmas\u0131z kalabilece\u011fini d\u00fc\u015f\u00fcnd\u00fcrmektedir(1). \u00c7\u00fcnk\u00fc bir afet durumunda genel olarak konvansiyonel radyografi (X-ray) de dahil olmak \u00fczere, bilgisayarl\u0131 tomografi (BT), ultrasonografi (USG), manyetik rezonans g\u00f6r\u00fcnt\u00fcleme (MRG) hatta gerekirse giri\u015fimsel i\u015flemlerin skopi alt\u0131nda yap\u0131labildi\u011fi g\u00f6r\u00fcnt\u00fcleme cihazlar\u0131na ve tedavi \u00fcnitelerine ve bu \u00fcniteler i\u00e7in teknik altyap\u0131ya ihtiya\u00e7 vard\u0131r. Afet b\u00f6lgelerinde hayat kurtaran giri\u015fimsel radyolojinin de uygulay\u0131c\u0131lar\u0131 i\u00e7erisinde oldu\u011fu ba\u015fl\u0131ca i\u015flemler, hemopn\u00f6motoraks i\u00e7in t\u00fcp torakotomi uygulamalar\u0131 ve santral ven\u00f6z katater i\u015flemleridir (3).<\/p>\n\n\n\n<p>Sadece teknik altyap\u0131 de\u011fil ayn\u0131 zamanda personel ve sarf malzemeleri\/ekipmanlar\u0131 da risk alt\u0131ndad\u0131r. Bu gibi durumlarda da t\u0131bbi g\u00f6r\u00fcnt\u00fcleme ve g\u00f6r\u00fcnt\u00fc yorumlama i\u015flemleri yap\u0131lamayacakt\u0131r. Tam da bu noktada g\u00f6r\u00fcnt\u00fcleme talepleri ve yorumlanmas\u0131 i\u00e7in sa\u011flam ileti\u015fim modelleri kurmak gerekir. Hastalar i\u00e7in istenen g\u00f6r\u00fcnt\u00fcleme y\u00f6nteminin, hastaya ait kimlik ve klinik bilgilerin gerekirse manuel olarak yaz\u0131lmas\u0131 afet durumlar\u0131ndaki sistemsel kesintilere kar\u015f\u0131 koruyucu olabilir (4,5).<\/p>\n\n\n\n<p>Afetlerde hastalar\u0131n tan\u0131nmas\u0131, tan\u0131mlanmas\u0131 ve takibi yaralanmalar\u0131n \u015fekli nedeniyle zor olabilir (1,4,6,7). Toprak kaymas\u0131 nedeniyle \u00e7amur ya da bal\u00e7\u0131k ile kaplanm\u0131\u015f cilt, t\u0131bbi g\u00f6r\u00fcnt\u00fclemelerde s\u0131n\u0131rland\u0131rmalar olu\u015fturabilir. Bunun \u00e7\u00f6z\u00fcm\u00fc i\u00e7in triaj alan\u0131ndaki dekontaminasyon i\u015flemleri i\u00e7in \u00f6nceden haz\u0131rl\u0131k yap\u0131lmas\u0131n\u0131n \u00f6nemli oldu\u011fu bildirilmi\u015ftir (8). Bug\u00fcn \u0130srail sald\u0131r\u0131s\u0131 alt\u0131ndaki Filistin\u2019deki \u00e7ocuklar\u0131n yaralanma durumlar\u0131nda tan\u0131nmalar\u0131 i\u00e7in \u00f6nceden v\u00fccutlar\u0131n\u0131n \u00e7e\u015fitli yerlerine bilgilerin yaz\u0131ld\u0131\u011f\u0131n\u0131 g\u00f6r\u00fcyoruz. \u0130lkel g\u00f6r\u00fcnen ancak i\u015fe yarayan bu kimliklendirme y\u00f6nteminin kullan\u0131\u015fl\u0131 oldu\u011funu bildiren yay\u0131nlar ayr\u0131ca mevcuttur (4,9). Hasta triaj alan\u0131nda kimliklendirilemeyen hastalar i\u00e7in radyo-opak numaralardan olu\u015fan hasta kimlik etiketlerinin hastalar\u0131n g\u00f6r\u00fcnt\u00fcleri ile e\u015fle\u015ftirilmesi a\u00e7\u0131s\u0131ndan kolayl\u0131k sa\u011flayacakt\u0131r (10) (<strong>Fig\u00fcr 2<\/strong>). Her \u015fey yolunda gitse ve g\u00f6r\u00fcnt\u00fcleme yap\u0131lm\u0131\u015f olsa bile PACS ar\u0131zas\u0131, elektrik kesintisi ya da afet ortam\u0131n\u0131n verdi\u011fi aciliyet durumu nedeniyle g\u00f6r\u00fcnt\u00fcler ar\u015fivlenemeyebilir ve raporland\u0131rma i\u015flemi elektronik olarak yap\u0131lamayabilir. \u00d6zellikle raporland\u0131rma i\u015flemi i\u00e7in \u00f6nceden haz\u0131rlanm\u0131\u015f, \u00e7oklu karbon ka\u011f\u0131tlar\u0131na rapor yazacak hekimin afetzede ile ilgili ilk ve en kritik t\u0131bbi bilgileri yazmas\u0131 g\u00f6r\u00fcnt\u00fc sonu\u00e7lar\u0131n\u0131n belgelendirilmesi i\u00e7in klinisyene kolayl\u0131k sa\u011flayacakt\u0131r (4).<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" width=\"1024\" height=\"360\" src=\"https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim2-1024x360.jpg\" alt=\"\" class=\"wp-image-1505\" srcset=\"https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim2-1024x360.jpg 1024w, https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim2-300x106.jpg 300w, https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim2-768x270.jpg 768w, https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim2-1170x412.jpg 1170w, https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim2-585x206.jpg 585w, https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim2.jpg 1356w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p><a><strong>Fig\u00fcr 2<\/strong><\/a>. Prototip radyoopak hasta tan\u0131mlama etiketleri (RAPIDS), bir afet durumunda sistem ar\u0131zas\u0131 varsa ileti\u015fim veya hasta kimli\u011finin kaydedilmesindeki hatalar\u0131 \u00f6nlemeye yard\u0131mc\u0131 olur. (A) Foto\u011fraf bir fantom \u00fczerindeki RAPIDS&#8217;i g\u00f6steriyor. (B) BT topogram\u0131 RAPIDS&#8217;in radyografik okunabilirli\u011fini g\u00f6steriyor. (C) Aksiyal BT g\u00f6r\u00fcnt\u00fcs\u00fc RAPIDS&#8217;ten kaynaklanan intrakraniyal g\u00f6r\u00fcnt\u00fc artefakt\u0131n\u0131n olmad\u0131\u011f\u0131n\u0131 g\u00f6steriyor (10).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Peki Hangi G\u00f6r\u00fcnt\u00fcleme Y\u00f6ntemi?<\/h2>\n\n\n\n<p>Yukar\u0131da bahsi ge\u00e7en t\u00fcm bu afet durumlar\u0131n\u0131 konu edinmi\u015f, 2000 y\u0131l\u0131 ile 2017 y\u0131l\u0131 aras\u0131ndaki en \u00e7ok at\u0131f alan 100 makale taranm\u0131\u015f bu makalelerin 59\u2019unun ilk yazar\u0131n\u0131n bir radyolog oldu\u011fu g\u00f6r\u00fclm\u00fc\u015f (11). Bu durum bile afetlerde t\u0131bbi g\u00f6r\u00fcnt\u00fcleme \u00fczerinde ne denli \u00f6nemle durulmas\u0131 gerekti\u011fini g\u00f6zler \u00f6n\u00fcne sermekte asl\u0131nda. Afetlerde en s\u0131k kullan\u0131lan g\u00f6r\u00fcnt\u00fcleme y\u00f6nteminin %52,8\u2019lik oran\u0131 ile bilgisayarl\u0131 tomografi (BT) oldu\u011fu, konvansiyonel radyografinin (X-ray) %33,3\u2019l\u00fck oran\u0131 ile ikinci s\u0131rada oldu\u011funu ve ultrasonografinin %9,7\u2019lik oran\u0131 ile \u00fc\u00e7\u00fcnc\u00fc s\u0131rada oldu\u011fu, MRG \u00e7ekiminin ise %3\u2019\u00fc ge\u00e7medi\u011fi g\u00f6r\u00fclm\u00fc\u015f. BT\u2019nin bu denli fazla kullan\u0131lmas\u0131n\u0131n nedeni de belki de pandemik durumlar olarak g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Merak edenler i\u00e7in bu \u00e7al\u0131\u015fmaya ait iki g\u00fczel \u00f6zet tablo (<strong>Fig\u00fcr 3<\/strong>) a\u015fa\u011f\u0131da, <em>yorum sizin\u2026<\/em><\/p>\n\n\n\n<div class=\"wp-block-group is-nowrap is-layout-flex wp-container-core-group-is-layout-ad2f72ca wp-block-group-is-layout-flex\">\n<figure class=\"wp-block-image size-full is-resized\"><img decoding=\"async\" width=\"412\" height=\"360\" src=\"https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim3.png\" alt=\"\" class=\"wp-image-1506\" style=\"width:548px;height:auto\" srcset=\"https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim3.png 412w, https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim3-300x262.png 300w\" sizes=\"(max-width: 412px) 100vw, 412px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"483\" height=\"358\" src=\"https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim4.png\" alt=\"\" class=\"wp-image-1507\" style=\"width:649px;height:auto\" srcset=\"https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim4.png 483w, https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim4-300x222.png 300w\" sizes=\"(max-width: 483px) 100vw, 483px\" \/><\/figure>\n<\/div>\n\n\n\n<p><a><strong>Fig\u00fcr 3<\/strong><\/a>: Taranm\u0131\u015f makalelere ve afet tipine g\u00f6re g\u00f6r\u00fcnt\u00fcleme \u00f6zellikleri (11)<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Bilgisayarl\u0131 Tomografi<\/h3>\n\n\n\n<p>Akut a\u015famada kesitsel g\u00f6r\u00fcnt\u00fclemenin en iyi yap\u0131ld\u0131\u011f\u0131 tetkik olmas\u0131 BT\u2019yi afet g\u00f6r\u00fcnt\u00fclemelerinde \u00f6n plana \u00e7\u0131kard\u0131\u011f\u0131 d\u00fc\u015f\u00fcn\u00fclebilir. 2013 y\u0131l\u0131nda Boston maratonu ko\u015fusundaki bombal\u0131 sald\u0131r\u0131 bir afetten ziyade kitlesel etki olu\u015fturan bir olay olarak d\u00fc\u015f\u00fcn\u00fclebilir asl\u0131nda (<strong>Resim 1<\/strong>). Bu sald\u0131r\u0131da abdomen ve pelvik b\u00f6lgelerinden yaralanan 87 hasta herhangi bir sa\u011fl\u0131k kurulu\u015funa getirilebilmi\u015f bu hastalar i\u00e7in kullan\u0131lan diagnostik g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemi BT olmu\u015ftur (\u00f6zellikle \u015farapnel par\u00e7alar\u0131n\u0131n tespiti i\u00e7in). Ayn\u0131 sald\u0131r\u0131da alt ekstremite yaralanmas\u0131 olan 115 hastan\u0131n de\u011ferlendirildi\u011fi bir ba\u015fka \u00e7al\u0131\u015fama da yine \u015farapnel par\u00e7alar\u0131n\u0131n ve doku b\u00fct\u00fcnl\u00fc\u011f\u00fcn\u00fcn tespiti i\u00e7in en \u00e7ok BT ve radyografi (X-ray) g\u00f6r\u00fcnt\u00fclemesi tercih edilmi\u015ftir (12, 13).<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"563\" height=\"320\" src=\"https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim5.png\" alt=\"\" class=\"wp-image-1508\" srcset=\"https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim5.png 563w, https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim5-300x171.png 300w\" sizes=\"(max-width: 563px) 100vw, 563px\" \/><\/figure>\n\n\n\n<p><strong>Resim 1:<\/strong> Boston maratonu esnas\u0131ndaki bombal\u0131 sald\u0131r\u0131 an\u0131<\/p>\n\n\n\n<p>Afetler travma sebebidir ve travmaya ait patolojileri akut a\u015famada en iyi g\u00f6steren kesitsel g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemi BT\u2019dir. Bu nedenle BT afetlerde s\u0131k\u00e7a kullan\u0131lmaktad\u0131r. Ancak afetlerde olan elektrik kesintileri ve sa\u011fl\u0131k merkezlerinin hasarlanmas\u0131 BT\u2019nin kullan\u0131lmas\u0131n\u0131 engellemektedir. Yukar\u0131da tablo ile sonu\u00e7lar\u0131n\u0131 verdi\u011fimiz makalede depremlerde %56\u2019l\u0131k oran\u0131 ile en s\u0131k kullan\u0131lan g\u00f6r\u00fcnt\u00fcleme y\u00f6nteminin BT oldu\u011fu bildirilmi\u015f olmas\u0131na ra\u011fmen depremlerde BT\u2019nin ilk kullan\u0131m\u0131n\u0131n depremden sonraki be\u015finci saate kadar uzayabildi\u011fi de belirtilmi\u015ftir (14). Kahramanmara\u015f depremindeki bir afetzedeye ait BT g\u00f6r\u00fcnt\u00fcleri <strong>Fig\u00fcr 4<\/strong>\u2019te g\u00f6sterilmi\u015ftir. Afetzedelerin \u00e7o\u011funa t\u00fcm v\u00fccut BT \u00e7ekilmesi hastan\u0131n tedavisinin planlanmas\u0131nda da klinisyene yol g\u00f6sterici olabilir ancak burada hasta say\u0131s\u0131 g\u00f6z \u00f6n\u00fcnde bulundurularak olas\u0131 gecikmeler ve y\u0131\u011f\u0131lmalar\u0131 da engellemek i\u00e7in \u00f6ncesinde travmaya odakl\u0131 ultrasonografik de\u011ferlendirme (FAST\/E-FAST) ile hasta se\u00e7ilmesi daha uygun olabilir (15-17). \u00c7ekilmesi planlanan BT\u2019nin de \u00f6zellikle deprem gibi afetlerde hastalarda crush sendromu ya da kompartman sendromu olabilece\u011finden kontrastl\u0131 \u00e7ekim hastalar i\u00e7in ayr\u0131ca risk fakt\u00f6r\u00fc olabilir. Bu a\u015famada hastalara ait b\u00f6brek fonksiyon testlerinden haberdar olmak yararl\u0131 olabilir. Yine de b\u00fcy\u00fck damar yaralanmas\u0131, diseksiyonu ya da pulmoner emboli gibi \u00f6zellikli durumlar d\u00fc\u015f\u00fcn\u00fcl\u00fcyorsa b\u00f6brek fonksiyon testleri beklenmeksizin intraven\u00f6z kontrast madde BT \u00e7ekimi i\u00e7in kullan\u0131labilir (18). COVID-19 pandemisi d\u00f6neminde BT \u00e7ekimi o kadar yayg\u0131n hale geldi ki, \u00fczerine say\u0131s\u0131z \u00e7al\u0131\u015fmalar yap\u0131larak literat\u00fcr adete COVID-19\u2019a ait toraks BT g\u00f6r\u00fcnt\u00fclemelerinin s\u0131n\u0131fland\u0131r\u0131lmas\u0131 ile doldu ta\u015ft\u0131. Bug\u00fcn bile hala COVID-19 pandemisi d\u00f6neminden kalma bir al\u0131\u015fkanl\u0131k olarak (<em>bence k\u00f6t\u00fc bir al\u0131\u015fkanl\u0131k<\/em>) konvansiyonel radyografi yerine, afet durumundan ba\u011f\u0131ms\u0131z olarak, BT \u00e7ekimi \u00f6n planda tutulmaya devam etmektedir.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"810\" height=\"862\" src=\"https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim6.png\" alt=\"\" class=\"wp-image-1509\" srcset=\"https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim6.png 810w, https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim6-282x300.png 282w, https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim6-768x817.png 768w, https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim6-585x623.png 585w\" sizes=\"(max-width: 810px) 100vw, 810px\" \/><\/figure>\n\n\n\n<p><strong>Fig\u00fcr 4.<\/strong> Travmatik pn\u00f6motoraks, pn\u00f6momediastinum hastas\u0131: 19 saat boyunca deprem enkaz\u0131nda mahsur kalan 43 ya\u015f\u0131nda erkek hasta. (a) \u00dcst torakal b\u00f6lgeden ge\u00e7en aksiyel g\u00f6r\u00fcnt\u00fclerde mediastende \u00e7oklu hava yo\u011funluklar\u0131 (ince siyah oklar, pn\u00f6momediastinum), sol akci\u011fer \u00fcst lobu yak\u0131n\u0131nda hava yo\u011funluklar\u0131 (y\u0131ld\u0131z i\u015fareti, pn\u00f6motoraks) ve sol akci\u011ferde daha bask\u0131n olarak yayg\u0131n cilt alt\u0131 amfizemi g\u00f6r\u00fcl\u00fcyor. Sol hemitoraks g\u00f6r\u00fcl\u00fcyor (kal\u0131n siyah oklar). (b) Toraks\u0131n orta k\u0131sm\u0131ndan ge\u00e7en aksiyel kesitlerde pn\u00f6momediastinum (ince siyah oklar) ve diff\u00fcz cilt alt\u0131 amfizem (kal\u0131n siyah oklar). (c,d) Kemik pencere aksiyal kesit g\u00f6r\u00fcnt\u00fclerinde yer de\u011fi\u015ftirmi\u015f kaburga k\u0131r\u0131\u011f\u0131 ve kemik par\u00e7as\u0131n\u0131n akci\u011fer parankimine uzan\u0131m\u0131 g\u00f6r\u00fcl\u00fcyor (kal\u0131n beyaz oklar). (e) Toraks alt k\u0131sm\u0131ndan ge\u00e7en aksiyal kesitlerde yayg\u0131n cilt alt\u0131 amfizemi (kal\u0131n siyah oklar) g\u00f6r\u00fcl\u00fcyor. (f) Koronal g\u00f6r\u00fcnt\u00fclerde pn\u00f6momediastinum (ince siyah oklar), pn\u00f6motoraks (y\u0131ld\u0131z i\u015fareti) ve yayg\u0131n cilt alt\u0131 amfizem (kal\u0131n siyah oklar) (15).<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Konvansiyonel radyografi (X-ray)<\/h3>\n\n\n\n<p>Konvansiyonel radyografi (X-ray), BT\u2019den sonra genel olarak en s\u0131k kullan\u0131lan g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemi gibi g\u00f6r\u00fcnmektedir. Kesitsel g\u00f6r\u00fcnt\u00fc alamamas\u0131, ayr\u0131nt\u0131l\u0131 g\u00f6r\u00fcnt\u00fc sa\u011flayamamas\u0131 BT\u2019ye g\u00f6re dezavantaj gibi g\u00f6r\u00fcnse de, mobil cihaz olarak kullan\u0131labilmeleri, enerji gereksiniminin BT\u2019den daha az olmas\u0131 avantajl\u0131 yanlar\u0131d\u0131r. Pn\u00f6motoraks takibinde, ekstremite frakt\u00fcrlerinin tan\u0131s\u0131nda ve takibinde, afet sonras\u0131 s\u00fcre\u00e7te geli\u015fen akci\u011fer \u00f6demi, pn\u00f6moni gibi \u00f6zellikli durumlar\u0131n da takibinde X-ray g\u00f6r\u00fcnt\u00fcleme s\u0131k\u00e7a kullan\u0131lacak gibi duruyor.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Manyetik rezonans g\u00f6r\u00fcnt\u00fcleme<\/h3>\n\n\n\n<p>Manyetik rezonans g\u00f6r\u00fcnt\u00fcleme (MRG), afet durumlar\u0131nda genellikle travmatik bir durum has\u0131l oldu\u011fu i\u00e7in akut a\u015famada \u00e7ok fazla kullan\u0131lan bir g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemi de\u011fildir. \u015earapnel par\u00e7alar\u0131n\u0131n hastalara ve MRG cihaz\u0131na verebilece\u011fi zararlar d\u00fc\u015f\u00fcn\u00fcld\u00fc\u011f\u00fcnde bu durum anla\u015f\u0131labilir. Ayr\u0131ca deprem gibi y\u0131k\u0131c\u0131 afet durumlar\u0131nda s\u00f6nd\u00fcrme ad\u0131 verilen MRG m\u0131knat\u0131s\u0131n\u0131 s\u00fcper iletken durumunda tutan s\u0131v\u0131 kriyojenin h\u0131zl\u0131 bir \u015fekilde gaz halinde sal\u0131nmas\u0131 ve bu gaz\u0131n ortamdan tahliye edilmesindeki problemler bo\u011fulma ya da donma tehlikesi olu\u015fturdu\u011fundan akut a\u015famada MRG kullan\u0131m\u0131 \u00f6nerilmez (14,16)<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Ultrasonografi<\/h3>\n\n\n\n<p>Afet durumlar\u0131nda ortada bir hastane de olmayabilir, var olan hastanede gerekli ekipman da. Var olan ekipman i\u00e7in gerekli elektrik enerjisi de olmayabilir, ekipman\u0131 kullanacak bir sa\u011fl\u0131k g\u00f6revlisi de. Bu gibi durumlarda bak\u0131m noktas\u0131 testi (<em>point of care testing<\/em>) denilen, hastan\u0131n oldu\u011fu yerde ya da yak\u0131n\u0131nda yap\u0131lan t\u0131bbi testler tan\u0131mlanm\u0131\u015ft\u0131r (19). Bak\u0131m noktas\u0131 testlerinin i\u00e7erisinde ultrasonografi gibi temel g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemleri, elektrolitler ve metabolitler gibi kan analizleri ve vital bulgular\u0131n monit\u00f6rizasyonu bulunmaktad\u0131r. 2010 y\u0131l\u0131ndaki Haiti depremi ve 2011 y\u0131l\u0131ndaki Japonya tsunamisi sonras\u0131 \u00f6n plana \u00e7\u0131kan bak\u0131m noktas\u0131 testlerinin kullan\u0131m\u0131 \u00f6zellikle tavsiye edilmi\u015f, bu testlerinin kullan\u0131m\u0131n\u0131n triyaj\u0131 h\u0131zland\u0131rd\u0131\u011f\u0131, ancak daha da \u00f6nemlisi afet-acil durum-kritik bak\u0131m s\u00fcreklili\u011fi i\u00e7in gerekli olan kan\u0131ta dayal\u0131 uygulamalar\u0131 kolayla\u015ft\u0131rd\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir. En temel g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemi de burada bahsi ge\u00e7en \u015fekilde ultrasonografi gibi g\u00f6r\u00fcn\u00fcyor.<\/p>\n\n\n\n<p>Bir hekim hele ki acilci bir hekim g\u00f6z\u00fcn\u00fcn g\u00f6rd\u00fc\u011f\u00fc hi\u00e7bir \u015feyden korkmaz. Tam da bu a\u015famada bizim hem pratik (olay yerinde ya da yatak ba\u015f\u0131nda kullan\u0131labilir), hem ger\u00e7ek zamanl\u0131, hem h\u0131zl\u0131, hem ucuz, hem radyasyon i\u00e7ermeyen, hem de kolay tekrarlanabilir bir g\u00f6r\u00fcnt\u00fcme y\u00f6ntemimiz var ki; ona, eski ve yeni t\u00fcm acilcilerin yeni nesil stetoskobu olarak da nitelenen, \u2018\u2019ultrasonografi (USG)\u2019\u2019 diyoruz. Daha \u00f6nceden radyologlar ya da radyograflar taraf\u0131ndan kullan\u0131l\u0131yor olmas\u0131na ra\u011fmen acilcilerin hayat\u0131na 1997 y\u0131l\u0131nda Amerikan Cerrahi Akademisi\u2019nin ileri travma ya\u015fam deste\u011fi k\u0131lavuzunda travmaya odakl\u0131 sonografik de\u011ferlendirme (FAST) olarak girmi\u015ftir (20). O zamandan beri acil servislerde travma hastalar\u0131n\u0131n acilciler taraf\u0131ndan hem ilk bak\u0131s\u0131nda ve takip eden bak\u0131lar\u0131nda kullan\u0131lm\u0131\u015f, hem de invaziv prosed\u00fcrlerin kolayla\u015ft\u0131r\u0131lmas\u0131 i\u00e7in acilcilere kolayl\u0131k sa\u011flam\u0131\u015ft\u0131r (21). Hatta FAST i\u015flemi geni\u015fleterek sadece bat\u0131n i\u00e7i ya da perikardiyal alan\u0131 de\u011fil ayn\u0131 zamanda toraks bo\u015fluklar\u0131n\u0131 hemotoraks\/pn\u00f6motoraks a\u00e7\u0131s\u0131ndan de\u011ferlendirmeyi ama\u00e7layan E-FAST i\u015flemine evrilmi\u015ftir. T\u00fcm travma hastalar\u0131nda oldu\u011fu kadar t\u00fcm kritik hastalarda da acil servislerde kullan\u0131m\u0131 \u00f6nerilmektedir. Hastane \u00f6ncesi d\u00f6nemde dahi, acil sa\u011fl\u0131k hizmetleri taraf\u0131ndan triyaj, tan\u0131 ve m\u00fcdahaleler i\u00e7in giderek daha fazla kullan\u0131lmaktad\u0131r (22). Son ya\u015fad\u0131\u011f\u0131m\u0131z Kahramanmara\u015f depremleri ultrasonografinin, \u00f6zellikle de E-FAST\u2019in, deprem gibi afet durumlar\u0131nda en eri\u015filebilir ve i\u015flevsel g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemi olarak \u00f6ne \u00e7\u0131kt\u0131\u011f\u0131n\u0131 g\u00f6stermi\u015ftir (15). Hatta yapay zeka ile entegre edilmi\u015f portabl USG cihazlar\u0131n\u0131n kullan\u0131m\u0131n\u0131n afet b\u00f6lgelerinde hastane \u00f6ncesi d\u00f6nemde afetzedelerdeki patolojileri tan\u0131mak a\u00e7\u0131s\u0131ndan olduk\u00e7a kullan\u0131\u015fl\u0131 bulunmu\u015ftur (23).<\/p>\n\n\n\n<p>Bu ba\u011flamda art\u0131k Acil T\u0131p Uzmanl\u0131k E\u011fitimi \u00c7ekirdek E\u011fitim M\u00fcfredat\u0131nda da USG kullan\u0131m\u0131 <em>\u2018Karma\u015f\u0131k olmayan, s\u0131k g\u00f6r\u00fclen tipik olgularda giri\u015fimi uygulayabilme d\u00fczeyini ifade eder.\u2019<\/em> \u015feklinde acil t\u0131p\u00e7\u0131n\u0131n sorumlulu\u011funa verilmi\u015ftir (24). Hal b\u00f6yle olunca sadece radyolog de\u011fil art\u0131k acilci de USG kullanmaya ba\u015flam\u0131\u015f; hatta i\u015fin i\u00e7ine afet durumlar\u0131nda da kullan\u0131m eklenmi\u015ftir.<\/p>\n\n\n\n<p>Afette USG kullan\u0131m\u0131 ile ilgili en \u00e7arp\u0131c\u0131 \u00f6rneklerden biri 1988 y\u0131l\u0131nda Ermenistan\u2019da meydana gelen 25 binden fazla ki\u015finin \u00f6ld\u00fc\u011f\u00fc ve 150 binden fazla ki\u015finin yaraland\u0131\u011f\u0131 6.9 b\u00fcy\u00fckl\u00fc\u011f\u00fcndeki depremdir. Nispeten daha az etkilenen ba\u015fkent Yerivan b\u00f6lgesindeki Cumhuriyet Hastanesine getirilen hastalar\u0131n acil servis triaj alan\u0131nda kurulan 2 odada d\u00f6n\u00fc\u015f\u00fcml\u00fc olarak \u00e7al\u0131\u015fan 6 hekim yaral\u0131lar\u0131 USG ile de\u011ferlendirmi\u015f ve b\u00fct\u00fcn de\u011ferlendirmeleri 72 saat boyunca kay\u0131t alt\u0131na alm\u0131\u015flard\u0131r. Bu 72 saat i\u00e7erisinde acil servise getirilen 750 afetzedenin 400\u2019\u00fcne toplamda 530 kez acil serviste USG de\u011ferlendirmesi yap\u0131lm\u0131\u015f, neredeyse 4 hastadan birinde (%24, n=96) en az bir patoloji oldu\u011fu fark edilmi\u015f. USG de\u011ferlendirmesinin hemen ard\u0131ndan direkt olarak ameliyathaneye 16 hasta g\u00f6nderilmi\u015f olup yap\u0131lan t\u00fcm USG de\u011ferlendirmelerinde sadece 4 hastada (%0,75) yanl\u0131\u015f negatif sonu\u00e7 elde edilmi\u015f ki bu durum da i\u00e7i bo\u015f organ yaralanmalar\u0131n, retroperitoneal kanamalar\u0131n ve obezite durumlar\u0131ndan kaynaklanan handikaplara ba\u011flanm\u0131\u015f (25). Akabinde hepimizin bildi\u011fi 17 binden fazla ki\u015finin \u00f6ld\u00fc\u011f\u00fc, 10 binden fazla yaral\u0131n\u0131n oldu\u011fu, 1999 y\u0131l\u0131ndaki 7,6 b\u00fcy\u00fckl\u00fc\u011f\u00fcndeki G\u00f6lc\u00fck depreminde y\u00fczlerce insan\u0131n renal komplikasyonlar ya\u015fad\u0131\u011f\u0131 ve crush yaralanmaya sekonder geli\u015fen akut b\u00f6brek yetmezli\u011fi nedeniyle hemodiyaliz ihtiya\u00e7lar\u0131n\u0131n oldu\u011fu tespit edilmi\u015f. Bu hastalar\u0131n depremden sonraki 16.saatten itibaren 6.haftaya kadar doppler USG ile renal diren\u00e7 indeksleri radyologlar taraf\u0131ndan izlenmi\u015f ve yap\u0131lan \u00f6l\u00e7\u00fcmlerin hemodiyaliz ihtiyac\u0131n\u0131n ve renal yetmezlik prognozunun bir g\u00f6stergesi olabilece\u011fi vurgulanm\u0131\u015f (26). O zamanlarda bile s\u0131n\u0131rl\u0131 g\u00f6r\u00fcnt\u00fcleme kaynaklar\u0131n aktif kullan\u0131m\u0131n\u0131n hem afet esnas\u0131nda hem de afetten g\u00fcnler sonra bile getirdi\u011fi katk\u0131 g\u00f6zler \u00f6n\u00fcne serilmi\u015f. Tabii b\u00fct\u00fcn bunlar hastane s\u0131n\u0131rlar\u0131 i\u00e7erisine getirilebilen hastalarda bildirilmi\u015f. Takip eden s\u00fcre\u00e7te art\u0131k cihazlar hastalara hastane \u00f6ncesi d\u00f6nemde kullan\u0131lmak \u00fczere geli\u015ftirilmeye ba\u015flanm\u0131\u015f. Dean ve arkada\u015flar\u0131 2005 y\u0131l\u0131nda Guatemala\u2019da meydana gelen b\u00fcy\u00fck bir toprak kaymas\u0131 felaketinin ard\u0131ndan yakla\u015f\u0131k 100 hastada tek bir ta\u015f\u0131nabilir bikonveks prob vas\u0131tas\u0131yla pek \u00e7ok anatomik lokasyonu de\u011ferlendirmi\u015f (27). Di\u011fer g\u00f6r\u00fcnt\u00fcleme cihazlar\u0131n\u0131n (bilgisayarl\u0131 tomografi gibi) hasar g\u00f6rd\u00fc\u011f\u00fc y\u0131k\u0131c\u0131 felaketler (deprem, kas\u0131rga, tsunami, sava\u015f gibi) ta\u015f\u0131nabilir USG cihazlar\u0131n\u0131 daha kullan\u0131\u015fl\u0131 olarak \u00f6n plana \u00e7\u0131karm\u0131\u015ft\u0131r (21,28). Hemodinamik a\u00e7\u0131dan stabil, yaral\u0131 hastalarda USG de bulgu olmamas\u0131 bile (negatif E-FAST) ger\u00e7ekten ihtiya\u00e7 duyan hastalar\u0131n BT gibi daha ileri g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemlerine ula\u015ft\u0131r\u0131lmas\u0131 i\u00e7in zaman kazand\u0131r\u0131r. Ya da tam tersi \u015fekilde gereksiz BT taramalar\u0131n\u0131n say\u0131s\u0131n\u0131 da azaltabilir. Yani yap\u0131lm\u0131\u015f olan USG hastalar i\u00e7in bir nevi cihaz triyaj\u0131 bile sa\u011flayabilir.<\/p>\n\n\n\n<p>Travmatik pn\u00f6motoraks tan\u0131s\u0131nda, uzun kemik k\u0131r\u0131klar\u0131n\u0131n tan\u0131s\u0131nda ve tespit sonras\u0131 red\u00fcksiyonunun de\u011ferlendirilmesinde ta\u015f\u0131nabilir USG cihazlar\u0131 giderek pop\u00fcler olmaya ba\u015flad\u0131 (29,30) Daha b\u00fcy\u00fck USG cihazlar\u0131 ta\u015f\u0131nabilir olanlara g\u00f6re daha az kullan\u0131\u015fl\u0131d\u0131r. Biyokimyasal laboratuvar testlerinin olmad\u0131\u011f\u0131 durumlarda bile, ta\u015f\u0131nabilir ultrasonografi cihazlar\u0131 ay\u0131r\u0131c\u0131 tan\u0131n\u0131n daralt\u0131lmas\u0131na veya daha ciddi hastal\u0131klar\u0131n ekarte edilmesine yard\u0131mc\u0131 olabilir (15). Afetzede bir gebe ise, ya da bir \u00e7ocuk ise USG\u2019nin tekrarlanabilir nonradyoaktif bir g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemi olma \u00f6zelli\u011fi klinisyen i\u00e7in adeta bir \u00e7\u0131k\u0131\u015f kap\u0131s\u0131d\u0131r. Kahramanmara\u015f depremindeki 8 ya\u015f\u0131ndaki bir hastaya ait olan USG g\u00f6r\u00fcnt\u00fcs\u00fc <strong>Fig\u00fcr 5<\/strong>\u2019te g\u00f6sterilmi\u015ftir. Katrina Kas\u0131rgas\u0131, New York&#8217;taki 11 Eyl\u00fcl sald\u0131r\u0131lar\u0131, 2006&#8217;daki L\u00fcbnan Sava\u015f\u0131 ve 2010&#8217;daki \u0130ran depreminden sonra FAST, hasta hacminin y\u00fcksek oldu\u011fu d\u00f6nemlerde hastalar\u0131n de\u011ferlendirilmesi ve triyaj\u0131n\u0131n yap\u0131lmas\u0131nda ba\u015far\u0131l\u0131 bulunmu\u015ftur. Afet sonras\u0131 akut d\u00f6nemde hemotoraks\/pn\u00f6motoraks, solid organ yaralanmas\u0131, k\u0131r\u0131klar, gebelik ve vask\u00fcler incelemeler, pediatrik kafa taramalar\u0131 ve intraven\u00f6z eri\u015fim yard\u0131m\u0131n\u0131 kontrol etmek i\u00e7in kullan\u0131labilir (15). Bir klinisyen bir radyolog kadar iyi E-FAST yapabilir mi sorusu akl\u0131n\u0131za gelebilir ancak kendi deneyimlerimden yola \u00e7\u0131karak \u015funu rahatl\u0131kla s\u00f6yleyebilirim ki temel USG e\u011fitimi alm\u0131\u015f bir acilci hele ki s\u00f6z konusu g\u00f6r\u00fcnt\u00fcleme E-FAST ise genellikle sorunsuz tan\u0131 koyabilmekte ve hastay\u0131 y\u00f6netebilmektedir. Kald\u0131 ki bir klinisyen, bir radyoloji asistan\u0131na k\u0131yasla FAST&#8217;i ayn\u0131 duyarl\u0131l\u0131kla ancak daha az \u00f6zg\u00fcll\u00fckle ger\u00e7ekle\u015ftirebilece\u011fi bildirilmi\u015ftir (15).<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"907\" height=\"285\" src=\"https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim7.png\" alt=\"\" class=\"wp-image-1510\" srcset=\"https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim7.png 907w, https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim7-300x94.png 300w, https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim7-768x241.png 768w, https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/07\/Resim7-585x184.png 585w\" sizes=\"(max-width: 907px) 100vw, 907px\" \/><\/figure>\n\n\n\n<p><strong>Fig\u00fcr 5.<\/strong> Kar\u0131n i\u00e7i kanama. Hasta 12 saat boyunca deprem enkaz\u0131nda mahsur kald\u0131. Sekiz ya\u015f\u0131nda erkek \u00e7ocuk, Travma ultrasonografi g\u00f6r\u00fcnt\u00fcleri i\u00e7in Sonografi ile Odaklanm\u0131\u015f De\u011ferlendirme. (a) Alt kar\u0131n kadran\u0131n\u0131n aksiyal g\u00f6r\u00fcn\u00fcm\u00fc, inframezokolik ba\u011f\u0131rsak anslar\u0131 aras\u0131nda \u00e7oklu i\u00e7 ekojenitelere sahip yayg\u0131n serbest s\u0131v\u0131 g\u00f6r\u00fcl\u00fcyor (ince oklar); (b, c) daha alt b\u00f6l\u00fcmlerde, alt kar\u0131n\/pelvik b\u00f6lgede \u00e7ok say\u0131da i\u00e7 ekojeniteye sahip serbest s\u0131v\u0131 (ince oklar). Kanama i\u00e7inde s\u0131v\u0131-s\u0131v\u0131 dengelemesi (kal\u0131n oklar) (15).<\/p>\n\n\n\n<div class=\"wp-block-group is-vertical is-layout-flex wp-container-core-group-is-layout-8cf370e7 wp-block-group-is-layout-flex\">\n<h2 class=\"wp-block-heading\">&#8211;<em>Peki ya hastalar radyoloji \u00fcnitesine g\u00f6r\u00fcnt\u00fcleme i\u00e7in gidemeyecek durumda ise?<\/em><\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">&#8211;<em>Peki ya radyoloji \u00fcnitesi kullan\u0131lamayacak durumda ise?<\/em><\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">&#8211;<em>Peki ya elektrik kesintisi varsa?<\/em><\/h2>\n<\/div>\n\n\n\n<p>Portabl konvansiyonel radyografi ve ultrasonografi pil \u00f6mr\u00fc elverdi\u011fi \u00f6l\u00e7\u00fcde elektrik kesintisi durumunda klinisyenin i\u015fini kolayla\u015ft\u0131r\u0131r. Portabl BT cihazlar\u0131 da hastane i\u00e7erisinde ameliyathane dahil pek \u00e7ok \u00fcniteye gidebilmekte ve hasta transferi ya da enfeksiyon kontrol\u00fc ile ilgili handikaplar\u0131n \u00f6n\u00fcne ge\u00e7ebilmektedir (31). Bunlar\u0131n haricinde ara\u00e7lar\u0131n i\u00e7erisine yerle\u015ftirilmi\u015f mobil BT ve manyetik rezonans g\u00f6r\u00fcnt\u00fcleme (MRG) \u00fcniteleri de kullan\u0131\u015fl\u0131 olabilir.<\/p>\n\n\n\n<p>Ortamda kullan\u0131labilecek hastane de olmayabilir ki bu durumda kullan\u0131lan spor salonlar\u0131, oteller, okullar ya da yeni kurulacak \u00e7ad\u0131r\/prefabrik hastaneler alternatif hasta bak\u0131m alanlar\u0131 olabilir. T\u0131bbi g\u00f6r\u00fcnt\u00fcleme altyap\u0131s\u0131n\u0131n olmad\u0131\u011f\u0131 bu yerlerde portabl cihazlar olduk\u00e7a kullan\u0131\u015fl\u0131 olacakt\u0131r.<\/p>\n\n\n\n<p>Zamansal a\u00e7\u0131dan klinik aciliyet arz eden durumlarda, mesafenin fazla oldu\u011fu ya da hastaneye ula\u015f\u0131m\u0131n k\u0131s\u0131tl\u0131 oldu\u011fu durumlarda hasta g\u00f6r\u00fcnt\u00fclemeye gelemiyorsa, g\u00f6r\u00fcnt\u00fcleme hastaya gidebilir. Bunu mobil inme \u00fcnitelerinin kullan\u0131m\u0131 ile zaten s\u0131k\u00e7a g\u00f6rd\u00fck (32,33). Benzeri mobil \u00fcniteler, beraberinde ya da uzaktan radyolog\/klinisyen deste\u011fi al\u0131rsa (teleradyoloji) olduk\u00e7a efektif \u015fekilde kullan\u0131labilir. Teleradyolojiyi yak\u0131n tarihte COVID-19 pandemisinde enfeksiyon ortam\u0131ndan uzak kalarak evlerinden raporlama yapan radyologlarda net bir \u015fekilde izleme f\u0131rsat\u0131 bulduk. Evden t\u0131bbi g\u00f6r\u00fcnt\u00fcleme raporland\u0131rmas\u0131 k\u0131lavuzlara dahi girmi\u015f, radyologlar\u0131n i\u015f stresini azaltm\u0131\u015f ancak meslekta\u015flar\u0131 ile olan ili\u015fkilerini bozmu\u015ftur (<em>hangi meslekta\u015flar\u0131 acaba? <\/em>\ud83d\ude0a) (34). Kahramanmara\u015f depremlerinde de radyologlar ya afet alanlar\u0131nda, ya teleradyoloji deste\u011fi vererek ya da hastalar\u0131n kabul edildi\u011fi \u00fc\u00e7\u00fcnc\u00fc basamak hastanelerde g\u00f6rev alarak afetlerdeki t\u0131bbi g\u00f6r\u00fcnt\u00fclemelere katk\u0131 sa\u011flad\u0131lar (35).<\/p>\n\n\n\n<p>Afetler sonras\u0131 meydana gelen \u00f6l\u00fcmler afetlerin tipine g\u00f6re (<strong>Fig\u00fcr 1<\/strong>) de\u011fi\u015fkenlik g\u00f6stermektedir. \u00d6rneklendirmelerimizi genellikle depremler \u00fczerinden veriyoruz \u00e7\u00fcnk\u00fc depremler t\u00fcm d\u00fcnyadaki en \u00f6l\u00fcmc\u00fcl afetler olarak g\u00f6r\u00fclmektedir. Depremler sonras\u0131 en s\u0131k \u00f6l\u00fcm nedeninin travmatik yaralanmalar oldu\u011fu, \u00f6l\u00fcm\/yaralanma oran\u0131n\u0131n 1\/3-4 oldu\u011fu bilinmektedir (36). Bir deprem felaketinde ani \u00f6l\u00fcmlerin genel olarak deprem sonras\u0131 meydana gelen beyin ve omurilik hasarlanmas\u0131 sonucu meydana geldi\u011fi bilinmektedir. Ancak tedavi edilmeksizin birka\u00e7 saat ya\u015fayabilen, tedavi ile kurtar\u0131labilme ihtimali olan hastalar vard\u0131r ki onlarda da \u00f6l\u00fcm\u00fcn temel sebebi genellikle travmatik intrakraniyal kanamalar, karaci\u011fer\/dalak laserasyonlar\u0131 ve pelvik k\u0131r\u0131klar olarak g\u00f6r\u00fcl\u00fcr. Takip eden s\u00fcre\u00e7te meydana gelen \u00f6l\u00fcmler ise daha \u00e7ok enfeksiyonlara sekonder geli\u015fen sepsis, \u00e7oklu organ yetmezlikleri ve yayg\u0131n damar i\u00e7i p\u0131ht\u0131la\u015fma sebebiyledir (15). Yine de depreme ba\u011fl\u0131 travmatik yaralanmalar\u0131n en s\u0131k ekstremitelerde \u00f6zellikle de alt ekstremitelerde oldu\u011fu bilinmektedir. Ekstremite travmalar\u0131n\u0131 s\u0131kl\u0131k s\u0131ras\u0131na g\u00f6re toraks travmalar\u0131, omurilik yaralanmalar\u0131, pelvik k\u0131r\u0131klar, kraniyal ve maksillofasiyal travma birlikteli\u011fi ve bat\u0131n travmalar\u0131 takip etmektedir (37). <em>Hangi afetlerde hangi yaralanma \u015fekli en s\u0131k g\u00f6r\u00fclmekte? Hangileri en \u00f6l\u00fcmc\u00fcl yaralanmalar?<\/em> vs. sorular\u0131n\u0131n cevaplar\u0131 \u00f6nceden bilinirse afetzedelere y\u00f6nelik g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemlerinin de en uygunu se\u00e7ilebilecektir. En s\u0131k k\u0131r\u0131lan alt ekstremite kemi\u011finin femur oldu\u011fu, ikinci s\u0131rada tibia \u015faft ve ayak bile\u011fi k\u0131r\u0131klar\u0131n\u0131n oldu\u011funu; humerusun en s\u0131k hasarlanan \u00fcst ekstremite kemi\u011fi oldu\u011funu; frakt\u00fcrlerin genel olarak par\u00e7al\u0131 frakt\u00fcrler oldu\u011funu; \u00e7ocuklarda da benzer durumlar\u0131n s\u00f6z konusu oldu\u011funu; pelvik k\u0131r\u0131klar\u0131n genellikle \u00e7oklu kemik ve bilateral olarak g\u00f6r\u00fcld\u00fc\u011f\u00fcn\u00fc; maksillofasiyal travmalar ile kafatas\u0131 k\u0131r\u0131klar\u0131n\u0131n birlikteli\u011finin s\u0131k oldu\u011funu; kompartman sendromunun s\u0131k\u00e7a g\u00f6r\u00fcld\u00fc\u011f\u00fcn\u00fc ve gerekirse vask\u00fcler g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemleriyle (BT anjiografi, Doppler USG gibi) damar l\u00fcmenindeki daralmalar\u0131n tespit edilebilece\u011fini bilmek en az\u0131ndan klinisyene hasta y\u00f6netimi i\u00e7in g\u00f6r\u00fcnt\u00fclemenin planlanma a\u015famas\u0131nda bir \u00f6ng\u00f6r\u00fcc\u00fc pencere a\u00e7abilir.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><em>\u00d6<\/em>zetle<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><em>Afetlerdeki g\u00f6r\u00fcnt\u00fclemeler afetzedelere ait patolojilerin tan\u0131nmas\u0131 i\u00e7in gereklidir, bu nedenle afet durumlar\u0131ndaki t\u0131bbi g\u00f6r\u00fcnt\u00fclemelerin planlanmas\u0131 kendine has bamba\u015fka bir konu olarak de\u011ferlendirilmelidir.<\/em><\/li>\n\n\n\n<li><em>Afet durumunda g\u00f6r\u00fcnt\u00fclemeye h\u00e2kim olmak i\u00e7in, afet tiplerine ve hangi afet ya da kitleleri etkileyen durumlar kar\u015f\u0131s\u0131nda ne tipte patolojiler olabilece\u011fine \u00f6nceden h\u00e2kim olmak gerekir.<\/em><\/li>\n\n\n\n<li><em>Afetlerde hastalar\u0131n kimliklendirilmesi, t\u0131bbi g\u00f6r\u00fcnt\u00fclemelerinin e\u015fle\u015ftirilmesi a\u00e7\u0131s\u0131ndan da olduk\u00e7a \u00f6nemli ve gereklidir.<\/em><\/li>\n\n\n\n<li><em>Afetlerdeki sistemsel ar\u0131zalar, g\u00f6r\u00fcnt\u00fcleme sonu\u00e7lar\u0131n\u0131n raporland\u0131r\u0131lmas\u0131 a\u015famas\u0131nda problem olu\u015fturabilir; bu durumda \u00e7oklu manuel yaz\u0131labilen karbon kopya ka\u011f\u0131tlar\u0131n\u0131n olmas\u0131 klinisyene yard\u0131mc\u0131 olacakt\u0131r.<\/em><\/li>\n\n\n\n<li><em>Afetlerde en s\u0131k kullan\u0131lan g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemi bilgisayarl\u0131 tomografi ve konvansiyonel radyografidir. Ancak portabl ultrasonografi hastane \u00f6ncesi d\u00f6nemde de rahatl\u0131kla kullan\u0131labildi\u011fi ba\u015fta travmaya odakl\u0131 de\u011ferlendirme olmak \u00fczere pek \u00e7ok patolojinin tan\u0131nmas\u0131nda giderek pop\u00fcler olmaktad\u0131r.<\/em><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Kaynaklar<\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Gibney BT, Roberts JM, D&#8217;Ortenzio RM, et al. Preventing and Mitigating Radiology System Failures: A Guide to Disaster Planning.\u00a0<em>Radiographics<\/em>. 2021;41(7):2111-2126. doi:10.1148\/rg.2021210083<\/li>\n\n\n\n<li>Desjardins B, Mirsky Y, Ortiz MP, et al. DICOM Images Have Been Hacked! Now What?.\u00a0<em>AJR Am J Roentgenol<\/em>. 2020;214(4):727-735. doi:10.2214\/AJR.19.21958<\/li>\n\n\n\n<li>Ferrara S. Radiology afloat: The impact of diagnostic and interventional radiology during the 2005 tsunami relief effort aboard the USNS Mercy.\u00a0<em>J Vasc Interv Radiol<\/em>. 2009;20(3):289-302. doi:10.1016\/j.jvir.2008.10.026<\/li>\n\n\n\n<li>Bolster F, Linnau K, Mitchell S, et al. Emergency radiology and mass casualty incidents-report of a mass casualty incident at a level 1 trauma center.\u00a0<em>Emerg Radiol<\/em>. 2017;24(1):47-53. doi:10.1007\/s10140-016-1441-y<\/li>\n\n\n\n<li>Bookman K, Zane R. Expedited electronic entry: a new way to manage mass-casualty radiology order workflow.\u00a0<em>Prehosp Disaster Med<\/em>. 2013;28(4):391-392. doi:10.1017\/S1049023X13003488<\/li>\n\n\n\n<li>Craigie RJ, Farrelly PJ, Santos R, Smith SR, Pollard JS, Jones DJ. Manchester Arena bombing: lessons learnt from a mass casualty incident.\u00a0<em>BMJ Mil Health<\/em>. 2020;166(2):72-75. doi:10.1136\/jramc-2018-000930<\/li>\n\n\n\n<li>Gonzalez JF, Thomas J, Decroocq L, et al. The 14 July 2016 terrorist attack in Nice: The experience of orthopaedic surgeons.\u00a0<em>Orthop Traumatol Surg Res<\/em>. 2019;105(3):505-511. doi:10.1016\/j.otsr.2019.02.009<\/li>\n\n\n\n<li>Sen D. Coping in a calamity: Radiology during the cloudburst at Leh.\u00a0<em>Indian J Radiol Imaging<\/em>. 2013;23(1):106-109. doi:10.4103\/0971-3026.113629<\/li>\n\n\n\n<li>O&#8217;Neill SB, Gibney B, O&#8217;Keeffe ME, Barrett S, Louis L. Mass Casualty Imaging-Policy, Planning, and Radiology Response to Mass Casualty Incidents.\u00a0<em>Can Assoc Radiol J<\/em>. 2020;71(3):388-395. doi:10.1177\/0846537120908073<\/li>\n\n\n\n<li>Gibney B, Ryan JW, MacMahon PJ, O&#8217;Connor GS, Bolster F. Assessment of RAdiopaque Patient IDentification Stickers (RAPIDS) for patient-scan correlation in a mass casualty incident.\u00a0<em>Emerg Radiol<\/em>. 2020;27(3):293-301. doi:10.1007\/s10140-020-01761-w<\/li>\n\n\n\n<li>Gong B, Mohammed MF, Nicolaou S, Nasrullah M, Forster BB, Khosa F. Diagnostic Imaging in Disasters: A Bibliometric Analysis.\u00a0<em>Disaster Med Public Health Prep<\/em>. 2018;12(2):265-277. doi:10.1017\/dmp.2017.52<\/li>\n\n\n\n<li>Singh AK, Sodickson A, Abujudeh H. Imaging of abdominal and pelvic injuries from the Boston Marathon bombing.\u00a0<em>Emerg Radiol<\/em>. 2016;23(1):35-39. doi:10.1007\/s10140-015-1354-1<\/li>\n\n\n\n<li>Konwinski RR, Singh A, Soto J. Imaging of lower extremity trauma from Boston Marathon bombing.\u00a0<em>Emerg Radiol<\/em>. 2016;23(5):433-437. doi:10.1007\/s10140-016-1414-1<\/li>\n\n\n\n<li>Gregan J, Balasingam A, Butler A. Radiology in the Christchurch earthquake of 22 February 2011: Challenges, interim processes and clinical priorities.\u00a0<em>J Med Imaging Radiat Oncol<\/em>. 2016;60(2):172-181. doi:10.1111\/1754-9485.12315<\/li>\n\n\n\n<li>Aydin S, Kazci O, Ece B, Kantarci M. Earthquakes from a radiological perspective: what is demanded from the radiologists, and what can we do? A pictorial review.\u00a0<em>Diagn Interv Radiol<\/em>. 2024;30(1):30-41. doi:10.4274\/dir.2023.232157<\/li>\n\n\n\n<li>Kakaei F, Zarrintan S, Rikhtegar R, Yaghoubi AR. Iranian 2012 earthquake: the importance of Focused Assessment with Sonography for Trauma (FAST) in assessing a huge mass of injured people.\u00a0<em>Emerg Radiol<\/em>. 2013;20(4):307-308. doi:10.1007\/s10140-013-1123-y<\/li>\n\n\n\n<li>Sedlic A, Chingkoe CM, Tso DK, Galea-Soler S, Nicolaou S. Rapid imaging protocol in trauma: a whole-body dual-source CT scan.\u00a0<em>Emerg Radiol<\/em>. 2013;20(5):401-408. doi:10.1007\/s10140-013-1139-3<\/li>\n\n\n\n<li>Stavrakakis IM, Daskalakis II, Detsis EPS, Karagianni CA, Papantonaki SN, Katsafarou MS. Hand compartment syndrome as a result of intravenous contrast extravasation.\u00a0<em>Oxf Med Case Reports<\/em>. 2018;2018(12):omy098. Published 2018 Nov 21. doi:10.1093\/omcr\/omy098<\/li>\n\n\n\n<li>Tran NK, Godwin Z, Bockhold J. Point-of-Care Testing at the Disaster-Emergency-Critical Care Interface.\u00a0<em>Point Care<\/em>. 2012;11(4):180-183. doi:10.1097\/POC.0b013e318265f7d9<\/li>\n\n\n\n<li>American College of Surgeons. Advanced Trauma Life Support for Physicians. Chicago: American College of Surgeons; 1997.<\/li>\n\n\n\n<li>Sajed D. The History of Point-of-Care Ultrasound Use in Disaster and Mass Casualty Incidents.\u00a0<em>Virtual Mentor<\/em>. 2010;12(9):744-749. Published 2010 Sep 1. doi:10.1001\/virtualmentor.2010.12.9.mhst1-1009<\/li>\n\n\n\n<li>Ketelaars R, Reijnders G, van Geffen GJ, Scheffer GJ, Hoogerwerf N. ABCDE of prehospital ultrasonography: a narrative review.\u00a0<em>Crit Ultrasound J<\/em>. 2018;10(1):17. Published 2018 Aug 8. doi:10.1186\/s13089-018-0099-y<\/li>\n\n\n\n<li>Gao X, Lv Q, Hou S. Progress in the Application of Portable Ultrasound Combined with Artificial Intelligence in Pre-Hospital Emergency and Disaster Sites.\u00a0<em>Diagnostics (Basel)<\/em>. 2023;13(21):3388. Published 2023 Nov 6. doi:10.3390\/diagnostics13213388<\/li>\n\n\n\n<li><a href=\"https:\/\/tuk.saglik.gov.tr\/TR,50050\/acil-tip.html\">https:\/\/tuk.saglik.gov.tr\/TR,50050\/acil-tip.html<\/a><\/li>\n\n\n\n<li>Sarkisian AE, Khondkarian RA, Amirbekian NM, Bagdasarian NB, Khojayan RL, Oganesian YT. Sonographic screening of mass casualties for abdominal and renal injuries following the 1988 Armenian earthquake.\u00a0<em>J Trauma<\/em>. 1991;31(2):247-250.<\/li>\n\n\n\n<li>Keven K, Ates K, Ya\u011fmurlu B, et al. Renal Doppler ultrasonographic findings in earthquake victims with crush injury.\u00a0<em>J Ultrasound Med<\/em>. 2001;20(6):675-679. doi:10.7863\/jum.2001.20.6.675<\/li>\n\n\n\n<li>Dean AJ, Ku BS, Zeserson EM. The utility of handheld ultrasound in an austere medical setting in Guatemala after a natural disaster.\u00a0<em>Am J Disaster Med<\/em>. 2007;2(5):249-256.<\/li>\n\n\n\n<li>Mazur SM, Rippey J. Transport and use of point-of-care ultrasound by a disaster medical assistance team.\u00a0<em>Prehosp Disaster Med<\/em>. 2009;24(2):140-144. doi:10.1017\/s1049023x00006701<\/li>\n\n\n\n<li>Du MJ, Lin YH, Chen WT, Zhao H. Advances in the application of ultrasound for fracture diagnosis and treatment.\u00a0<em>Eur Rev Med Pharmacol Sci<\/em>. 2022;26(21):7949-7954. doi:10.26355\/eurrev_202211_30146<\/li>\n\n\n\n<li>Savoia P, Jayanthi SK, Chammas MC. Focused Assessment with Sonography for Trauma (FAST).\u00a0<em>J Med Ultrasound<\/em>. 2023;31(2):101-106. Published 2023 Jun 19. doi:10.4103\/jmu.jmu_12_23<\/li>\n\n\n\n<li>Bates DDB, Vintonyak A, Mohabir R, et al. Use of a portable computed tomography scanner for chest imaging of COVID-19 patients in the urgent care at a tertiary cancer center.\u00a0<em>Emerg Radiol<\/em>. 2020;27(6):597-600. doi:10.1007\/s10140-020-01801-5<\/li>\n\n\n\n<li>Nair R, Rempel J, Khan K, et al. Direct to Angiosuite in Acute Stroke with Mobile Stroke Unit.\u00a0<em>Can J Neurol Sci<\/em>. 2024;51(2):226-232. doi:10.1017\/cjn.2023.36<\/li>\n\n\n\n<li>Fatima N, Saqqur M, Hussain MS, Shuaib A. Mobile stroke unit versus standard medical care in the management of patients with acute stroke: A systematic review and meta-analysis.\u00a0<em>Int J Stroke<\/em>. 2020;15(6):595-608. doi:10.1177\/1747493020929964<\/li>\n\n\n\n<li>Quraishi MI, Rizvi AA, Heidel RE. Off-Site Radiology Workflow Changes Due to the Coronavirus Disease 2019 (COVID-19) Pandemic.\u00a0<em>J Am Coll Radiol<\/em>. 2020;17(7):878-881. doi:10.1016\/j.jacr.2020.05.008<\/li>\n\n\n\n<li>Erdemir AG, Yurttutan N, Onur MR, et al. Radiological management and challenges of the twin earthquakes of February 6th.\u00a0<em>Emerg Radiol<\/em>. 2023;30(5):659-666. doi:10.1007\/s10140-023-02162-5<\/li>\n\n\n\n<li>Bartholdson S, von Schreeb J. Natural Disasters and Injuries: What Does a Surgeon Need to Know?.\u00a0<em>Curr Trauma Rep<\/em>. 2018;4(2):103-108. doi:10.1007\/s40719-018-0125-3<\/li>\n\n\n\n<li>Dong ZH, Yang ZG, Chu ZG, et al. Earthquake-related injuries: evaluation with multidetector computed tomography and digital radiography of 1491 patients.\u00a0<em>J Crit Care<\/em>. 2012;27(1):103.e1-103.e1036. doi:10.1016\/j.jcrc.2011.03.007<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Sorular Hadi \u015fimdi bu sorular\u0131n yan\u0131tlar\u0131n\u0131 vermeye \u00e7al\u0131\u015fal\u0131m &gt;&gt;&gt; Giri\u015f Acil servisteki n\u00f6betiniz esnas\u0131nda bilgisayarl\u0131 tomografinin (BT) bozuldu\u011funu d\u00fc\u015f\u00fcn\u00fcn. Bu durum bile&hellip;<\/p>\n","protected":false},"author":1927,"featured_media":1511,"comment_status":"open","ping_status":"open","sticky":true,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[10043],"tags":[10082,10059,10053,10079,10107],"class_list":["post-1503","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-afet-yazi-dizisi","tag-6-subat-kahramanmaras-depremleri","tag-afet","tag-afet-tibbi","tag-afet-yonetimi","tag-goruntuleme"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/posts\/1503","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/users\/1927"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/comments?post=1503"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/posts\/1503\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/media\/1511"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/media?parent=1503"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/categories?post=1503"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/tags?post=1503"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}