{"id":548,"date":"2022-06-15T06:15:26","date_gmt":"2022-06-15T03:15:26","guid":{"rendered":"https:\/\/tatd.org.tr\/afet\/?p=548"},"modified":"2022-06-13T20:21:44","modified_gmt":"2022-06-13T17:21:44","slug":"afetlerde-multitravma-yonetimi","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/afet\/afet-yazi-dizisi\/afetlerde-multitravma-yonetimi\/","title":{"rendered":"Afetlerde Multitravma Y\u00f6netimi"},"content":{"rendered":"

Afet komisyonumuz taraf\u0131ndan haz\u0131rlanan, afetlerde y\u00f6netim i\u00e7in \u00f6neriler ve g\u00fcncel bilgiler \u0131\u015f\u0131\u011f\u0131nda bu ay yaz\u0131m\u0131zda da amac\u0131m\u0131z acil t\u0131p hekimleri olarak a\u015fina oldu\u011fumuz multitravma hastalar\u0131n\u0131 afet perspektifinde nas\u0131l y\u00f6netebilece\u011fimiz hakk\u0131nda fikirlerimizi g\u00f6zden ge\u00e7irece\u011fiz.<\/p>\n

Tan\u0131m\u0131 itibari ile multitravma, birden \u00e7ok sistemde travma ile karakterizedir. Acil servislerde g\u00fcnl\u00fck hayatta s\u0131k\u00e7a trafik kazas\u0131, y\u00fcksekten d\u00fc\u015fme, ate\u015fli silah yaralanmas\u0131 gibi mekanizmalarla meydana gelen multitravma vakalar\u0131yla kar\u015f\u0131la\u015fmaktay\u0131z. Afetlerde kar\u015f\u0131m\u0131za gelecek olan multitravma hastalar\u0131n\u0131n da yaralanma mekanizmas\u0131na ba\u011fl\u0131 olarak farkl\u0131 t\u00fcr ve sistemlerde olaya \u00f6zel yaralanma \u00e7e\u015fitleri ile ve crush sendromu gibi e\u015flik eden patolojilerle kar\u015f\u0131m\u0131za gelece\u011fini ak\u0131lda bulundurmak gerekecektir. Mekanizma, bulunulan \u00e7evre, yaral\u0131 say\u0131s\u0131 gibi afet \u00f6zelliklerini bilmek acil servisi daha etkin kullanmak ve triaj planlamas\u0131 ve hasta y\u00f6netimi a\u00e7\u0131s\u0131ndan elzemdir.<\/p>\n

\"\"<\/p>\n

Acil t\u0131p e\u011fitiminde ve prati\u011finde yayg\u0131n olarak kulland\u0131\u011f\u0131m\u0131z ATLS prensipleri afet sonucunda kar\u015f\u0131m\u0131za gelen travma hastalar\u0131 i\u00e7in de ge\u00e7erlidir. Ancak afetlerde spesifik mekanizma ve sonu\u00e7lara dair bilgi ve beklentilerimizi de bu prensiplere eklemek gerekecektir. Patlama yaralanmalar\u0131 \u00f6rne\u011fi ile incelemek gerekir ise patlay\u0131c\u0131 t\u00fcr\u00fc, bulunulan ortam, patlama b\u00f6lgesine uzakl\u0131k gibi fakt\u00f6rler ile yaralanma mekanizmalar\u0131n\u0131n bilinmesi kar\u015f\u0131lad\u0131\u011f\u0131m\u0131z hastalarda beklenen patolojileri \u00f6n g\u00f6rmek ve h\u0131zl\u0131 hareket edebilmek a\u00e7\u0131s\u0131ndan bize yard\u0131mc\u0131 olacakt\u0131r.<\/p>\n

Afet t\u0131bb\u0131 yaz\u0131 serilerinde ge\u00e7ti\u011fimiz ba\u015fl\u0131k afet triaj\u0131 idi. Yaz\u0131da \u00e7ok ki\u015fiyi i\u00e7eren yaralanmalarda kaynaklar\u0131m\u0131zla afetzedelere en iyi fayday\u0131 nas\u0131l sa\u011flayabilece\u011fimiz tart\u0131\u015f\u0131lm\u0131\u015ft\u0131. Hastane \u00f6ncesinde triaj ve ilk yard\u0131m uygulamalar\u0131 sonras\u0131nda hastalar\u0131n uygun merkezlere nakli sa\u011flanmal\u0131d\u0131r. Sa\u011fl\u0131k kurumlar\u0131na ula\u015f\u0131ld\u0131\u011f\u0131nda hastalar\u0131n yeniden triaj\u0131 yap\u0131lmaktad\u0131r. \u00d6nceki yaz\u0131m\u0131zda tart\u0131\u015f\u0131lan triaj sistemlerinde multitravma hastalar\u0131 acil\/k\u0131rm\u0131z\u0131 veya bekletilebilir\/sari kategoride yer alabilir. Yine de afet sonras\u0131 ba\u015fvurularda hastalar\u0131n %20 kadar\u0131n\u0131n hastanelerde yat\u0131r\u0131larak izlendi\u011fi, bunlar\u0131n da bir k\u0131sm\u0131n\u0131n yaralanma ciddiyetinden de\u011fil, sadece afetzede olduklar\u0131ndan bir geceli\u011fine de olsa yat\u0131r\u0131larak izlenmi\u015f oldu\u011fu belirtilmi\u015ftir. \u00a0Bu noktada acil t\u0131p uzmanl\u0131\u011f\u0131n\u0131n amac\u0131 afet halindeki s\u0131n\u0131rl\u0131 kaynaklarla gereken acil t\u0131bbi yard\u0131m\u0131 sa\u011flamak ve gereksiz kaynak t\u00fcketimini engellemek olmal\u0131d\u0131r.<\/p>\n

Afet \u00e7e\u015fidine, ili\u015fkili hastalar\u0131n ba\u015fvuru zamanlar\u0131na ba\u011fl\u0131 olarak hastalar\u0131n interne edildi\u011fi kliniklerin farkl\u0131 oldu\u011fu izlenmektedir. \u00d6rne\u011fin 1999 Marmara depremi ile 2011 y\u0131l\u0131nda ger\u00e7ekle\u015fen Van depremlerinde hastalar\u0131n \u00f6nemli oranda ortopedi ve travmatoloji kliniklerinde izlendi\u011fi veya ortopedik ameliyatlara ihtiya\u00e7 duydu\u011fu belirtilmi\u015ftir. Torasik, abdominal, kranial, maksilofasyal yaralanmalar gibi ek yaralanmalar da bu kliniklerde yatan hastalar i\u00e7in olu\u015fturulacak travma timleri ile takip edilebilmelidir.<\/p>\n

Sa\u011fl\u0131k kurulu\u015funa kardiyak arrest olarak geitirilen veya hastane i\u00e7erisinde kardiyak arrest geli\u015fen olgularda ciddi s\u00fcre, ekipman ve insan g\u00fcc\u00fc ile ROSC sa\u011flanabilmektedir. \u00c7ok say\u0131da afetzede olan ve s\u0131n\u0131rl\u0131 kaynaklar ile ba\u015fedilen afet durumlar\u0131nda, res\u00fcsitasyon i\u015flemi afet t\u00fcr\u00fcne ve hastan\u0131n arrest s\u00fcresi gibi durumlara g\u00f6re de\u011fi\u015febilmektedir. \u00d6rne\u011fin \u00e7\u0131\u011f yaralanmalar\u0131nda hipoterminin varl\u0131\u011f\u0131, g\u00f6m\u00fclme s\u00fcresi gibi durumlar g\u00f6z\u00f6n\u00fcnde bulundurularak k\u0131lavuzlara g\u00f6re res\u00fcsitasyon i\u015flemleri y\u00f6netilebilir. Ancak yine de t\u00fcm afetlere y\u00f6nelik genel bir res\u00fcsitasyon s\u00fcresi \u00f6nerisi bulunmamaktad\u0131r.<\/p>\n

\"\"<\/p>\n

Resim-1: Kaynak: trthaber.com\/haber<\/p>\n

Afet yaralanmalar\u0131nda tek hayati tehlike olu\u015fturabilecek durum mekanik etkilerle geli\u015fen yaralanmalar olmayabilir. \u00d6rne\u011fin yang\u0131nlarda inhalasyon yaralanmas\u0131na ek olarak ciddi yan\u0131klar olabilece\u011fi gibi, b\u00fct\u00fcnl\u00fc\u011f\u00fcn\u00fc kaybeden binalar\u0131n sebep olaca\u011f\u0131 ezilme yaralanmalar\u0131n\u0131n e\u015flik etmesi olas\u0131d\u0131r. Major yan\u0131klar\u0131n gerekli tedavisi, s\u0131v\u0131 res\u00fcsitasyonu, b\u00f6brek fonskiyonlar\u0131n\u0131n takibi, havayolu y\u00f6netiminin sa\u011flanmas\u0131 mekanik travmalar\u0131n y\u00f6netimi ile e\u015f zamanl\u0131 sa\u011flan\u0131r. Tsunamide bo\u011fulma hastalar\u0131n\u0131n akci\u011fer yaralanmalar\u0131n\u0131n \u00f6tesinde s\u00fcr\u00fcklenen nesnelerle mekanik yaralanmalara maruz kalmas\u0131 hi\u00e7 de nadir olmayacakt\u0131r. \u00c7\u0131\u011f felaketlerinde g\u00f6m\u00fclmeler hipotermi ve asfiksi ile dola\u015f\u0131m bozukluklar\u0131 ve kardiyak arreste sebep olmaktad\u0131r. Her t\u00fcrl\u00fc afette geli\u015febilecek s\u0131k\u0131\u015fma durumlar\u0131nda ortaya \u00e7\u0131kabilecek crush sendromu ile renal yetmezlik geli\u015fen hastalara zaman\u0131nda hemodiyaliz uygulamas\u0131 yap\u0131lmas\u0131 i\u00e7in yak\u0131n takip ve planlama sa\u011flanmal\u0131d\u0131r.<\/p>\n

K\u0131saca afet sonras\u0131 acil servis ortam\u0131nda kar\u015f\u0131lad\u0131\u011f\u0131m\u0131z multitravma hastalar\u0131 i\u00e7in \u00f6nerilemiz \u015f\u00f6yle s\u0131ralanabilir:<\/p>\n

    \n
  1. Afetlere haz\u0131r bulunu\u015fluk sa\u011flanmal\u0131: Toplumsal ve kurumsal haz\u0131rl\u0131klar, afet fark\u0131ndal\u0131\u011f\u0131n\u0131n olu\u015fturulmu\u015f olmas\u0131 \u00fclkemizin de s\u0131k\u00e7a ya\u015fad\u0131\u011f\u0131 ve afet riskinin y\u00fcksek oldu\u011fu co\u011frafyam\u0131zda afet an\u0131nda uygun refleksleri sa\u011flayacakt\u0131r.<\/li>\n
  2. Afet an\u0131nda hastane \u00f6ncesi alan i\u00e7in belirlenen triaj ve ilk yard\u0131m uygulamalar\u0131 ger\u00e7ekle\u015ftirilmelidir. Nakil ihtiyac\u0131 olan hastalar uygun \u015fekilde sa\u011fl\u0131k kurulu\u015funa nakledilmelidir.<\/li>\n
  3. Sa\u011fl\u0131k kurulu\u015flar\u0131na hastalar\u0131n transport sa\u011flanmadan \u00f6nce olay \u015fekli, b\u00fcy\u00fckl\u00fc\u011f\u00fc, beklenen yaral\u0131 say\u0131s\u0131, yaralanma mekanizmas\u0131 ve varsa e\u015flik eden riskli durumlar aktar\u0131lmal\u0131d\u0131r. Hastane afet planlar\u0131na g\u00f6re uygun \u00f6nlemler al\u0131nmal\u0131 ve gereken m\u00fcdahale timleri active edilmelidir.<\/li>\n
  4. Temel triaj uygulamalar\u0131 sa\u011fl\u0131k kurulu\u015funda da yap\u0131lmal\u0131d\u0131r.<\/li>\n
  5. Multitravma hastalar\u0131n\u0131n ATLS \u00f6nerilerine g\u00f6re de\u011ferlendirilmesi yap\u0131lmal\u0131, mevcut kaynaklar g\u00f6z \u00f6n\u00fcnde bulundurularak acil serviste gereken m\u00fcdahalelerin ard\u0131ndan definitif tedavisini sa\u011flamak \u00fczere h\u0131zla ameliyathane\/yo\u011fun bak\u0131m veya servislere nakli sa\u011flanmal\u0131d\u0131r.<\/li>\n
  6. Afet t\u00fcr\u00fcne ve klinik duruma g\u00f6re kardiyak arrest geli\u015fen hastalarda res\u00fcsitasyon s\u00fcresi k\u0131lavuzlara, ya\u015fam beklentisine g\u00f6re de\u011ferlendirilmeli, ya\u015fam beklentisi bulunmuyorsa afet an\u0131nda daha faydal\u0131 olunabilecek di\u011fer yaral\u0131lar\u0131n bak\u0131m\u0131na ge\u00e7ilebilmelidir.<\/li>\n<\/ol>\n

    Kaynaklar:<\/p>\n

      \n
    1. Bulut M, Turano\u011flu G, Arma\u011fan E, Akk\u00f6se S, Ozg\u00fc\u00e7 H, Tokyay R. The analysis of traumatized patients who were admitted to the Uludag University Medical School Hospital after the Marmara earthquake, Ulus Travma Derg.\u00a02001;7:262\u2013266<\/li>\n
    2. Disaster medicine. Editors, David E. Hogan, Jonathan L. Burstein.\u20132nd ed. Lippincot Williams and Wilkins 2007<\/li>\n
    3. Kurt N, K\u00fc\u00e7\u00fck HF, Celik G, Demirhan R, G\u00fcl O, Altaca G. Evaluation of patients wounded in the 17 August 1999 Marmara earthquake. Ulus Travma Derg<\/li>\n
    4. Dursun R, G\u00f6rmeli CA, G\u00f6rmeli G. Evaluation of the patients in Van Training and Research Hospital following the 2011 Van earthquake in Turkey.\u00a0Ulus Travma Acil Cerrahi Derg.\u00a02012;18:260\u2013264<\/li>\n
    5. Zengin Y, Icer M, Gunduz E, Dursun R, Durgun HM, Gullu MN, Orak M, Guloglu C. How was Felt Van Earthquake by a Neighbor University Hospital? Turk J Emerg Med. 2016 Mar 2;15(1):33-8. doi: 10.5505\/1304.7361.2015.03274. PMID: 27437521; PMCID: PMC4909966.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

      Afet komisyonumuz taraf\u0131ndan haz\u0131rlanan, afetlerde y\u00f6netim i\u00e7in \u00f6neriler ve g\u00fcncel bilgiler \u0131\u015f\u0131\u011f\u0131nda bu ay yaz\u0131m\u0131zda da amac\u0131m\u0131z acil t\u0131p hekimleri olarak a\u015fina…<\/p>\n","protected":false},"author":15,"featured_media":549,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[10043],"tags":[10053,10065],"class_list":["post-548","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-afet-yazi-dizisi","tag-afet-tibbi","tag-multitravma"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/posts\/548","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\/15"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/comments?post=548"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/posts\/548\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/media\/549"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/media?parent=548"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/categories?post=548"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/tags?post=548"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}