0<\/sup>C\u2019nin \u00fczerine \u00e7\u0131kt\u0131\u011f\u0131nda \u0131\u015f\u0131ma durur. \u0130kincisi buharla\u015fmad\u0131r. Toplam \u0131s\u0131n\u0131n %22 kadar\u0131 bu yolla kaybedilebilir. S\u0131cak havalarda v\u00fccudun \u0131s\u0131 kayb\u0131 i\u00e7in kulland\u0131\u011f\u0131 birincil y\u00f6ntem budur. Ancak ba\u011f\u0131l nem artt\u0131k\u00e7a buharla\u015fma da azald\u0131\u011f\u0131 i\u00e7in bu mekanizma nemli s\u0131cak havalarda i\u015flemez hale gelir. \u00dc\u00e7\u00fcnc\u00fc mekanizma konveksiyondur, \u0131s\u0131n\u0131n yakla\u015f\u0131k %15\u2019i bu mekanizmayla uzakla\u015ft\u0131r\u0131l\u0131r. Bu r\u00fczgarl\u0131 havalarda \u0131s\u0131 kayb\u0131na yard\u0131mc\u0131 olur, ancak r\u00fczgar h\u0131z\u0131 ve ortam s\u0131cakl\u0131k-nem durumuna ba\u011f\u0131ml\u0131d\u0131r. Son mekanizma ise kond\u00fcksiyondur. Ortamdaki cisimlere do\u011frudan temas yoluyla \u0131s\u0131 aktar\u0131m\u0131d\u0131r. Yine ortam s\u0131cakl\u0131\u011f\u0131 y\u00fcksek oldu\u011funda i\u015flevsiz hale gelir.<\/p>\n![\"\"](\"https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2022\/10\/a53874eb647a7bc57873e8baaaf6c677.jpg\")
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Kaynak:https:\/\/hastane.ksu.edu.tr\/depo\/belgeler\/YA%C5%9EAM%20BULGULARI_1711171152482372.pdf<\/p>\n
Ortamdaki \u0131s\u0131 artt\u0131\u011f\u0131nda hipotalamus iki mekanizmayla \u0131s\u0131y\u0131 sabit tutmaya \u00e7al\u0131\u015f\u0131r. Birincisi deride vazodilatasyon ve neticesinde kalp h\u0131z\u0131nda artma, ikincisi ter bezlerini aktive ederek terleme ve v\u00fccut y\u00fczeyinden buharla\u015fma ile \u0131s\u0131 kayb\u0131 (terle birlikte elektrolit kayb\u0131 da olur).<\/p>\n
Mekanizmalar\u0131n i\u015fe yaramad\u0131\u011f\u0131 ya da \u00e7al\u0131\u015fmad\u0131\u011f\u0131 durumlarda s\u0131caktan etkilenme ba\u015flar.<\/p>\n
Klinik<\/strong><\/p>\nS\u0131cak \u00f6demi:<\/strong> Ciltte olu\u015fan vazodilatasyona ba\u011fl\u0131 g\u00f6r\u00fcl\u00fcr. Semptomatik yakla\u015f\u0131m yeterlidir.<\/p>\nS\u0131cak d\u00f6k\u00fcnt\u00fcs\u00fc(isilik):<\/strong> Ka\u015f\u0131nt\u0131l\u0131, eritemli, mak\u00fclopap\u00fcller d\u00f6k\u00fcnt\u00fclerdir. Ter bezlerinin t\u0131kanmas\u0131 sonucu g\u00f6r\u00fcl\u00fcr. Tedavide \u0131l\u0131k du\u015f \u00f6nerilir.<\/p>\nKramp:<\/strong> Terlemeye ba\u011fl\u0131 elektrolit bozuklu\u011fu nedeniyle iskelet kaslar\u0131nda g\u00f6zlenebilir.<\/p>\nS\u0131cak bitkinli\u011fi:<\/strong> Ciltteki vazodilatasyon ve kan ak\u0131m\u0131n\u0131n artmas\u0131na ba\u011fl\u0131 olarak beyne yeterince kan gitmemesi ve sonucunda geli\u015fen halsizlik, g\u00fc\u00e7s\u00fczl\u00fck, ba\u015f d\u00f6nmesi, bulant\u0131, ba\u015f a\u011fr\u0131s\u0131 gibi semptomlar. V\u00fccut so\u011futulmazsa s\u0131cak \u00e7arpmas\u0131na ilerleyebilir.<\/p>\nS\u0131cak senkobu:<\/strong> Beynin kan ak\u0131m\u0131n\u0131n daha da azalmas\u0131 ve senkop geli\u015fmesi. Hasta so\u011futulmal\u0131d\u0131r.<\/p>\nS\u0131cak \u00e7arpmas\u0131:<\/strong> S\u0131cak bitkinli\u011fi bulgular\u0131na ek olarak hastalar terlemez, bilin\u00e7 de\u011fi\u015fikli\u011fi g\u00f6zlenir ve v\u00fccut s\u0131cakl\u0131\u011f\u0131 400<\/sup>C \u00fczerindedir. Hastalarda s\u0131cak k\u0131rm\u0131z\u0131 cilt g\u00f6zlenir. Ta\u015fikardi, hipotansiyon, hiperventilasyon olur. Koag\u00fclasyon bozukluklar\u0131 s\u0131kt\u0131r. Bilin\u00e7 d\u00fczeyleri hafif konf\u00fczyondan diren\u00e7li n\u00f6betlere kadar de\u011fi\u015febilir.<\/p>\n![\"\"](\"https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2022\/10\/4f569d53bdf994e351cc63f9823d5827.jpg\")
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Kaynak: https:\/\/www.geauxcrossfit.com\/wods\/heat-exhaustion-or-heat-stroke-know-the-difference<\/p>\n
A\u015f\u0131r\u0131 s\u0131ca\u011fa maruz kalan herkeste bu klinikler g\u00f6zlemlenebilir. Ancak baz\u0131 risk gruplar\u0131nda klini\u011fin ortaya \u00e7\u0131kmas\u0131 daha kolayd\u0131r. Risk grubundakiler:<\/p>\n
\n- 4 ya\u015f alt\u0131 ve 75 ya\u015f \u00fcst\u00fc ki\u015filer<\/li>\n
- Kronik alkol kullananlar<\/li>\n
- Obezite<\/li>\n
- So\u011futma yapmadan a\u015f\u0131r\u0131 egzersiz yapanlar<\/li>\n
- Hipertiroidi<\/li>\n
- Feokromasitoma<\/li>\n
- Baz\u0131 konjenital hastal\u0131klar<\/li>\n
- Ter bezi yoklu\u011fu<\/li>\n
- Skleroderma<\/li>\n
- Baz\u0131 kronik hastal\u0131klara ba\u011fl\u0131 ila\u00e7 kullan\u0131m\u0131<\/li>\n
- Antipsikotik ila\u00e7lar<\/li>\n
- Antikolinerjik ila\u00e7lar<\/li>\n
- Parkinson ila\u00e7lar<\/li>\n
- Beta bloker ila\u00e7lar<\/li>\n
- Ca kanal blokeri ila\u00e7lar<\/li>\n
- Vazodilat\u00f6rler<\/li>\n<\/ul>\n
<\/p>\n
Tedavi <\/strong><\/p>\nEtkilenen ki\u015finin s\u0131ca\u011fa maruz kald\u0131\u011f\u0131n\u0131 ve buna ba\u011fl\u0131 klini\u011finin oldu\u011funu d\u00fc\u015f\u00fcn\u00fcyorsak ilk yap\u0131lacak i\u015f s\u0131cak maruziyetini kesip hastay\u0131 so\u011futmak olmal\u0131d\u0131r. Giysileri \u00e7\u0131kart\u0131l\u0131r, m\u00fcmk\u00fcnse hasta \u0131slat\u0131l\u0131p fanlarla h\u0131zl\u0131 bir \u015fekilde so\u011futulmas\u0131 sa\u011flanabilir. S\u0131v\u0131 al\u0131m\u0131na erken d\u00f6nemde ba\u015flamak iyidir ancak hastan\u0131n bilinci yerinde de\u011filse aspirasyon riski a\u00e7\u0131s\u0131ndan dikkat edilmelidir.<\/p>\n
Bu hastalarda antipiretik vermenin herhangi bir yarar\u0131 yoktur.<\/p>\n
\u00c7ocuklarda ve egzersize ba\u011fl\u0131 s\u0131cak \u00e7arpmas\u0131 olan ki\u015filerde buzlu suya dald\u0131rma da h\u0131zl\u0131 \u0131s\u0131 d\u00fc\u015f\u00fc\u015f\u00fc a\u00e7\u0131s\u0131ndan de\u011ferlendirilebilir.<\/p>\n
Hastalar acil servise geldikten sonra ilk olarak ABC de\u011ferlendirilir, monit\u00f6rize edilir ve s\u0131cakl\u0131k takibi yap\u0131l\u0131r. S\u0131cakl\u0131k takibi i\u00e7in ideal olan rektal ya da \u00f6zefagial \u00f6l\u00e7\u00fcmd\u00fcr. Hastalar\u0131n aksilla, kas\u0131k, boyun gibi b\u00f6lgelerine so\u011fuk kompres yap\u0131lmas\u0131 i\u015fe yarayabilir ancak bu hastalar\u0131 ajite edebilir, titremelerine neden olabilir. Bu durumda IV benzodiazapin verilebilir. So\u011futma i\u00e7in so\u011fuk IV salin verilebilir ancak so\u011fuk gastrik lavaj \u00f6nerilmemekte.<\/p>\n
\u00d6zetleyecek olursak:<\/p>\n
\n- K\u00fcresel \u0131s\u0131nma ve etkileri t\u00fcm h\u0131z\u0131yla g\u00f6r\u00fclmeye ba\u015fland\u0131. \u00d6zellikle son iki y\u0131ld\u0131r yazlar\u0131 bunu daha iyi anlayabiliyoruz.<\/li>\n
- S\u0131ca\u011fa ba\u011fl\u0131 olu\u015fan durumlar\u0131 ortaya \u00e7\u0131karmak zor. \u0130yi bir anamnez ve g\u00f6zlem hayat kurtar\u0131c\u0131.<\/li>\n
- Meteorolojinin s\u0131cakl\u0131k uyar\u0131lar\u0131n\u0131 \u00f6zellikle risk grubundakilerinin dikkate almas\u0131 \u00f6nemli.<\/li>\n
- S\u0131cak \u00e7arpmas\u0131 diyebilmek i\u00e7in s\u0131cak maruziyeti, bilin\u00e7 de\u011fi\u015fikli\u011fi ve \u00f6l\u00e7\u00fclen v\u00fccut s\u0131cakl\u0131\u011f\u0131n\u0131n 400<\/sup>C \u00fczerinde olmas\u0131 gerek.<\/li>\n
- Tedavide \u00f6ncelik h\u0131zl\u0131 ve efektif periferik so\u011futma.<\/li>\n
- Antipiretiklerin tedavide yeri yok. Hastan\u0131n klini\u011fine g\u00f6re benzodiyazepinler verilebilir.<\/li>\n<\/ul>\n
<\/p>\n
Kaynaklar:<\/p>\n
\n- FG. Gaudio, CK\u00a0Grissom, Cooling Methods in Heat Stroke, Clinical Review,\u00a02016; 50:4, 607\u2013616<\/li>\n
- WWF 5. De\u011ferlendirme Raporu<\/li>\n
- Tintinalli’s Emergency Medicine, A Comprehensive Study Guide,<\/strong><\/em> 9th edition<\/strong>, Judith E. Tintinalli, et. al. ISBN: 1260019934<\/li>\n
- https:\/\/www.tatd.org.tr\/files\/files\/TATD-heatrelatedillnesses-policy.pdf<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"
\u015eu s\u0131cak yaz g\u00fcnlerinde, \u00fclkemizde yaz\u0131n en s\u0131cak ya\u015fand\u0131\u011f\u0131 yerlerden biri olan Antalya\u2019da bu yaz\u0131y\u0131 yazmak ironik bir durum. K\u00fcresel \u0131s\u0131nma g\u00fcn\u00fcm\u00fcz\u00fcn…<\/p>\n","protected":false},"author":769,"featured_media":589,"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":[10043,1],"tags":[10055,10053,10070,10072],"class_list":["post-583","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-afet-yazi-dizisi","category-genel","tag-acil-tip","tag-afet-tibbi","tag-iklim-krizi","tag-sicak-acilleri"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/posts\/583","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\/769"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/comments?post=583"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/posts\/583\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/media\/589"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/media?parent=583"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/categories?post=583"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/tags?post=583"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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