{"id":468,"date":"2024-07-18T13:01:34","date_gmt":"2024-07-18T10:01:34","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=468"},"modified":"2024-07-23T10:08:57","modified_gmt":"2024-07-23T07:08:57","slug":"yasli-multiple-travma-hastasinin-yonetimi","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/genel\/yasli-multiple-travma-hastasinin-yonetimi\/","title":{"rendered":"Ya\u015fl\u0131 Multiple Travma Hastas\u0131n\u0131n Y\u00f6netimi"},"content":{"rendered":"\n<p><strong>Giri\u015f<\/strong><\/p>\n\n\n\n<p>Acil servislerde, ya\u015fl\u0131 n\u00fcfusun artmas\u0131 ile, ileri ya\u015f travma vakalar\u0131yla s\u0131k\u00e7a kar\u015f\u0131la\u015fmaktay\u0131z. Ya\u015fl\u0131 travma hastas\u0131n\u0131n y\u00f6netimi, travmaya neden olan ikincil durumlar, g\u00fcvenilmez vital bulgu \u00f6l\u00e7\u00fcmleri ve temel fiziksel bulgulardaki de\u011fi\u015fiklikler nedeniyle di\u011fer ya\u015f gruplar\u0131na g\u00f6re daha karma\u015f\u0131kt\u0131r. Yeti\u015fkin travma hastas\u0131n\u0131n y\u00f6netiminde kullan\u0131lan tipik g\u00f6stergelerin t\u00fcm\u00fc, geriatrik hastalarda yaralanman\u0131n erken tespiti i\u00e7in g\u00fcvenilmezdir. Bu zorluklar i\u00e7erisinde yap\u0131lan acil servisteki ilk de\u011ferlendirme, travman\u0131n tan\u0131mlanmas\u0131 ve y\u00f6netimi i\u00e7in kritik \u00f6neme sahiptir. Komorbid hastal\u0131klar\u0131n, mental durum bozukluklar\u0131n\u0131n, k\u0131r\u0131lganl\u0131\u011f\u0131n ve polifarmasinin tan\u0131mlanmas\u0131 ve y\u00f6netimi de ayn\u0131 derecede \u00f6nemlidir. Acil serviste al\u0131nacak \u00f6nlemler hasta tedavisini \u00f6nemli \u00f6l\u00e7\u00fcde de\u011fi\u015ftirir ve hastanede kal\u0131\u015f s\u00fcresini, morbiditeyi, mortaliteyi ve hastane maaliyetlerini azalt\u0131r. Bu nedenle ya\u015fl\u0131 travma hastas\u0131n\u0131n bak\u0131s\u0131 \u00f6zellikli bir durumdur ve acil serviste ba\u015flayan disiplinler aras\u0131 travma bak\u0131m\u0131, geriatrik hastalar i\u00e7in en iyi y\u00f6netim yakla\u015f\u0131m\u0131d\u0131r.<\/p>\n\n\n\n<p>\u2018Ya\u015fl\u0131 travma hastas\u0131 neden \u00f6zeldir?\u2019 ba\u015fl\u0131kl\u0131 blog yaz\u0131s\u0131nda Dr. G\u00f6ksel Aydo\u011fan, ya\u015fl\u0131 travma hastalar\u0131n\u0131n epidemiyolojik \u00f6zelliklerinden ve ya\u015fl\u0131l\u0131\u011fa ba\u011fl\u0131 \u00f6zel durumlardan bahsetmi\u015fti. Merak edenler yaz\u0131ya <a href=\"https:\/\/tatd.org.tr\/geriatri\/genel\/yasli-travma-hastasi-neden-ozeldir\/\">buradan<\/a> ula\u015fabilir. Bu yaz\u0131da ise ya\u015fl\u0131 travma hastas\u0131n\u0131n acil servis y\u00f6netimini aktarmaya \u00e7al\u0131\u015faca\u011f\u0131m.<\/p>\n\n\n\n<p><strong>Birincil Bak\u0131 &#8211; Geriatrik Travma ABCDEFs<\/strong><\/p>\n\n\n\n<p>Her travma hastas\u0131nda oldu\u011fu gibi ya\u015fl\u0131 hastalarda da birincil bak\u0131 ile travma de\u011ferlendirmesine ba\u015flanmal\u0131d\u0131r. Birincil bak\u0131da hedef hayat\u0131 potansiyel olarak tehdit edebilecek yaralanmalar\u0131 saptamak ve kritik m\u00fcdahaleleri erken d\u00f6nemde yapmak olmal\u0131d\u0131r. Bunu yaparken ya\u015fl\u0131l\u0131\u011fa ba\u011fl\u0131 \u00f6nemli ek durumlar\u0131n ve potansiyel tuzaklar\u0131n fark\u0131nda olmak b\u00fcy\u00fck \u00f6neme sahiptir.<\/p>\n\n\n\n<p><strong><em>A &#8211; Hava Yolu&nbsp;<\/em><\/strong><\/p>\n\n\n\n<p>Ya\u015fl\u0131 hastada hava yolunun g\u00fcvence alt\u0131na al\u0131nmas\u0131, doku hipertrofisi, faringeal kas deste\u011finin kayb\u0131 ve s\u0131n\u0131rl\u0131 mandibular protr\u00fczyon nedeniyle potansiyel olarak zor kabul edilir. Bu nedenle ileri. Hava yolu gereksinimi olan t\u00fcm ya\u015fl\u0131 travma hastalar\u0131 i\u00e7in zor havayolu ekipmanlar\u0131n\u0131n (\u00f6rne\u011fin, elastik bougie&#8217;ler ve laringeal maske hava yollar\u0131) mutlaka haz\u0131rda bulunmas\u0131 gerekir.&nbsp;&nbsp;Zor hava yolu ekibinin olu\u015fturulmas\u0131 ve video laringoskoplar\u0131n kullan\u0131m\u0131 havayolu giri\u015fimlerinin ba\u015far\u0131 oranlar\u0131n\u0131 artt\u0131racakt\u0131r. \u0130kinci nesil supraglottik cihazlar, \u00f6nceki cihazlara g\u00f6re daha fazla aspirasyondan koruma sa\u011flar ve ya\u015fl\u0131 hastalarda g\u00fcvenle uygulanabilir. Ya\u015fl\u0131 hastada hava yolu g\u00fcvenli\u011fini sa\u011flamadaki baz\u0131 potansiyel zorluklar \u015funlard\u0131r:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><em>Servikal omurga artriti,<\/em>&nbsp;vokal kordun g\u00f6r\u00fcnt\u00fclenmesinde ve ent\u00fcbasyonda zorlu\u011fa neden olabilir. Zor hava yolunun \u00f6ng\u00f6r\u00fclmesi, ent\u00fcbasyon ba\u015far\u0131 oranlar\u0131n\u0131 optimize etmenin anahtar\u0131d\u0131r. Acil endotrakeal ent\u00fcbasyon gereken hastalarda Bougie kullan\u0131lmas\u0131, anlaml\u0131 derecede daha y\u00fcksek ilk giri\u015fim ba\u015far\u0131s\u0131 sa\u011flar&nbsp;(1).<\/li>\n\n\n\n<li><em>Temporomandibular eklem hastal\u0131\u011f\u0131&nbsp;<\/em>varl\u0131\u011f\u0131nda<em>&nbsp;<\/em>krikotiroidotomi gerekebilir. \u0130leri hava yolu tekniklerinin ba\u015far\u0131l\u0131 bir \u015fekilde uygulanmas\u0131, ent\u00fcbasyona izin vererek cerrahi hava yolu ihtiyac\u0131n\u0131 ortadan kald\u0131rabilir.<\/li>\n\n\n\n<li><em>Di\u015f yap\u0131s\u0131<\/em>&nbsp;ya\u015fl\u0131 hastalarda havayolu y\u00f6netimini zorla\u015ft\u0131rabilir. Di\u015fsiz hastalarda hava yolu a\u00e7\u0131kl\u0131\u011f\u0131n\u0131 korumak i\u00e7in, balon valv maske kullan\u0131l\u0131rken protezler yerinde b\u0131rak\u0131lmal\u0131, ancak ent\u00fcbasyon i\u00e7in protezler \u00e7\u0131kar\u0131lmal\u0131d\u0131r.<\/li>\n\n\n\n<li><em>Hava yolu kollaps\u0131 \/ K\u0131r\u0131lgan ve kuru mukozal dokular<\/em>&nbsp;ya\u015fl\u0131 hastalarda hava yolu g\u00fcvenli\u011finin sa\u011flarken bir dizi soruna neden olur. Ya\u015fl\u0131 yeti\u015fkinlerde hava yolu kollaps\u0131na ve obstr\u00fcksiyonuna e\u011filim oldu\u011fundan, nazogastrik t\u00fcplerin yan\u0131 s\u0131ra nazal ve oral airwaylerin kayganla\u015ft\u0131r\u0131lmas\u0131 gerekmektedir. Travmatik yerle\u015ftirmelerden kaynaklanan kanaman\u0131n kontrol\u00fc i\u00e7in topikal traneksamik asit kullan\u0131labilir.<\/li>\n\n\n\n<li><em>\u0130la\u00e7 dozlar\u0131<\/em>&nbsp;ya\u015fl\u0131 hastalarda farkl\u0131l\u0131k g\u00f6stermektedir. Ya\u015fl\u0131 yeti\u015fkin hastalarda h\u0131zl\u0131 seri ent\u00fcbasyon i\u00e7in \u00e7e\u015fitli doz ayarlamalar\u0131 gereklidir (Tablo 1).<\/li>\n\n\n\n<li><em>Cerrahi hava yolu giri\u015fimleri<\/em>, servikal hareketlili\u011fin azalmas\u0131, boyundaki cildin daha gev\u015fek olmas\u0131 ve krikotiroid membran\u0131n daha sert ve k\u00fc\u00e7\u00fck olmas\u0131 nedeniyle daha zordur. Ent\u00fcbasyon ve supraglottik tekniklerin ba\u015far\u0131s\u0131z olmas\u0131ndan sonra, balon valv maske ile ventilasyon sa\u011flanam\u0131yorsa krikotiroidotomi \u00f6nerilen kurtarma tekni\u011fidir.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-table\"><div class=\"pcrstb-wrap\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>\u0130LA\u00c7LAR<\/strong><\/td><td><strong>DOZ AYARLAMASI<\/strong><\/td><\/tr><tr><td colspan=\"2\"><strong>\u0130ND\u00dcKS\u0130YON AJANLARI<\/strong><strong><\/strong><\/td><\/tr><tr><td><strong>Ketamin:&nbsp;<\/strong>Miyokardiyal oksijen ihtiyac\u0131nda art\u0131\u015fa neden olabilir (koroner arter hastal\u0131\u011f\u0131 olan hastalarda dikkat edilmeli). Katekolamin t\u00fckenmesi hipotansiyona katk\u0131da bulunabilir. Subdissosiyatif dozlar a\u011fr\u0131 y\u00f6netimine yard\u0131mc\u0131 olur ancak ya\u015fl\u0131 yeti\u015fkinlerde olumsuz psiko-alg\u0131sal etkileri olabilir.<\/td><td>Ent\u00fcbasyon dozu: 1mg\/kgSubdissosiyatif doz: 0,3 mg\/kg<\/td><\/tr><tr><td><strong>Propofol:<\/strong>&nbsp;Genel olarak iyi tolere edilir. Baz\u0131 ya\u015fl\u0131 yeti\u015fkinlerde hipotansiyon ve apneye neden olabilir.<\/td><td>\u0130nd\u00fcksiyon dozu: 1 &#8211; 1.5 mg\/kg, inf\u00fczyon 0,5 &#8211; 1,0 mg\/kg\/saat<\/td><\/tr><tr><td><strong>\u2018Ketofol\u2019:<\/strong>&nbsp;\u0130nd\u00fcksiyondan sonraki ilk 10 dakika i\u00e7inde hemodinamik stabiliteyi art\u0131ran propofol ve ketamin kombinasyonu, daha az solunumsal yan etkiye sahiptir.<\/td><td>Ent\u00fcbasyon dozu: Her iki ajandan 0,5 mg\/kg<\/td><\/tr><tr><td><strong>Etomidat<\/strong><\/td><td>0,3 mg\/kg IV dozundan 01-0,2 mg\/kg IV dozuna d\u00fc\u015f\u00fcr\u00fclmeli<\/td><\/tr><tr><td colspan=\"2\"><strong>OP\u0130O\u0130DLER<\/strong><\/td><\/tr><tr><td><strong>T\u00fcm Opioidler<\/strong><\/td><td>T\u00fcm dozlar\u0131&#8221;d\u00fc\u015f\u00fck ba\u015fla, yava\u015f ver&#8221; rehberli\u011finde azalt\u0131lmal\u0131<\/td><\/tr><tr><td><strong>Fentanil<\/strong><\/td><td>%20 ila %40 oran\u0131nda doz azalt\u0131lmal\u0131<\/td><\/tr><tr><td colspan=\"2\"><strong>BENZOD\u0130AZEP\u0130NLER<\/strong><\/td><\/tr><tr><td><strong>Midazolam<\/strong><\/td><td>%20 ila %40 oran\u0131nda doz azalt\u0131lmal\u0131<\/td><\/tr><tr><td colspan=\"2\"><strong>N\u00d6ROM\u00dcSK\u00dcLER BLOK\u00d6R AJANLAR<\/strong><strong><\/strong><\/td><\/tr><tr><td><strong>Depolarizan Ajanlar:&nbsp;<\/strong>Her ya\u015fta benzer derecede blokaj olu\u015fturur, ancak ya\u015fl\u0131 hastalarda 2 dakikal\u0131k bir gecikme ve daha uzun bir etki s\u00fcresine sahip olabilir.S\u00fcksinilkolin<\/td><td>B\u00f6brek fonksiyonundan ba\u011f\u0131ms\u0131z olarak dozlar\u0131n de\u011fi\u015ftirilmesi gerekmez.&nbsp;1,5 mg\/kg IV<\/td><\/tr><tr><td><strong>Non-Depolarizan Ajanlar:&nbsp;<\/strong>Geriatrik hastalarda daha uzun etki s\u00fcresine sahiptir.Rocuronium&nbsp;Cisatracurium: Geriatrik hastalarda en az s\u00fcre de\u011fi\u015fkenli\u011fine ve en y\u00fcksek g\u00fcvenilirli\u011fe sahip ajand\u0131r.<\/td><td>&nbsp;&nbsp;1 mg\/kg55 mikrogram\/kg<\/td><\/tr><\/tbody><\/table><\/div><figcaption class=\"wp-element-caption\">Tablo 1: H\u0131zl\u0131 Seri Ent\u00fcbasyon \u0130\u00e7in \u0130la\u00e7 Dozaj Ayarlamalar\u0131&nbsp;(3)<\/figcaption><\/figure>\n\n\n\n<p><strong><em>B &#8211; Solunum<\/em><\/strong><\/p>\n\n\n\n<p>Ya\u015fl\u0131 hastalarda solunum h\u0131z\u0131 25 soluk\/dk\u2019a kadar normal kabul edilir. Daha y\u00fcksek bir solunum h\u0131z\u0131, solunum yolu tehlikesinin ilk belirtisi olarak kabul edilmelidir.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><em>Hipoksi ve hiperkarbi&nbsp;<\/em>solunum kaslar\u0131n\u0131n zay\u0131flamas\u0131 ve elastik kapasitenin azalmas\u0131 nedeniyle ya\u015fl\u0131 hastalarda daha s\u0131k g\u00f6r\u00fcl\u00fcr ve bu da vital kapasiteyi azalt\u0131r. Hipoksi ve hiperkarbi, ya\u015fl\u0131 hastalarda artan \u00f6l\u00fc bo\u015fluk ve azalan solunum rezervi nedeniyle daha da h\u0131zl\u0131 meydana gelir. Ya\u015fl\u0131 hastan\u0131n hipoksi ve hiperkarbiye verdi\u011fi yan\u0131t, gen\u00e7 yeti\u015fkinlerle kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda s\u0131ras\u0131yla %50 ve %40 oran\u0131nda daha azd\u0131r. Ya\u015fl\u0131 travma hastas\u0131nda oksijen sat\u00fcrasyonu i\u00e7in &gt;%90 hedeflenmelidir.<\/li>\n\n\n\n<li><em>Ventilat\u00f6r y\u00f6netimi,<\/em>&nbsp;ya\u015fl\u0131 hastalarda de\u011fi\u015fen akci\u011fer fizyolojisi nedeni ile de\u011fi\u015fkenlik g\u00f6sterir. D\u00fc\u015f\u00fck vol\u00fcml\u00fc ve d\u00fc\u015f\u00fck bas\u0131n\u00e7l\u0131 ventilasyonun ya\u015fl\u0131 hastalarda daha iyi sonu\u00e7larla ili\u015fkilidir. Tidal vol\u00fcm i\u00e7in 6 mL\/kg olmal\u0131 ve plato bas\u0131nc\u0131 i\u00e7in 30 cm H<sub>2<\/sub>O veya daha d\u00fc\u015f\u00fck bir de\u011fer hedeflenmeli. Hiperventilasyon uygulanan travma hastalar\u0131nda, mortalitenin artt\u0131\u011f\u0131 i\u00e7in hiperventilasyondan ka\u00e7\u0131n\u0131lmal\u0131d\u0131r. Mutlak veya g\u00f6receli hipovolemisi olan hastalarda, y\u00fcksek ventilasyon h\u0131zlar\u0131 ve pozitif bas\u0131n\u00e7l\u0131 ventilasyon ven\u00f6z d\u00f6n\u00fc\u015f\u00fc bozarak hipotansiyonu k\u00f6t\u00fcle\u015ftirebilir ve kardiyovask\u00fcler kollapsa neden olabilir.<\/li>\n<\/ul>\n\n\n\n<p><strong><em>C &#8211; Dola\u015f\u0131m<\/em><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ya\u015fl\u0131 travma hastalar\u0131nda vital bulgular genellikle atipiktir. Kardiyovask\u00fcler sistemdeki ya\u015fa ba\u011fl\u0131 de\u011fi\u015fiklikler, ya\u015fl\u0131 travma hastas\u0131n\u0131 yanl\u0131\u015fl\u0131kla hemodinamik olarak normal olarak kategorize edilme a\u00e7\u0131s\u0131ndan \u00f6nemli bir risk alt\u0131na sokar. Ya\u015fl\u0131 hastan\u0131n kalp h\u0131z\u0131 ve kardiyak debisi sabit olabilece\u011finden, hipovolemiye yan\u0131t sistemik vask\u00fcler direncin artmas\u0131n\u0131 \u015feklinde olacakt\u0131r. Ayr\u0131ca, bir\u00e7ok ya\u015fl\u0131 hastada \u00f6nceden hipertansiyon oldu\u011fundan, g\u00f6r\u00fcn\u00fc\u015fte kabul edilebilir bir kan bas\u0131nc\u0131 ger\u00e7ekten g\u00f6receli bir hipotansif durumu yans\u0131tabilir. 65 ya\u015f \u00fcst\u00fc yeti\u015fkinlerde hipotansiyonu tan\u0131mlamak i\u00e7in 110 mm Hg&#8217;lik bir sistolik kan bas\u0131nc\u0131n\u0131n e\u015fik de\u011fer olarak kullan\u0131lmas\u0131 genel olarak kabul g\u00f6rmektedir&nbsp;(2).<\/li>\n\n\n\n<li>Ya\u015fl\u0131 yeti\u015fkin travma hastalar\u0131nda katekolamin duyars\u0131zl\u0131\u011f\u0131, ateroskleroz, miyosit fibrozu, iletim anormallikleri, beta ve kalsiyum kanal blokerleri gibi kullan\u0131lan ila\u00e7lar nedeniyle hipovolemi ile&nbsp;<em>kompansatuar ta\u015fikardi<\/em>&nbsp;olmayabilir.<\/li>\n\n\n\n<li><em>Okk\u00fclt hipoperf\u00fczyon (OH)<\/em>&nbsp;ya\u015fl\u0131 travma hastalar\u0131nda s\u0131k\u00e7a g\u00f6r\u00fclebilen bir durumdur. Vol\u00fcm kayb\u0131 olan ya\u015fl\u0131 hastada normal s\u0131n\u0131rlardaki sistolik kan bas\u0131nc\u0131 (SKB) OH nedeni ile yan\u0131lt\u0131c\u0131 olabilir. Ba\u015flang\u0131\u00e7 veya ge\u00e7mi\u015f SKB de\u011ferlerinin hasta takibi s\u0131ras\u0131nda \u00f6l\u00e7\u00fclen kan bas\u0131nc\u0131 de\u011ferleri ile kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131 vol\u00fcm kayb\u0131 derecesinin belirlenmesine yard\u0131mc\u0131 olabilir. Konjestif kalp yetmezli\u011fi, koroner arter hastal\u0131\u011f\u0131 ve b\u00f6brek yetmezli\u011fi olan ya\u015fl\u0131 hastalarda yayg\u0131n olarak OH g\u00f6r\u00fcl\u00fcr. Bu durumlar\u0131n her biri ba\u015flang\u0131\u00e7ta a\u015f\u0131r\u0131 s\u0131v\u0131 y\u00fcklenmesine yol a\u00e7arak akut vol\u00fcm kayb\u0131 durumunda klinik tabloyu daha da karma\u015f\u0131k hale getirir. Deri turgor testi ve kapiller dolum zaman\u0131, \u015foktaki ya\u015fl\u0131 hastalar\u0131n klinik muayenesinde g\u00fcvenilir de\u011fildir. Ya\u015fl\u0131 hastada \u015fok indeksinin 0,7&#8217;ye e\u015fit veya daha y\u00fcksek olmas\u0131, transf\u00fczyon ihtiyac\u0131n\u0131 \u00f6ng\u00f6rmede %83 \u00f6zg\u00fcll\u00fc\u011fe sahiptir&nbsp;(4).<\/li>\n<\/ul>\n\n\n\n<p><strong>\u015eokun De\u011ferlendirilmesi ve Y\u00f6netimi<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>\u015eok Durumunun Nedenleri:&nbsp;<\/strong>\u015eok tablosundaki ya\u015fl\u0131 hastada yatak ba\u015f\u0131 ultrasonografi ile inferior vena kava, kalp, akci\u011ferler, bat\u0131n ve aortun de\u011ferlendirilmesi \u015fok etiyolojilerinin %80&#8217;ini tan\u0131mlayabilir ve de\u011ferlendirme devam ederken do\u011fru res\u00fcsitasyona olanak tan\u0131r&nbsp;(3). Kanaman\u0131n yan\u0131 s\u0131ra, miyokardiyal iskemi gibi durumlar\u0131n da hipotansiyona neden olabilece\u011fi veya klinik tabloyu \u015fiddetlendirebilece\u011fi unutulmamal\u0131d\u0131r.<\/li>\n\n\n\n<li><strong>Laboratuvar Belirte\u00e7leri:&nbsp;<\/strong>Acil serviste laktat ve baz defisiti (BD) de\u011ferleri OH&#8217;yi h\u0131zl\u0131 bir \u015fekilde tan\u0131mlayabilir ve erken agresif res\u00fcsitasyona rehberlik edebilir. Hemodinamik olarak stabil g\u00f6r\u00fcnen bir hastada BD&#8217;nin 6 veya daha d\u00fc\u015f\u00fck ya da laktat\u0131n 2,4 mmol\/L veya daha y\u00fcksek olmas\u0131 OH&#8217;yi d\u00fc\u015f\u00fcnd\u00fcr\u00fcr. \u0130lk laboratuvar de\u011ferleri normalse, ba\u015fvuru saatinden 30 ila 45 dakika sonra elde edilen ikinci bir serum laktat veya BD \u00f6l\u00e7\u00fcm\u00fc olas\u0131 bir ok\u00fclt kanamay\u0131 g\u00f6stermede faydal\u0131d\u0131r. BD ve laktat klirensi ise hemodinamik res\u00fcsitasyon ile ilgili bizlere rehberlik sa\u011flar.<\/li>\n\n\n\n<li><strong>Uygun S\u0131v\u0131 Res\u00fcsitasyonu:&nbsp;<\/strong>A\u011f\u0131r travma ge\u00e7iren ya\u015fl\u0131 hastalara transf\u00fczyon yapmaktan ka\u00e7\u0131n\u0131lmamal\u0131d\u0131r. Ya\u015f tek ba\u015f\u0131na y\u00fcksek hacimli transf\u00fczyon i\u00e7in bir kontrendikasyon de\u011fildir. Transf\u00fczyon gereken hastalarda hastaneye yat\u0131\u015ftan sonraki 4 saat i\u00e7erisinde transf\u00fczyon yap\u0131lmazsa mortalite riski artmaktad\u0131r. Bununla birlikte, bir transf\u00fczyon &#8220;tavan\u0131&#8221; veya maksimum de\u011feri mevcut gibi g\u00f6r\u00fcnmektedir; bu de\u011ferden sonra ek transf\u00fczyonun hastalar i\u00e7in s\u0131n\u0131rl\u0131 sa\u011fkal\u0131m faydas\u0131 vard\u0131r. \u0130ki \u00fcnite eritrosit s\u00fcspansiyonu alan oktojenaryanlarda mortalite oran\u0131 %28 iken, bu oran 10 \u00fcnitede yakla\u015f\u0131k %80&#8217;e y\u00fckselmekte, 21-30 \u00fcnite uygulananlarda ise %90&#8217;a ula\u015fmaktad\u0131r&nbsp;(5).&nbsp;<\/li>\n<\/ul>\n\n\n\n<p>Ya\u015fl\u0131 travma hastalar\u0131 genellikle daha d\u00fc\u015f\u00fck ba\u015fvuru hemoglobin seviyelerine sahiptir ve hastane takipleri s\u0131ras\u0131nda di\u011fer yeti\u015fkinlere g\u00f6re daha fazla miktarda eritrosit s\u00fcspansiyonu transf\u00fczyonu al\u0131rlar. Geriatrik travma hastalar\u0131n\u0131n yakla\u015f\u0131k %10&#8217;u ba\u015flang\u0131\u00e7ta anemiktir ve d\u00fc\u015f\u00fck bazal hemoglobin ba\u011f\u0131ms\u0131z bir mortalite belirleyicisidir&nbsp;(3).<\/p>\n\n\n\n<p>\u015eok kanamaya ba\u011fl\u0131 oldu\u011funda, hastaneye var\u0131\u015ftan sonra kristaloidlerin s\u0131n\u0131rland\u0131r\u0131lmas\u0131 gerekir. Fazla s\u0131v\u0131 res\u00fcsitasyonu p\u0131ht\u0131la\u015fma fakt\u00f6rlerini seyrelterek koag\u00fclopatiyi art\u0131rabilir ve ayr\u0131ca hipotermiye neden olabilir. Ek olarak, ortalama arter bas\u0131nc\u0131n\u0131n a\u015f\u0131r\u0131 y\u00fckselmesi daha fazla kanamaya neden olabilir. En uygun s\u0131v\u0131 t\u00fcr\u00fc, uygulanacak hacim ve uygulama h\u0131z\u0131, res\u00fcsitatif hedefler ve perf\u00fczyon bas\u0131nc\u0131n\u0131n d\u00fczenlenmesi tart\u0131\u015fmal\u0131d\u0131r. Kritik hastalarda s\u0131v\u0131 uygulamas\u0131 ve de\u011ferlendirmesi i\u00e7in kesin standartlar tan\u0131mlanmam\u0131\u015ft\u0131r.<\/p>\n\n\n\n<p>Hemorajik olmayan \u015fok durumlar\u0131nda, iyatrojenik a\u015f\u0131r\u0131 s\u0131v\u0131 y\u00fcklenmesi konusunda dikkatli olunmal\u0131d\u0131r. Ancak bu endi\u015fenin res\u00fcsitasyonu geciktirmesine veya engellemesine izin verilmemeli. \u0130yatrojenik a\u015f\u0131r\u0131 s\u0131v\u0131 y\u00fcklenmesi riskini en aza indirmek i\u00e7in aral\u0131klarla 250 mL ila 500 mL boluslar\u0131n uygulanmal\u0131 ve hastan\u0131n s\u0131k s\u0131k yeniden de\u011ferlendirilmesi gerekmektedir&nbsp;(6).<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Antikoag\u00fclasyon:<\/strong>&nbsp;Ya\u015fl\u0131 hastalar s\u0131kl\u0131kla kanama riskini art\u0131ran antikoag\u00fclan ila\u00e7lar kullanmaktad\u0131r. Bu ila\u00e7lar \u00f6zellikle ciddi kanamalar\u0131n geli\u015fmesini kolayla\u015ft\u0131rabilir. \u0130lk bak\u0131 sonras\u0131 mutlaka hastan\u0131n kulland\u0131\u011f\u0131 ila\u00e7lar sorgulanmal\u0131d\u0131r. Antikoag\u00fclan ila\u00e7 kullan\u0131m\u0131 olan ve hemorajik \u015fok tablosundaki hastalarda ila\u00e7 antidotlar\u0131n\u0131n kullan\u0131m\u0131 gerekecektir (Tablo 2).<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"722\" src=\"https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2024\/07\/6e9d25c03d896c45fef81661f59f4a9f-1024x722.png\" alt=\"\" class=\"wp-image-623\" srcset=\"https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2024\/07\/6e9d25c03d896c45fef81661f59f4a9f-1024x722.png 1024w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2024\/07\/6e9d25c03d896c45fef81661f59f4a9f-300x211.png 300w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2024\/07\/6e9d25c03d896c45fef81661f59f4a9f-768x541.png 768w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2024\/07\/6e9d25c03d896c45fef81661f59f4a9f-100x70.png 100w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2024\/07\/6e9d25c03d896c45fef81661f59f4a9f-1536x1083.png 1536w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2024\/07\/6e9d25c03d896c45fef81661f59f4a9f-894x630.png 894w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2024\/07\/6e9d25c03d896c45fef81661f59f4a9f.png 1694w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p><strong><em>D \u2013 N\u00f6rolojik De\u011ferlendirme (Disability)<\/em><\/strong><\/p>\n\n\n\n<p>Ya\u015fl\u0131 travma hastas\u0131n\u0131n de\u011ferlendirilmesi s\u0131ras\u0131nda m\u00fcmk\u00fcn oldu\u011funda yava\u015f ve nazik bir yakla\u015f\u0131m sergilenmelidir. Ya\u015fl\u0131 hastalar genellikle g\u00f6rsel ve i\u015fitsel yard\u0131mc\u0131lar kullan\u0131r. \u0130lk res\u00fcsitasyon s\u0131ras\u0131nda bunlar\u0131n \u00e7\u0131kar\u0131lmas\u0131 kafa kar\u0131\u015f\u0131kl\u0131\u011f\u0131n\u0131 art\u0131r\u0131r ve ya\u015fl\u0131 hastan\u0131n sorulara yan\u0131t vermesini zorla\u015ft\u0131r\u0131r. Duyular\u0131 sa\u011flam olsa bile, hastan\u0131n neler oldu\u011funu anlamas\u0131 i\u00e7in zaman tan\u0131nmal\u0131d\u0131r.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Glasgow Koma Skalas\u0131 (GKS):<\/strong>&nbsp;Glokom, katarakt ameliyat\u0131, ve sistemik ila\u00e7lar GKS skorunu de\u011fi\u015ftirebilece\u011finden bu gibi durumlar dikkate al\u0131narak de\u011ferlendirme yap\u0131lmal\u0131d\u0131r.<\/li>\n\n\n\n<li><strong>Demans ve Bili\u015fsel Bozulma:<\/strong>&nbsp;Bili\u015fsel de\u011fi\u015fimler ya\u015fl\u0131 pop\u00fclasyonunda s\u0131kl\u0131kla g\u00f6r\u00fcl\u00fcr ve d\u00fc\u015fme ve travmatik beyin hasar\u0131 i\u00e7in ba\u011f\u0131ms\u0131z risk fakt\u00f6r\u00fcd\u00fcr. Hem birincil hem de ikincil de\u011ferlendirme bili\u015fsel bozukluklar nedeni ile ya\u015fl\u0131 hasta grubunda daha karma\u015f\u0131kt\u0131r. Bu durum ayn\u0131 zamanda akut patolojilerin tan\u0131nmas\u0131n\u0131 zorla\u015ft\u0131rabilir ve travmaya neden olan altta yatan durumlar\u0131n tan\u0131 ve tedavisinde gecikmelere sebep olabilir. Demans GKS&#8217;yi yanl\u0131\u015fl\u0131kla d\u00fc\u015f\u00fcrebilir, \u00e7\u00fcnk\u00fc ba\u015flang\u0131\u00e7taki zihinsel durum bilinmedi\u011finde zihinsel durumda \u00f6nceden var olan de\u011fi\u015fiklikler yeni olarak kabul edilir. Bu nedenle ilk de\u011ferlendirme sonras\u0131nda hastan\u0131n bazal bilin\u00e7 durumu sorgulanmal\u0131 ve kay\u0131t alt\u0131na al\u0131nmal\u0131d\u0131r. Anl\u0131k a\u011fr\u0131 beyanlar\u0131 genellikle do\u011frudur; ancak yak\u0131n ge\u00e7mi\u015fteki veya ge\u00e7mi\u015fteki a\u011fr\u0131 durumu beyanlar\u0131 veya tedavi seyri s\u0131ras\u0131ndaki de\u011fi\u015fiklikler g\u00fcvenilir olmayabilir.<\/li>\n\n\n\n<li><strong>Deliryum:<\/strong>&nbsp;Deliryum, ya\u015fl\u0131 hastalarda akut bir duruma i\u015faret eder. \u00d6zellikle h\u0131zl\u0131 bir travma de\u011ferlendirmesinde s\u0131kl\u0131kla g\u00f6zden ka\u00e7abilir. Acil servis de\u011ferlendirmesi s\u0131ras\u0131nda deliryum tan\u0131mal\u0131 ve aksi kan\u0131tlanana kadar kritik hastal\u0131k belirtisi olarak kabul edilmelidir.<\/li>\n\n\n\n<li><strong>Spinal Stenoz:<\/strong>&nbsp;Omurilik kanal\u0131n\u0131n daralmas\u0131 olan servikal spondilozu olan ya\u015fl\u0131 yeti\u015fkinler, kemik anormalli\u011fi olmaks\u0131z\u0131n kord yaralanmas\u0131 riski alt\u0131ndad\u0131rlar. Bu durum, normal g\u00f6r\u00fcnt\u00fclemeye ra\u011fmen santral kord veya Brown-S\u00e9quard benzeri sendromlarla sonu\u00e7lanabilir.<\/li>\n<\/ul>\n\n\n\n<p><strong><em>E \u2013 Soyma (Exposure)<\/em><\/strong><\/p>\n\n\n\n<p>Klasik travma y\u00f6netiminde oldu\u011fu gibi ya\u015fl\u0131 \u00e7oklu travma hastas\u0131n\u0131n t\u00fcm giysileri \u00e7\u0131kar\u0131larak muayene edilmesi olduk\u00e7a \u00f6nemlidir. Bununla birlikte azalm\u0131\u015f hipotalamik fonksiyon, yetersiz beslenme, ya\u011fs\u0131z kas k\u00fctlesi kayb\u0131 ve mikrovask\u00fcler de\u011fi\u015fiklikler, ya\u015fl\u0131 travma hastas\u0131n\u0131 hipotermiye duyarl\u0131 hale getirir ve bu durum koag\u00fclopatiye neden oldu\u011fundan dikkat edilmelidir.&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Hipotermi:<\/strong>&nbsp;Hipotermi, hipovolemiden kaynaklanan mortaliteyi b\u00fcy\u00fck \u00f6l\u00e7\u00fcde art\u0131r\u0131r ve disritmi ve koag\u00fclopatiye katk\u0131da bulunur. Do\u011fru bir s\u0131cakl\u0131k \u00f6l\u00e7\u00fcm\u00fc elde etmek i\u00e7in rektal termometre kullan\u0131lmal\u0131d\u0131r. S\u0131cak battaniyeler veya s\u0131cak bir oda ile hipotermiye gidi\u015f \u00f6nlenmelidir. Res\u00fcsitasyon i\u00e7in \u0131l\u0131k s\u0131v\u0131lar\u0131n kullan\u0131lmas\u0131 yeterli olacakt\u0131r.<\/li>\n\n\n\n<li><strong>Cilt B\u00fct\u00fcnl\u00fc\u011f\u00fcn\u00fcn Bozulmas\u0131:<\/strong>&nbsp;S\u0131rt tahtalar\u0131, boyunluklar, sedyeler ve hareketsizlikten kaynaklanan bas\u0131n\u00e7, 2 saat gibi k\u0131sa bir s\u00fcrede cildin bozulmas\u0131na katk\u0131da bulunur. \u015eiddetli \u00fclserler 6 saat i\u00e7inde olu\u015fabilir. De\u011ferlendirme s\u0131ras\u0131nda risk alt\u0131ndaki t\u00fcm cilt b\u00f6lgelerine (\u00f6zellikle \u00e7ene, oksiput, sakrum ve topuklar) pedler yerle\u015ftirerek cildin bozulmas\u0131 \u00f6nlenmelidir. Erken bilgisayarl\u0131 tomografi (BT) aktivasyonu, BT okuma ve sabitleme i\u00e7in kullan\u0131lan sert cihazlar\u0131n en k\u0131sa s\u00fcrede \u00e7\u0131kar\u0131labilmesi i\u00e7in protokoller olu\u015fturulmal\u0131d\u0131r.<\/li>\n<\/ul>\n\n\n\n<p><strong><em>F &#8211; K\u0131r\u0131lganl\u0131k&nbsp;<\/em><\/strong><\/p>\n\n\n\n<p>Travma i\u00e7in geleneksel ABCDE birincil de\u011ferlendirmesine ek olarak k\u0131r\u0131lganl\u0131\u011f\u0131n de\u011ferlendirilmesi, ya\u015fl\u0131 hastalarda ilk de\u011ferlendirme s\u0131ras\u0131nda son derece \u00f6nemli bir husustur. Acil serviste k\u0131r\u0131lganl\u0131\u011f\u0131n belirlenmesi, hasta y\u00f6netimi ve prognoz hakk\u0131nda karar verme s\u00fcrecine rehberlik etmenin yan\u0131 s\u0131ra, kaynaklar\u0131 erken d\u00f6nemde iyatrojenik zararlar, fonksiyonel gerileme, hastal\u0131\u011f\u0131n ilerlemesi ve \u00f6l\u00fcm a\u00e7\u0131s\u0131ndan en fazla risk alt\u0131nda olan hastalara yo\u011funla\u015ft\u0131rmaya yard\u0131mc\u0131 olabilir. Tablo 3\u2019de bulunan travmaya spesifik k\u0131r\u0131lganl\u0131k \u00f6l\u00e7e\u011fi t\u00fcm ya\u015fl\u0131 travma hastalar\u0131nda kullan\u0131lmal\u0131d\u0131r.<\/p>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<figure class=\"wp-block-table is-style-stripes\"><div class=\"pcrstb-wrap\"><table class=\"has-fixed-layout\"><tbody><tr><td class=\"has-text-align-left\" data-align=\"left\" colspan=\"4\"><strong>15 DE\u011e\u0130\u015eKENL\u0130 TRAVMAYA SPES\u0130F\u0130K KIRILGANLIK \u00d6L\u00c7E\u011e\u0130<\/strong><\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\"><em><strong>Ek Hastal\u0131klar<br><\/strong><\/em><strong>Kanser Hikayesi<\/strong><br>Koroner Arter <br>Hastal\u0131\u011f\u0131&nbsp;<br><strong>Demans<\/strong><\/td><td>&nbsp;<br><strong>Evet (1)<\/strong><br>Miyokard enfarkt\u00fcs\u00fc (1)<br>\u0130la\u00e7 kullan\u0131m\u0131 (0,5)<br><strong>Ciddi (1) Hay\u0131r (0)<\/strong><\/td><td>&nbsp;<br><strong>Hay\u0131r (0)<\/strong><br>Koroner&nbsp;&nbsp;arter bypass (0,75) Yok (0)<br><strong>Orta (0,5)<\/strong><\/td><td>&nbsp;<br><br>Perk\u00fctan anjiografi (0,5)<br><strong>Hafif (0,25)<\/strong><\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\"><em><strong>G\u00fcnl\u00fck Aktivite<br><\/strong><\/em><strong>Bak\u0131m\u0131 yard\u0131ml\u0131<\/strong><br>Para y\u00f6netimine yard\u0131m<br><strong>Ev i\u015flerinde yard\u0131m<\/strong><br>Tuvalete yard\u0131m<br><strong>Y\u00fcr\u00fcmeye yard\u0131m<\/strong><\/td><td><br><br><strong>Evet (1)<\/strong><br>Evet (1)<br><strong>Evet (1)<\/strong><br>Evet (1)<br><strong>Tekerlekli Sandalye (1)<\/strong><br><strong>Hay\u0131r (0)<\/strong><\/td><td><br><strong>Hay\u0131r (0)<\/strong><br>Hay\u0131r (0)<br><strong>Hay\u0131r (0)<\/strong><br>Hay\u0131r (0)<br><strong>Walker (0,75)<\/strong><\/td><td>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<br><br><br><br><br><strong>Baston (0,5)<\/strong><\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\"><strong><em>Sa\u011fl\u0131k Tutumu<br><\/em>Az i\u015fe yarar hissediyor<br><\/strong>\u00dczg\u00fcn hissediyor<br><strong>Her\u015fey i\u00e7in \u00e7aba gerek<br><\/strong>Yaln\u0131z hissediyor<br><strong>D\u00fc\u015fme<\/strong><\/td><td><br><strong>Genellikle (1)<br><\/strong>Genellikle (1)<br><strong>Genellikle (1)<br><\/strong>Genellikle (1)<br><strong>Son 1 ayda (1)<\/strong><\/td><td><br><strong>Bazen (0,5)<br><\/strong>Bazen (0,5)<br><strong>Bazen (0,5)<br><\/strong>Bazen (0,5)<br><strong>1 aydan eski (0,5)<\/strong><\/td><td><br><strong>Hi\u00e7bir zaman (0)<br><\/strong>Hi\u00e7bir zaman (0)<br><strong>Hi\u00e7bir zaman (0)<br><\/strong>Hi\u00e7bir zaman (0)<br><strong>Hi\u00e7bir zaman (0)<\/strong><\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\"><strong>Fonksiyon<\/strong><br>Cinsel aktivite<\/td><td>&nbsp;<br>Evet (0)<\/td><td>&nbsp;<br>Hay\u0131r (0)<\/td><td>&nbsp;<\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\"><strong>Beslenme<\/strong><br>Albumin<\/td><td>&nbsp;<br>&lt;3 (1)<\/td><td>&nbsp;<br>&gt;3 (0)<\/td><td>&nbsp;<\/td><\/tr><\/tbody><\/table><\/div><figcaption class=\"wp-element-caption\">Tablo 3. Travmaya Spesifik K\u0131r\u0131lganl\u0131k \u00d6l\u00e7e\u011fi&nbsp;(3)<br><strong>Puanlama:<\/strong>&nbsp;Her de\u011fi\u015fken i\u00e7in uygun cevap i\u015faretleyin ve puanlar\u0131 toplay\u0131n. Anketten elde edilen toplam puan 15&#8217;e b\u00f6l\u00fcnerek travmaya spesifik k\u0131r\u0131lganl\u0131k indeksi (TSK\u0130) elde edilir. Hastalar ayr\u0131ca TSK\u0130&#8217;lerine g\u00f6re k\u0131r\u0131lgan olmayan (TSKI &lt; 0,25) ve k\u0131r\u0131lgan (TSKI \u2265 0,25) gruplara ayr\u0131labilir&nbsp;(7).<\/figcaption><\/figure>\n\n\n\n<p><strong>Ya\u015fl\u0131 Travma Hastas\u0131n\u0131n \u0130kincil Bak\u0131s\u0131<\/strong><\/p>\n\n\n\n<p>Birincil bak\u0131 t\u00fcm hastalar i\u00e7in tek tip bir yakla\u015f\u0131m izlese de, \u00f6zellikle yer seviyesinden d\u00fc\u015fmeler gibi basit gibi g\u00f6z\u00fcken travmalar\u0131n alt\u0131nda kronik ve akut sorunlar\u0131n olabilece\u011fi ak\u0131lda tutulmal\u0131d\u0131r. Buna ek olarak, ya\u015fl\u0131 yeti\u015fkinlerin a\u011fr\u0131 alg\u0131s\u0131 azalm\u0131\u015f olabilir ve bu da g\u00f6\u011f\u00fcs, kar\u0131n ve iskelet k\u0131r\u0131klar\u0131 dahil olmak \u00fczere ciddi yaralanmalar\u0131n varl\u0131\u011f\u0131n\u0131 klinik g\u00f6r\u00fcn\u00fcmden gizleyebilir.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Laboratuvar:<\/strong>&nbsp;Bir\u00e7ok ya\u015fl\u0131 hasta birden fazla ila\u00e7 kullanmaktad\u0131r ve birden fazla komorbiditesi vard\u0131r, bu nedenle \u00f6zellikle \u00e7oklu yaralanmas\u0131 olan veya hayat\u0131 tehdit eden ciddi yaralanmalar\u0131 olan hastalar i\u00e7in kapsaml\u0131 bir laboratuvar de\u011ferlendirmesi yapmak en iyi uygun yakla\u015f\u0131md\u0131r. \u00d6nerilen laboratuvar \u00e7al\u0131\u015fmalar\u0131 paneli \u015funlar\u0131 i\u00e7erir:<ul><li>Kan gaz\u0131 (arteriyel veya ven\u00f6z) ile laktat ve baz defisiti \u00f6l\u00e7\u00fcm\u00fc<\/li><\/ul><ul><li>PT\/PTT, INR<\/li><\/ul><ul><li>Kapsaml\u0131 metabolik panel (Eektrolit bozukluklar\u0131n\u0131n, renal ve karaci\u011fer fonksiyon bozukluklar\u0131n\u0131n de\u011ferlendirilmesi)&nbsp;<\/li><\/ul><ul><li>Tam kan say\u0131m\u0131&nbsp;<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Kan alkol seviyesi ve idrarda uyu\u015fturucu dahil toksikoloji paneli<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Protrombin zaman\u0131\/INR, varfarin re\u00e7ete edilen hastalar i\u00e7in yeterli olsa da, do\u011frudan oral antikoag\u00fclan (DOAK) kullanan hastalar i\u00e7in neredeyse hi\u00e7bir bilgi sa\u011flamaz. DOAK&#8217;ler do\u011frudan trombin inhibit\u00f6rlerini (\u00f6rn. dabigatran) ve fakt\u00f6r Xa inhibit\u00f6rlerini (\u00f6rn. rivaroksaban ve apiksaban) i\u00e7erir. Travmatik beyin hasar\u0131, intraabdominal solid organ yaralanmas\u0131, retroperitoneal hematoma neden olan kemik pelvis yaralanmas\u0131, aktif kanama kan\u0131t\u0131 veya acil cerrahi m\u00fcdahale ihtiyac\u0131 durumunda DOAK alan hastalar i\u00e7in tromboelastografi d\u00fc\u015f\u00fcn\u00fclmelidir. Antiplatelet ajanlar\u0131n (\u00f6rn. aspirin, klopidogrel, tikagrelor, tiklopidin ve eptifibatid) etkilerini \u00f6l\u00e7mek i\u00e7in hi\u00e7bir objektif test klinik olarak yararl\u0131 de\u011fildir.<\/li>\n\n\n\n<li><strong>G\u00f6r\u00fcnt\u00fcleme:<\/strong>&nbsp;Ya\u015fl\u0131 \u00e7oklu travma hastas\u0131nda ilk g\u00f6r\u00fcnt\u00fcleme i\u00e7in BT taramas\u0131 liberal bir \u015fekilde kullan\u0131lmal\u0131d\u0131r. Ya\u015fl\u0131 hastalarda gizli yaralanmalar s\u0131k g\u00f6r\u00fcld\u00fc\u011f\u00fcnden, radyasyon maruziyeti, kontrast uygulamas\u0131 ve y\u00fcksek maaliyet gibi nedenlerle g\u00f6r\u00fcnt\u00fcleme e\u015fi\u011fi y\u00fcksek tutulmamal\u0131d\u0131r. Bu durum \u00f6zellikle travmatik beyin hasar\u0131, kronik demans, metabolik ensefalopati veya zehirlenme nedeniyle bilin\u00e7 durum de\u011fi\u015fikli\u011fi olan ve muayenesi g\u00fcvenilmez olan hastalar i\u00e7in ge\u00e7erlidir. Ayn\u0131 seviyeden d\u00fc\u015fmeler gibi d\u00fc\u015f\u00fck enerjili travmalar, \u00f6zellikle 55 ya\u015f\u0131ndan b\u00fcy\u00fcklerde \u00f6nemli yaralanmalara neden olabilir, bu nedenle bu pop\u00fclasyonun de\u011ferlendirilmesinde ba\u015f, boyun, g\u00f6\u011f\u00fcs, kar\u0131n ve pelvis BT&#8217;si olduk\u00e7a faydal\u0131 bilgiler sunar. Potansiyel akut veya kronik b\u00f6brek hasar\u0131 endi\u015feleri nedeniyle kontrast uygulamas\u0131ndan \u00e7ekinilmemelidir.<\/li>\n<\/ul>\n\n\n\n<p><strong>Sonu\u00e7<\/strong><\/p>\n\n\n\n<p>Ya\u015fl\u0131 hastalarda atipik ve gizli tablolar g\u00f6r\u00fclebilece\u011fi unutulmamal\u0131d\u0131r Ya\u015fl\u0131 travma de\u011ferlendirmesinde, \u00f6nemli yaralanmalar a\u00e7\u0131s\u0131ndan y\u00fcksek bir \u015f\u00fcphe indeksi korunmal\u0131d\u0131r. Geriatrik travma pop\u00fclasyonunun k\u00f6t\u00fc sonu\u00e7lar a\u00e7\u0131s\u0131ndan y\u00fcksek risk ta\u015f\u0131yan alt k\u00fcmesini belirlemek i\u00e7in dikkatli bir de\u011ferlendirme yap\u0131lmal\u0131d\u0131r. Ya\u015fl\u0131 hastalar, ilk travma y\u00f6netimi s\u0131ras\u0131nda benzer yaralanma mekanizmalar\u0131na sahip gen\u00e7 hastalara g\u00f6re daha agresif bir yakla\u015f\u0131m\u0131 hak etmektedir. \u0130leri hasta ya\u015f\u0131 endi\u015femizi art\u0131rmal\u0131 fakat ya\u015f\u0131n getirdi\u011fi de\u011fi\u015fiklikler ak\u0131lda tutularak uygulanacak multidisipliner hasta y\u00f6netimi her zaman olumlu sonu\u00e7lar do\u011furacakt\u0131r.<\/p>\n\n\n\n<p><strong>Kaynaklar<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Driver BE, Prekker ME, Klein LR, Reardon RF, Miner JR, Fagerstrom ET, et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA. 2018 Jun 5;319(21):2179.&nbsp;<\/li>\n\n\n\n<li>Galvagno SM, Nahmias JT, Young DA. Advanced trauma life support\u00ae Update 2019: management and applications for adults and special populations. Anesthesiol Clin. 2019;37(1):13\u201332.&nbsp;<\/li>\n\n\n\n<li>Best Practices Guidelines in Geriatric Trauma Management. American College of Surgeons; 2023.&nbsp;<\/li>\n\n\n\n<li>DeMuro JP, Simmons S, Jax J, Gianelli SM. Application of the shock index to the prediction of need for hemostasis intervention. Am J Emerg Med. 2013 Aug;31(8):1260\u20133.&nbsp;<\/li>\n\n\n\n<li>Morris MC, Niziolek GM, Baker JE, Huebner BR, Hanseman D, Makley AT, et al. Death by Decade: Establishing a Transfusion Ceiling for Futility in Massive Transfusion. J Surg Res. 2020 Aug;252:139\u201346.&nbsp;<\/li>\n\n\n\n<li>Perera T, Cortijo-Brown A. Geriatric Resuscitation. Emerg Med Clin North Am. 2016 Aug;34(3):453\u201367.&nbsp;<\/li>\n\n\n\n<li>Joseph B, Pandit V, Zangbar B, Kulvatunyou N, Tang A, O\u2019Keeffe T, et al. Validating trauma-specific frailty index for geriatric trauma patients: a prospective analysis. J Am Coll Surg. 2014 Jul;219(1):10-17.e1.&nbsp;<\/li>\n<\/ol>\n<\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Giri\u015f Acil servislerde, ya\u015fl\u0131 n\u00fcfusun artmas\u0131 ile, ileri ya\u015f travma vakalar\u0131yla s\u0131k\u00e7a kar\u015f\u0131la\u015fmaktay\u0131z. Ya\u015fl\u0131 travma hastas\u0131n\u0131n y\u00f6netimi, travmaya neden olan ikincil durumlar,&hellip;<\/p>\n","protected":false},"author":1185,"featured_media":0,"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":[1],"tags":[],"class_list":["post-468","post","type-post","status-publish","format-standard","hentry","category-genel"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/468","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/users\/1185"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=468"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/468\/revisions"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=468"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=468"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=468"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}