{"id":774,"date":"2026-10-19T09:48:03","date_gmt":"2026-10-19T06:48:03","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=774"},"modified":"2026-10-19T09:48:05","modified_gmt":"2026-10-19T06:48:05","slug":"yasli-hastada-dis-acilleri-acil-serviste-tani-ilk-mudahale-ve-guvenli-yonlendirme","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/akademik-blog-yazisi\/yasli-hastada-dis-acilleri-acil-serviste-tani-ilk-mudahale-ve-guvenli-yonlendirme\/","title":{"rendered":"Ya\u015fl\u0131 Hastada Di\u015f Acilleri: Acil Serviste Tan\u0131, \u0130lk M\u00fcdahale ve G\u00fcvenli Y\u00f6nlendirme"},"content":{"rendered":"\n

Edit\u00f6r: <\/strong>Prof.Dr. Arzu Denizba\u015f\u0131 Yazar: <\/strong>Do\u00e7. Dr. Mehmet Altunta\u015f<\/p>\n\n\n\n

Giri\u015f<\/h1>\n\n\n\n

Di\u015f a\u011fr\u0131s\u0131, di\u015f eti kanamas\u0131 ya da proteze ba\u011fl\u0131 bir yara acil serviste ilk bak\u0131\u015fta d\u00fc\u015f\u00fck \u00f6ncelikli bir yak\u0131nma gibi g\u00f6r\u00fcnebilir. Ya\u015fl\u0131 hastada ise ayn\u0131 yak\u0131nma; komorbiditeler, polifarmasi, k\u0131r\u0131lganl\u0131k, beslenme bozuklu\u011fu ve anamnez g\u00fc\u00e7l\u00fc\u011f\u00fc nedeniyle daha geni\u015f bir klinik \u00e7er\u00e7evede de\u011ferlendirilmelidir. Lokal bir enfeksiyonun derin boyun bo\u015fluklar\u0131na ilerlemesi, kanaman\u0131n kullan\u0131lan ila\u00e7larla uzamas\u0131 veya travmatik bir di\u015f yaralanmas\u0131n\u0131n altta yatan senkop ya da aritminin ilk ipucu olmas\u0131 m\u00fcmk\u00fcnd\u00fcr.<\/p>\n\n\n\n

Medicare verilerini inceleyen bir \u00e7al\u0131\u015fmada, 2016-2020 aras\u0131nda 65 ya\u015f ve \u00fczerindeki bireylerin \u00f6nlenebilir di\u015f ve oral kavite sorunlar\u0131 nedeniyle y\u0131lda yakla\u015f\u0131k 110 bin kez acil servise ba\u015fvurdu\u011fu bildirilmi\u015ftir (1). ABD genelinde 2020-2022 d\u00f6neminde di\u015f hastal\u0131klar\u0131 i\u00e7in y\u0131lda ortalama 1,94 milyon acil servis ba\u015fvurusu ger\u00e7ekle\u015fmi\u015f; 65 ya\u015f ve \u00fczeri hastalar bu ba\u015fvurular\u0131n %6,9\u2019unu olu\u015fturmu\u015ftur (2). Bu oran g\u00f6rece d\u00fc\u015f\u00fck g\u00f6r\u00fcnse de ya\u015fl\u0131 hastan\u0131n fizyolojik rezervi ve e\u015flik eden hastal\u0131klar\u0131, ba\u015fvurunun klinik a\u011f\u0131rl\u0131\u011f\u0131n\u0131 art\u0131rabilir.<\/p>\n\n\n\n

Bir Dakikada K\u0131rm\u0131z\u0131 Bayraklar<\/h1>\n\n\n\n
    \n
  • Trismus veya a\u011f\u0131z a\u00e7\u0131kl\u0131\u011f\u0131nda belirgin azalma<\/li>\n\n\n\n
  • Disfaji, odinofaji, salya akmas\u0131 ya da oral sekresyonlar\u0131 y\u00f6netememe<\/li>\n\n\n\n
  • Ses de\u011fi\u015fikli\u011fi, bo\u011fuk \u201cs\u0131cak patates\u201d sesi veya stridor<\/li>\n\n\n\n
  • Sublingual ya da submandibular b\u00f6lgede sertlik, kabar\u0131kl\u0131k veya h\u0131zla artan \u015fi\u015flik<\/li>\n\n\n\n
  • Boyuna yay\u0131lan \u015fi\u015flik, toksik g\u00f6r\u00fcn\u00fcm, hipotansiyon veya bilin\u00e7 de\u011fi\u015fikli\u011fi<\/li>\n\n\n\n
  • \u0130mm\u00fcns\u00fcpresyon, kontrols\u00fcz diyabet veya yak\u0131n zamanda kemoterapi<\/li>\n\n\n\n
  • Oral al\u0131m\u0131n bozulmas\u0131, dehidratasyon veya yeni geli\u015fen deliryum<\/li>\n\n\n\n
  • Antikoag\u00fclan kullan\u0131m\u0131yla birlikte kontrol edilemeyen kanama<\/li>\n<\/ul>\n\n\n\n

    Ya\u015fl\u0131 Hasta Neden Farkl\u0131d\u0131r?<\/h1>\n\n\n\n

    Ya\u015f tek ba\u015f\u0131na bir risk belirleyicisi de\u011fildir; as\u0131l fark\u0131 yaratan, ya\u015fla birlikte biriken klinik ve sosyal y\u00fcklerdir.<\/p>\n\n\n\n

      \n
    • Atipik veya silik ba\u015fvuru: A\u011fr\u0131 alg\u0131s\u0131ndaki de\u011fi\u015fiklik, n\u00f6ropati, demans ya da ileti\u015fim g\u00fc\u00e7l\u00fc\u011f\u00fc nedeniyle ciddi enfeksiyon daha hafif yak\u0131nmalarla ortaya \u00e7\u0131kabilir.<\/li>\n\n\n\n
    • Polifarmasi: Antikoag\u00fclanlar, antiplatelet ila\u00e7lar, kortikosteroidler, imm\u00fcns\u00fcpresif ajanlar ve antiresorptif tedaviler hem kanama hem de enfeksiyon y\u00f6netimini etkiler.<\/li>\n\n\n\n
    • Komorbidite: Diyabet, kronik b\u00f6brek hastal\u0131\u011f\u0131, kalp yetersizli\u011fi, kapak hastal\u0131klar\u0131 ve malignite; iyile\u015fmeyi geciktirebilir ve sistemik komplikasyon riskini art\u0131rabilir.<\/li>\n\n\n\n
    • K\u0131r\u0131lganl\u0131k ve d\u00fc\u015f\u00fck fizyolojik rezerv: Lokal bir enfeksiyon, gen\u00e7 hastaya g\u00f6re daha h\u0131zl\u0131 dehidratasyon, deliryum veya sepsisle sonu\u00e7lanabilir.<\/li>\n\n\n\n
    • Beslenme ve a\u011f\u0131z bak\u0131m\u0131: Di\u015f kayb\u0131, protez uyumsuzlu\u011fu, a\u011f\u0131z kurulu\u011fu ve yutma g\u00fc\u00e7l\u00fc\u011f\u00fc oral al\u0131m\u0131 azaltabilir; maln\u00fctrisyon ise iyile\u015fmeyi daha da bozabilir.<\/li>\n\n\n\n
    • Bak\u0131m ve eri\u015fim sorunu: Ya\u015fl\u0131 hastan\u0131n di\u015f hekimine ula\u015fmas\u0131; hareket k\u0131s\u0131tl\u0131l\u0131\u011f\u0131, bak\u0131m veren deste\u011fi, ekonomik durum ve sa\u011fl\u0131k okuryazarl\u0131\u011f\u0131 nedeniyle gecikebilir.<\/li>\n<\/ul>\n\n\n\n

      Ya\u015fl\u0131 di\u015f dokusunda da ya\u015fa ba\u011fl\u0131 de\u011fi\u015fiklikler klinik de\u011ferlendirmeyi g\u00fc\u00e7le\u015ftirebilir. Sekonder ve tersiyer dentin birikimiyle pulpa odas\u0131n\u0131n k\u00fc\u00e7\u00fclmesi, pulpal vask\u00fclarite ve h\u00fccreselli\u011fin azalmas\u0131 termal uyaranlara yan\u0131t\u0131 zay\u0131flatabilir. Bu nedenle pulpal hastal\u0131k, gen\u00e7 eri\u015fkinde beklenen tipik s\u0131cak-so\u011fuk hassasiyeti veya belirgin a\u011fr\u0131 \u00f6r\u00fcnt\u00fcs\u00fc olmadan da ilerleyebilir (3).<\/p>\n\n\n\n

      T\u00fcrkiye\u2019den yak\u0131n tarihli bir kesitsel \u00e7al\u0131\u015fma da a\u011f\u0131z-di\u015f sa\u011fl\u0131\u011f\u0131 ile sistemik acillerin kesi\u015fimini hat\u0131rlatmaktad\u0131r. Y\u00fcz yirmi di\u015f hekiminin kat\u0131ld\u0131\u011f\u0131 \u00e7al\u0131\u015fmada son 12 ayda en s\u0131k bildirilen t\u0131bbi aciller hipoglisemi (%32,5) ve vazovagal senkop (%25,8) olmu\u015ftur (4). Bu veriler acil servise dental ba\u015fvuru s\u0131kl\u0131\u011f\u0131n\u0131 g\u00f6stermez; ancak \u00f6zellikle \u00e7oklu hastal\u0131\u011f\u0131 ve ila\u00e7 kullan\u0131m\u0131 olan ya\u015fl\u0131larda dental yak\u0131nman\u0131n genel t\u0131bbi durumdan ba\u011f\u0131ms\u0131z ele al\u0131nmamas\u0131 gerekti\u011fini destekleyen yerel bir ba\u011flam sunar.<\/p>\n\n\n\n

      Di\u015f kaynakl\u0131 acil servis ba\u015fvurular\u0131n\u0131n \u00f6nemli bir b\u00f6l\u00fcm\u00fc, kesin tedavi gerektiren ancak rutin di\u015f hekimli\u011fi hizmetine eri\u015filemedi\u011fi i\u00e7in acil servise ta\u015f\u0131nan durumlard\u0131r. D\u00fc\u015f\u00fck sosyoekonomik d\u00fczey, sigorta yetersizli\u011fi ve sa\u011fl\u0131k hizmetine eri\u015fim g\u00fc\u00e7l\u00fc\u011f\u00fc nontravmatik dental ba\u015fvurularla ili\u015fkilidir (5,6). D\u00fc\u015f\u00fck sa\u011fl\u0131k ve a\u011f\u0131z sa\u011fl\u0131\u011f\u0131 okuryazarl\u0131\u011f\u0131 da acil dental hizmet kullan\u0131m\u0131n\u0131 ve d\u00fczenli di\u015f hekimi ba\u015fvurusunu etkileyebilir (7,8). Tekrarlayan ba\u015fvurular \u00e7o\u011fu zaman kesin tedaviye ula\u015f\u0131lamamas\u0131n\u0131n ve eri\u015fim engellerinin s\u00fcrmesinin sonucudur (9). Bu \u00e7al\u0131\u015fmalar\u0131n \u00f6nemli bir b\u00f6l\u00fcm\u00fc genel eri\u015fkin n\u00fcfusu kapsamaktad\u0131r; bulgular ya\u015fl\u0131 hastalara do\u011frudan genellenmemelidir.<\/p>\n\n\n\n

      Acil Serviste De\u011ferlendirme<\/h1>\n\n\n\n

      Muayene yaln\u0131zca a\u011f\u0131z i\u00e7iyle s\u0131n\u0131rland\u0131r\u0131lmamal\u0131d\u0131r. \u0130lk soru, \u201cBu hasta yaln\u0131zca di\u015f a\u011fr\u0131s\u0131 m\u0131 ya\u015f\u0131yor, yoksa havayolunu, dola\u015f\u0131m\u0131 veya genel durumunu tehdit eden daha geni\u015f bir s\u00fcre\u00e7 mi var?\u201d olmal\u0131d\u0131r.<\/p>\n\n\n\n

      \u00d6yk\u00fcde \u00f6zellikle sorgulanmas\u0131 gerekenler<\/h2>\n\n\n\n
        \n
      • Yak\u0131nman\u0131n ba\u015flang\u0131c\u0131, ilerleme h\u0131z\u0131 ve \u00f6nceki di\u015f i\u015flemleri<\/li>\n\n\n\n
      • Ate\u015f, titreme, disfaji, nefes darl\u0131\u011f\u0131 ve boyun a\u011fr\u0131s\u0131<\/li>\n\n\n\n
      • Antibiyotik kullan\u0131m\u0131 ve son d\u00f6nemde tekrarlayan ba\u015fvurular<\/li>\n\n\n\n
      • Warfarin, do\u011frudan oral antikoag\u00fclan, antiplatelet ve NSA\u0130\u0130 kullan\u0131m\u0131<\/li>\n\n\n\n
      • Bisfosfonat veya denosumab tedavisi; tedavinin endikasyonu ve s\u00fcresi<\/li>\n\n\n\n
      • Diyabet, b\u00f6brek ve karaci\u011fer hastal\u0131\u011f\u0131, kalp kapak hastal\u0131\u011f\u0131, malignite ve imm\u00fcns\u00fcpresyon<\/li>\n\n\n\n
      • D\u00fc\u015fme, senkop, ba\u015f d\u00f6nmesi, \u00e7arp\u0131nt\u0131 veya yeni n\u00f6rolojik yak\u0131nma<\/li>\n\n\n\n
      • Hastan\u0131n ila\u00e7lar\u0131n\u0131 ve taburculuk \u00f6nerilerini anlay\u0131p uygulayabilme durumu; bak\u0131m veren deste\u011fi<\/li>\n<\/ul>\n\n\n\n

        Fizik muayenede odaklan\u0131lacak noktalar<\/h2>\n\n\n\n
          \n
        • Y\u00fcz ve boyunda asimetri, \u015fi\u015flik ve yay\u0131l\u0131m bulgular\u0131<\/li>\n\n\n\n
        • A\u011f\u0131z a\u00e7\u0131kl\u0131\u011f\u0131 ve trismusun derecesi<\/li>\n\n\n\n
        • A\u011f\u0131z taban\u0131, dilin pozisyonu ve sublingual-submandibular sertlik<\/li>\n\n\n\n
        • Di\u015f hassasiyeti, \u00e7\u00fcr\u00fck, k\u0131r\u0131k, mobilite, gingival \u015fi\u015flik ve fluktuasyon<\/li>\n\n\n\n
        • Protez \u00e7\u0131kar\u0131ld\u0131ktan sonra mukoza, \u00fclser ve yabanc\u0131 cisim de\u011ferlendirmesi<\/li>\n\n\n\n
        • Malokl\u00fczyon, \u00e7ene hareketleri, step deformitesi ve mental sinir duyusu<\/li>\n\n\n\n
        • Oral al\u0131m, hidrasyon, bilin\u00e7 durumu ve genel k\u0131r\u0131lganl\u0131k<\/li>\n<\/ul>\n\n\n\n

          S\u0131k Kar\u015f\u0131la\u015f\u0131lan Klinik Tablolar<\/h1>\n\n\n\n

          1. Pulpal hastal\u0131k, odontojenik enfeksiyon, apse ve sel\u00fclit<\/h2>\n\n\n\n

          Periapikal ve periodontal enfeksiyonlar; lokal di\u015f a\u011fr\u0131s\u0131ndan y\u00fcz sel\u00fclitine ve derin boyun enfeksiyonuna kadar geni\u015f bir yelpazede g\u00f6r\u00fclebilir. Acil serviste temel ayr\u0131m; lokalize, drenaj gerektiren bir koleksiyon ile diff\u00fcz sel\u00fclit veya derin bo\u015fluk enfeksiyonu aras\u0131ndad\u0131r.<\/p>\n\n\n\n

          \n
          \n
          \n
          \"\"<\/figure>\n<\/figure>\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n

          Resim 1a. Dental Apse<\/em><\/p>\n\n\n\n

          \"\"<\/figure>\n\n\n\n

          Resim 1b.<\/strong> Dental Apse Ekstraoral Fist\u00fcl<\/em><\/strong><\/p>\n\n\n\n

          Pulpal a\u011fr\u0131y\u0131 ya\u015fl\u0131 hastada nas\u0131l yorumlamal\u0131y\u0131z?<\/h3>\n\n\n\n

          Reversibl pulpitiste a\u011fr\u0131 genellikle s\u0131cak, so\u011fuk veya tatl\u0131 gibi bir uyaranla ortaya \u00e7\u0131kar ve uyaran ortadan kalk\u0131nca h\u0131zla geriler; irreversibl pulpitiste ise spontan, uzayan ve gece uykudan uyand\u0131rabilen a\u011fr\u0131 daha tipiktir. Bununla birlikte ya\u015fl\u0131 hastada pulpa odas\u0131n\u0131n daralmas\u0131 ve duyusal yan\u0131t\u0131n azalmas\u0131 nedeniyle bu klasik ayr\u0131m daha belirsiz olabilir. Dolay\u0131s\u0131yla silik semptomlar ciddi pulpal veya periapikal hastal\u0131\u011f\u0131 d\u0131\u015flamaz (3).<\/p>\n\n\n\n

          Nontravmatik dental sorunlar\u0131n \u00e7o\u011fu kesin olarak di\u015f hekimli\u011fi ortam\u0131nda tedavi edilir. Acil servis \u00e7o\u011fu zaman a\u011fr\u0131 ve enfeksiyonu ge\u00e7ici olarak kontrol eder; altta yatan pulpal veya periodontal kayna\u011f\u0131 ortadan kald\u0131rmaz. Kanada verilerinde ba\u015fvurular\u0131n en s\u0131k nedeni pulpa ve periapikal dokular\u0131n hastal\u0131klar\u0131 olmu\u015f; ba\u015fvurular\u0131n b\u00fcy\u00fck b\u00f6l\u00fcm\u00fcnde tedavi analjezik ve antibiyotikle s\u0131n\u0131rl\u0131 kalm\u0131\u015ft\u0131r (10). Bu nedenle taburculuk, yaln\u0131zca re\u00e7ete d\u00fczenlemek de\u011fil, zaman\u0131nda kesin tedaviye eri\u015fimi de g\u00fcvence alt\u0131na almak anlam\u0131na gelmelidir.<\/p>\n\n\n\n

          Antibiyotik ne zaman d\u00fc\u015f\u00fcn\u00fclmeli?<\/h3>\n\n\n\n

          Antibiyotik her di\u015f a\u011fr\u0131s\u0131n\u0131n tedavisi de\u011fildir. Lokalize pulpitis veya sistemik bulgusu olmayan s\u0131n\u0131rl\u0131 periapikal a\u011fr\u0131da as\u0131l tedavi dental giri\u015fimdir. Ate\u015f, yayg\u0131n sel\u00fclit, lenfadenopati, trismus, sistemik toksisite, imm\u00fcns\u00fcpresyon veya derin bo\u015fluk yay\u0131l\u0131m\u0131 varsa antibiyotik d\u00fc\u015f\u00fcn\u00fclmelidir. Ulusal ABD verilerinde nontravmatik dental ba\u015fvurular\u0131n yakla\u015f\u0131k %63\u2019\u00fcnde antibiyotik verildi\u011fi; opioid kullan\u0131m\u0131n\u0131n azalmas\u0131na kar\u015f\u0131n antibiyotik kullan\u0131m\u0131n\u0131n b\u00fcy\u00fck \u00f6l\u00e7\u00fcde sabit kald\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir (11). Ya\u015fl\u0131 hastada se\u00e7im yap\u0131l\u0131rken b\u00f6brek ve karaci\u011fer fonksiyonlar\u0131, ila\u00e7 etkile\u015fimleri, yak\u0131n zamanda antibiyotik kullan\u0131m\u0131, alerji \u00f6yk\u00fcs\u00fc ve Clostridioides difficile riski dikkate al\u0131nmal\u0131d\u0131r.<\/p>\n\n\n\n

          G\u00f6r\u00fcnt\u00fcleme ve POCUS<\/h3>\n\n\n\n

          Basit, lokalize dental a\u011fr\u0131da rutin BT gerekli de\u011fildir. Y\u00fcz ve boyunda yayg\u0131n \u015fi\u015flik, derin bo\u015fluk tutulumu, osteomiyelit, k\u0131r\u0131k veya t\u00fcm\u00f6r \u015f\u00fcphesi varsa kontrastl\u0131 BT de\u011ferlidir. Dental apse \u015f\u00fcphesi olan 29 eri\u015fkini i\u00e7eren k\u00fc\u00e7\u00fck bir prospektif \u00e7al\u0131\u015fmada POCUS\u2019un duyarl\u0131l\u0131\u011f\u0131 y\u00fcksek, \u00f6zg\u00fcll\u00fc\u011f\u00fc d\u00fc\u015f\u00fck bulunmu\u015ftur (12). Bu nedenle POCUS, se\u00e7ilmi\u015f y\u00fczeyel koleksiyonlarda yard\u0131mc\u0131 bir y\u00f6ntem olabilir; BT\u2019nin veya uzman de\u011ferlendirmesinin yerini ald\u0131\u011f\u0131 kabul edilmemelidir.<\/p>\n\n\n\n

          2. Ludwig anjini ve derin boyun enfeksiyonu<\/h2>\n\n\n\n

          Ludwig anjini, submandibular, sublingual ve submental bo\u015fluklar\u0131n \u00e7o\u011funlukla bilateral tutulumuyla seyreden, h\u0131zl\u0131 ilerleyebilen bir havayolu acilidir. Dilin yukar\u0131 ve arkaya itilmesi, a\u011f\u0131z taban\u0131nda sertlik, trismus, disfaji, salya akmas\u0131 ve ses de\u011fi\u015fikli\u011fi alarm bulgular\u0131d\u0131r.<\/p>\n\n\n\n

            \n
          1. Havayolunu erken ve tekrarlayan bi\u00e7imde de\u011ferlendirin; hasta k\u00f6t\u00fcle\u015fmeden anestezi ve Kulak Burun Bo\u011faz ekibini s\u00fcrece dahil edin.<\/li>\n\n\n\n
          2. Havayolu riski belirginse g\u00f6r\u00fcnt\u00fcleme i\u00e7in g\u00fcvenli\u011fi geciktirmeyin. Uyan\u0131k fleksibl ent\u00fcbasyon veya cerrahi havayolu olas\u0131l\u0131\u011f\u0131 i\u00e7in haz\u0131rl\u0131k yap\u0131n.<\/li>\n\n\n\n
          3. Hasta stabilse ve supin pozisyonu tolere edebiliyorsa kontrastl\u0131 boyun BT ile yay\u0131l\u0131m\u0131 de\u011ferlendirin.<\/li>\n\n\n\n
          4. Geni\u015f spektrumlu intraven\u00f6z antibiyotik ve cerrahi kaynak kontrol\u00fcn\u00fc birlikte planlay\u0131n (13).<\/li>\n<\/ol>\n\n\n\n

            3. Post-ekstraksiyon veya spontan oral kanama<\/h2>\n\n\n\n

            Antikoag\u00fclan veya antiplatelet kullanan ya\u015fl\u0131larda post-ekstraksiyon kanamas\u0131 s\u0131k kar\u015f\u0131la\u015f\u0131lan bir sorundur. \u0130lk yakla\u015f\u0131m sistemik ilac\u0131 refleks olarak kesmek de\u011fil, kanaman\u0131n yerini belirlemek ve lokal hemostaz sa\u011flamakt\u0131r.<\/p>\n\n\n\n

              \n
            1. Soketi temizleyin; uygun gazl\u0131 bezle kesintisiz ve yeterli s\u00fcre bas\u0131 uygulay\u0131n.<\/li>\n\n\n\n
            2. Gerekirse lokal hemostatik ajan, s\u00fct\u00fcr veya traneksamik asitli lokal uygulama kullan\u0131n.<\/li>\n\n\n\n
            3. Warfarin kullananlarda INR\u2019yi; beklenmeyen veya yayg\u0131n kanamada hemogram, b\u00f6brek-karaci\u011fer fonksiyonlar\u0131 ve uygun koag\u00fclasyon testlerini de\u011ferlendirin.<\/li>\n\n\n\n
            4. \u0130lac\u0131n kesilmesi veya antidot uygulanmas\u0131 karar\u0131n\u0131 kanama \u015fiddeti, tromboemboli riski ve ilgili uzmanlarla birlikte verin.<\/li>\n<\/ol>\n\n\n\n

              EXTRACT-NOAC \u00e7al\u0131\u015fmas\u0131nda %10 traneksamik asit gargaras\u0131, do\u011frudan oral antikoag\u00fclan kullanan hastalarda toplam post-ekstraksiyon kanamas\u0131n\u0131 plaseboya g\u00f6re anlaml\u0131 bi\u00e7imde azaltmam\u0131\u015f; ancak gecikmi\u015f kanama ve \u00e7oklu di\u015f \u00e7ekimi sonras\u0131 kanama daha az g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Yetmi\u015f be\u015f ya\u015f ve \u00fczerindeki alt grupta koruyucu etki daha belirgin bulunmu\u015ftur (14). Traneksamik asit yararl\u0131 bir ek y\u00f6ntem olabilir; fakat mekanik lokal hemostaz\u0131n ve kanama kayna\u011f\u0131n\u0131n kontrol\u00fcn\u00fcn yerini almaz.<\/p>\n\n\n\n

              4. \u0130la\u00e7 ili\u015fkili \u00e7ene osteonekrozu<\/h2>\n\n\n\n

              Bisfosfonat veya denosumab kullanan hastada iyile\u015fmeyen \u00e7ekim yeri, ekspoze kemik, fist\u00fcl, a\u011fr\u0131, \u015fi\u015flik ya da sekonder enfeksiyon ila\u00e7 ili\u015fkili \u00e7ene osteonekrozunu d\u00fc\u015f\u00fcnd\u00fcrmelidir. Risk \u00f6zellikle malignite nedeniyle y\u00fcksek doz parenteral antiresorptif tedavi alanlarda daha fazlad\u0131r. Di\u015f \u00e7ekimi ve lokal enfeksiyonlar \u00f6nemli tetikleyiciler aras\u0131ndad\u0131r (15). Acil serviste ama\u00e7 tan\u0131y\u0131 kesinle\u015ftirmekten \u00e7ok enfeksiyon ve a\u011fr\u0131y\u0131 kontrol etmek, gereksiz invaziv giri\u015fimden ka\u00e7\u0131nmak ve a\u011f\u0131z-di\u015f-\u00e7ene cerrahisine zaman\u0131nda y\u00f6nlendirmektir.<\/p>\n\n\n\n

              \"\"<\/figure>\n\n\n\n

              Resim 2.<\/strong> Bisfosfonat \u0130li\u015fkili \u00c7ene Osteonekrozu<\/em><\/p>\n\n\n\n

              5. Travmatik di\u015f ve orofasiyal yaralanmalar<\/h2>\n\n\n\n

              Ya\u015fl\u0131 hastada dental travma \u00e7o\u011fu zaman d\u00fc\u015fmenin par\u00e7as\u0131d\u0131r. Kron k\u0131r\u0131klar\u0131, yumu\u015fak doku laserasyonlar\u0131 ve alveoler yaralanmalar g\u00f6r\u00fclebilir (16). Ancak yaln\u0131zca di\u015fe odaklanmak \u00f6nemli bir f\u0131rsat\u0131 ka\u00e7\u0131rabilir: d\u00fc\u015fme mekanik mi, yoksa senkop, ortostatik hipotansiyon, aritmi, ila\u00e7 yan etkisi veya n\u00f6rolojik olay sonucu mu geli\u015fmi\u015ftir?<\/p>\n\n\n\n

                \n
              • Kay\u0131p di\u015f veya kron par\u00e7as\u0131 tam olarak bulunam\u0131yorsa dudak ve yanak i\u00e7inde g\u00f6m\u00fcl\u00fc par\u00e7a aray\u0131n; gerekirse yumu\u015fak doku grafisi kullan\u0131n.<\/li>\n\n\n\n
              • Mandibula k\u0131r\u0131\u011f\u0131 i\u00e7in malokl\u00fczyon, \u00e7ene hareketinde a\u011fr\u0131, step deformitesi ve mental sinir duyu kayb\u0131n\u0131 de\u011ferlendirin.<\/li>\n\n\n\n
              • Av\u00fclse kal\u0131c\u0131 di\u015fte h\u0131zl\u0131 dental kons\u00fcltasyon gerekir; ancak ileri periodontal hastal\u0131k, aspirasyon riski ve genel klinik durum reimplantasyon karar\u0131n\u0131 etkileyebilir.<\/li>\n\n\n\n
              • Antikoag\u00fclan kullananlarda e\u015flik eden kafa travmas\u0131n\u0131 ve intrakraniyal kanama riskini ayr\u0131ca de\u011ferlendirin.<\/li>\n<\/ul>\n\n\n\n
                \"\"<\/figure>\n\n\n\n

                Resim 3.<\/strong> Ya\u015fl\u0131 hastada travma sonras\u0131 rezorbe olmu\u015f mandibula frakt\u00fcr\u00fc<\/em><\/p>\n\n\n\n

                6. Protez kaynakl\u0131 yaralanmalar, \u00fclserler ve yabanc\u0131 cisim<\/h2>\n\n\n\n

                Uyumsuz protezler bas\u0131 \u00fclserine, mukozal laserasyona, a\u011fr\u0131ya ve sekonder enfeksiyona yol a\u00e7abilir. Hareketli protezin k\u0131r\u0131lmas\u0131 aspirasyon veya yutma riski de olu\u015fturabilir. Travmatik neden ortadan kald\u0131r\u0131ld\u0131ktan sonra iki hafta i\u00e7inde iyile\u015fmeyen, sert tabanl\u0131, d\u00fczensiz kenarl\u0131 veya kolay kanayan \u00fclserlerde oral malignite d\u0131\u015flanmal\u0131d\u0131r. Bu hastalar yaln\u0131zca semptomatik tedaviyle taburcu edilmemeli; a\u011f\u0131z-di\u015f-\u00e7ene cerrahisi veya Kulak Burun Bo\u011faz de\u011ferlendirmesi planlanmal\u0131d\u0131r.<\/p>\n\n\n\n

                Dental i\u015flemler s\u0131ras\u0131nda k\u00fc\u00e7\u00fck protetik restorasyonlar\u0131n, dolgu materyallerinin veya el aletlerinin yutulmas\u0131 ya da aspirasyonu da bildirilmi\u015ftir; yatar veya yar\u0131 yatar pozisyon bu t\u00fcr olaylar\u0131n fark edilmesini g\u00fc\u00e7le\u015ftirebilir (17). Kay\u0131p bir protez ya da par\u00e7a tam olarak bulunam\u0131yorsa, \u00f6zellikle \u00f6ks\u00fcr\u00fck, dispne, ses de\u011fi\u015fikli\u011fi veya a\u00e7\u0131klanamayan solunum bulgular\u0131 varsa yabanc\u0131 cisim aspirasyonu olas\u0131l\u0131\u011f\u0131 ayr\u0131ca de\u011ferlendirilmelidir.<\/p>\n\n\n\n

                7. Temporomandibular eklem sorunlar\u0131 ve akut okl\u00fczyon de\u011fi\u015fikli\u011fi<\/h2>\n\n\n\n

                Akut \u00e7ene kilitlenmesi, protezin aniden oturmamas\u0131 veya yeni geli\u015fen malokl\u00fczyon basit temporomandibular eklem disfonksiyonundan kaynaklanabilir; ancak travma, mandibula k\u0131r\u0131\u011f\u0131, dislokasyon, enfeksiyon veya kitle de d\u00fc\u015f\u00fcn\u00fclmelidir. Ya\u015fl\u0131 hastada yeni ba\u015flang\u0131\u00e7l\u0131 ve a\u00e7\u0131klanamayan okl\u00fczyon de\u011fi\u015fikli\u011fi, \u00f6zellikle kilo kayb\u0131, uyu\u015fma veya iyile\u015fmeyen oral lezyonla birlikteyse ileri de\u011ferlendirme gerektirir.<\/p>\n\n\n\n

                A\u011fr\u0131 Tedavisi: Ya\u015fa De\u011fil Hastaya G\u00f6re<\/h1>\n\n\n\n

                Akut dental a\u011fr\u0131da parasetamol ve uygun hastalarda NSA\u0130\u0130\u2019ler \u00e7o\u011fu zaman opioidlerden daha etkili bir temel olu\u015fturur. Ancak ya\u015fl\u0131 hastada NSA\u0130\u0130 karar\u0131; kronik b\u00f6brek hastal\u0131\u011f\u0131, kalp yetersizli\u011fi, peptik \u00fclser, antikoag\u00fclan kullan\u0131m\u0131 ve hipertansiyon g\u00f6z \u00f6n\u00fcne al\u0131narak verilmelidir. Parasetamol i\u00e7in de d\u00fc\u015f\u00fck v\u00fccut a\u011f\u0131rl\u0131\u011f\u0131, maln\u00fctrisyon, karaci\u011fer hastal\u0131\u011f\u0131 ve e\u015f zamanl\u0131 kombinasyon \u00fcr\u00fcnleri dikkate al\u0131nmal\u0131d\u0131r.<\/p>\n\n\n\n

                Opioid gerekiyorsa en d\u00fc\u015f\u00fck etkili doz ve en k\u0131sa s\u00fcre tercih edilmeli; sedasyon, d\u00fc\u015fme, konstipasyon, deliryum ve solunum depresyonu riski hesaba kat\u0131lmal\u0131d\u0131r. ABD\u2019de di\u015f hastal\u0131klar\u0131na ba\u011fl\u0131 acil servis ba\u015fvurular\u0131nda yaln\u0131z opioid verilme oran\u0131n\u0131n 2014-2016\u2019daki %38,1\u2019den 2020-2022\u2019de %16,5\u2019e d\u00fc\u015ft\u00fc\u011f\u00fc bildirilmi\u015ftir (2).<\/p>\n\n\n\n

                S\u0131k Yap\u0131lan Hata: Her Kapak Hastas\u0131na Profilaksi Verilmez<\/h1>\n\n\n\n

                Kalp kapak hastal\u0131\u011f\u0131 bulunan her ya\u015fl\u0131 hastaya antibiyotik profilaksisi gerekmez. G\u00fcncel \u00f6neriler profilaksiyi; protez kalp kapa\u011f\u0131 veya kapak onar\u0131m\u0131nda kullan\u0131lan protez materyal, \u00f6nceki enfektif endokardit, se\u00e7ilmi\u015f konjenital kalp hastal\u0131klar\u0131 ve kapak yetersizli\u011fi geli\u015fmi\u015f kalp transplantasyonu gibi en y\u00fcksek riskli durumlarla s\u0131n\u0131rlar (18). Acil serviste profilaksi karar\u0131, yap\u0131lacak dental i\u015flemin t\u00fcr\u00fc ve hastan\u0131n kardiyak risk grubu birlikte de\u011ferlendirilerek verilmelidir.<\/p>\n\n\n\n

                Kons\u00fcltasyon, Yat\u0131\u015f ve G\u00fcvenli Taburculuk<\/h1>\n\n\n\n

                Acil kons\u00fcltasyon veya yat\u0131\u015f gerektiren durumlar<\/h2>\n\n\n\n
                  \n
                • Havayolunu tehdit eden \u015fi\u015flik, stridor, sekresyonlar\u0131 y\u00f6netememe veya ilerleyen trismus<\/li>\n\n\n\n
                • Derin boyun enfeksiyonu veya Ludwig anjini \u015f\u00fcphesi<\/li>\n\n\n\n
                • Sepsis, hipotansiyon, yeni bilin\u00e7 de\u011fi\u015fikli\u011fi veya belirgin sistemik toksisite<\/li>\n\n\n\n
                • H\u0131zla ilerleyen y\u00fcz-boyun sel\u00fcliti ya da imm\u00fcns\u00fcprese hastada enfeksiyon<\/li>\n\n\n\n
                • Kontrol edilemeyen oral kanama veya semptomatik anemi<\/li>\n\n\n\n
                • Oral al\u0131m\u0131n s\u00fcrd\u00fcr\u00fclememesi, dehidratasyon veya ciddi maln\u00fctrisyon riski<\/li>\n\n\n\n
                • Mandibula\/maksilla k\u0131r\u0131\u011f\u0131, ciddi alveoler yaralanma veya aspirasyon riski<\/li>\n\n\n\n
                • G\u00fcvenli ayaktan izlem kurulamayan k\u0131r\u0131lgan, kognitif bozuklu\u011fu olan veya yaln\u0131z ya\u015fayan hasta<\/li>\n<\/ul>\n\n\n\n

                  Ayaktan izlem d\u00fc\u015f\u00fcn\u00fclebilecek durumlar<\/h2>\n\n\n\n
                    \n
                  • Sistemik bulgusu ve yay\u0131l\u0131m i\u015fareti olmayan lokalize dental a\u011fr\u0131 veya s\u0131n\u0131rl\u0131 enfeksiyon<\/li>\n\n\n\n
                  • Lokal \u00f6nlemlerle tamamen kontrol edilen min\u00f6r kanama<\/li>\n\n\n\n
                  • Komplike olmayan protez bas\u0131 yaras\u0131<\/li>\n\n\n\n
                  • K\u0131r\u0131k veya ciddi yumu\u015fak doku yaralanmas\u0131 bulunmayan min\u00f6r dental travma<\/li>\n<\/ul>\n\n\n\n

                    Ayaktan izlem karar\u0131 yaln\u0131zca klinik stabiliteye dayanmaz. Hastan\u0131n re\u00e7eteyi anlayabilmesi, ilaca eri\u015febilmesi, oral al\u0131m\u0131n\u0131 s\u00fcrd\u00fcrebilmesi, bak\u0131m veren deste\u011fi ve belirlenen s\u00fcrede di\u015f hekimine ula\u015fabilmesi de de\u011ferlendirilmelidir. Acil servislerin kesin dental tedavi sa\u011flamad\u0131\u011f\u0131 ve tekrarlayan ba\u015fvurular\u0131n s\u0131k g\u00f6r\u00fclebildi\u011fi unutulmamal\u0131d\u0131r (9,19).<\/p>\n\n\n\n

                    Be\u015f Ad\u0131ml\u0131 Acil Servis Algoritmas\u0131<\/h1>\n\n\n\n
                    Ad\u0131m<\/strong><\/td>Temel soru<\/strong><\/td>Eylem<\/strong><\/td><\/tr>
                    1. Havayolu<\/td>Trismus, disfaji, ses de\u011fi\u015fikli\u011fi, stridor veya a\u011f\u0131z taban\u0131 \u015fi\u015fli\u011fi var m\u0131?<\/td>Varsa g\u00f6r\u00fcnt\u00fclemeyi beklemeden havayolu ekibini ve Kulak Burun Bo\u011faz\/anesteziyi devreye sok.<\/td><\/tr>
                    2. Yay\u0131l\u0131m<\/td>Ate\u015f, toksisite, boyun tutulumu, imm\u00fcns\u00fcpresyon veya sepsis bulgusu var m\u0131?<\/td>Laboratuvar, uygun g\u00f6r\u00fcnt\u00fcleme, IV antibiyotik, kons\u00fcltasyon ve kaynak kontrol\u00fc planla.<\/td><\/tr>
                    3. Lokal sorun<\/td>Drenaj gerektiren apse, aktif kanama, travma veya protez yaras\u0131 var m\u0131?<\/td>Lokal m\u00fcdahaleyi yap; BT ve uzman deste\u011fini klinik gereklili\u011fe g\u00f6re kullan. POCUS\u2019u se\u00e7ilmi\u015f y\u00fczeyel koleksiyonlarda yard\u0131mc\u0131 y\u00f6ntem olarak de\u011ferlendir.<\/td><\/tr>
                    4. \u0130la\u00e7 ve komorbidite<\/td>Antikoag\u00fclan, antiresorptif ila\u00e7, b\u00f6brek-karaci\u011fer hastal\u0131\u011f\u0131 veya diyabet var m\u0131?<\/td>Analjezik ve antibiyotik se\u00e7imini, kanama ve \u00e7ene osteonekrozu riskini buna g\u00f6re d\u00fczenle.<\/td><\/tr>
                    5. G\u00fcvenli \u00e7\u0131k\u0131\u015f<\/td>Hasta yiyip i\u00e7ebiliyor, \u00f6nerileri anlayabiliyor ve di\u015f hekimine ula\u015fabiliyor mu?<\/td>Hay\u0131rsa g\u00f6zlem\/yat\u0131\u015f veya sosyal destek; evetse yaz\u0131l\u0131 uyar\u0131lar ve kesin takip plan\u0131 ver.<\/td><\/tr><\/tbody><\/table><\/div><\/figure>\n\n\n\n

                    Ak\u0131lda Kalmas\u0131 Gerekenler<\/h1>\n\n\n\n
                      \n
                    • Ya\u015fl\u0131 hastada \u201cbasit di\u015f a\u011fr\u0131s\u0131\u201d tan\u0131s\u0131, havayolu ve sistemik de\u011ferlendirme tamamland\u0131ktan sonra konulmal\u0131d\u0131r.<\/li>\n\n\n\n
                    • Ya\u015fl\u0131 hastada pulpal hastal\u0131k klasik s\u0131cak-so\u011fuk hassasiyeti veya belirgin a\u011fr\u0131 \u00f6r\u00fcnt\u00fcs\u00fc olmadan ilerleyebilir.<\/li>\n\n\n\n
                    • Trismus, disfaji, ses de\u011fi\u015fikli\u011fi ve a\u011f\u0131z taban\u0131 \u015fi\u015fli\u011fi birlikteyse derin boyun enfeksiyonu kabul edilene kadar dikkatli olunmal\u0131d\u0131r.<\/li>\n\n\n\n
                    • Antibiyotik, kesin dental tedavinin yerine ge\u00e7mez; sistemik veya yay\u0131l\u0131m bulgusu yoksa rutin kullan\u0131m\u0131ndan ka\u00e7\u0131n\u0131lmal\u0131d\u0131r.<\/li>\n\n\n\n
                    • Antikoag\u00fclan ili\u015fkili oral kanamada ilk ad\u0131m lokal hemostazd\u0131r; antitrombotik tedavi kontrols\u00fcz bi\u00e7imde kesilmemelidir.<\/li>\n\n\n\n
                    • Dental travmada d\u00fc\u015fmenin nedeni, kafa travmas\u0131 ve kullan\u0131lan ila\u00e7lar ayr\u0131ca de\u011ferlendirilmelidir.<\/li>\n\n\n\n
                    • Taburculuk g\u00fcvenli\u011fi; klinik durum kadar bili\u015fsel kapasite, bak\u0131m veren deste\u011fi ve di\u015f hekimine eri\u015fime de ba\u011fl\u0131d\u0131r.<\/li>\n<\/ul>\n\n\n\n

                      Sonu\u00e7<\/h1>\n\n\n\n

                      Ya\u015fl\u0131 hastada di\u015f ve oral kavite acilleri, lokal bir a\u011f\u0131z sorununun \u00f6tesinde de\u011ferlendirilmelidir. Acil hekiminin temel g\u00f6revi; havayolunu tehdit eden enfeksiyonu, kontrols\u00fcz kanamay\u0131, travman\u0131n sistemik nedenlerini ve k\u0131r\u0131lgan hastada geli\u015febilecek komplikasyonlar\u0131 erken tan\u0131makt\u0131r. Bunun ard\u0131ndan a\u011fr\u0131 ve enfeksiyonun rasyonel y\u00f6netimi, gereksiz antibiyotik ve opioid kullan\u0131m\u0131ndan ka\u00e7\u0131nma, uygun g\u00f6r\u00fcnt\u00fcleme ve kesin dental tedaviye eri\u015fimin sa\u011flanmas\u0131 gelir. Ba\u015far\u0131l\u0131 bir taburculuk, yaln\u0131zca re\u00e7ete yazmak de\u011fil; hastan\u0131n \u00f6nerileri uygulayabilece\u011finden ve zaman\u0131nda di\u015f hekimine ula\u015fabilece\u011finden emin olmakt\u0131r.<\/p>\n\n\n\n

                      Not:<\/strong> G\u00f6rseller Recep Tayyip Erdo\u011fan \u00dcniversitesi, Di\u015f Hekimli\u011fi Fak\u00fcltesi, A\u011f\u0131z Di\u015f ve \u00c7ene Cerrahisi Ana Bilim Dal\u0131 ar\u015fivinden temin edilmi\u015ftir.<\/em><\/p>\n\n\n\n

                      Kaynak\u00e7a<\/h1>\n\n\n\n

                      1. Dahal R, Jarosek S, Virnig B. Emergency Department Use for Dental Problems Among Medicare Fee-for-Service Older Adults in the U.S. (2016 to 2020). Innov Aging. 2022;6(Suppl 1):762-763. doi:10.1093\/geroni\/igac059.2877.<\/p>\n\n\n\n

                      2. Schappert SM, Santo L. Emergency Department Visits for Tooth Disorders: United States, 2020-2022. NCHS Data Brief. 2025;(531):1-11.<\/p>\n\n\n\n

                      3. Toman M, T\u00fcrk\u00fcn M, Toksavul S, \u00c7al E. Geriatrik hastalarda acil m\u00fcdahale gerektiren dental problemler. Ege T\u0131p Dergisi. 2014;53(Ek Say\u0131):53-55.<\/p>\n\n\n\n

                      4. Sevin\u00e7 G\u00fcl SN, Dilsiz A, Diri E, Huseyinli I. Di\u015f Hekimli\u011fi Kliniklerinde T\u0131bbi Acil Durum Y\u00f6netimi: Bilgi, Tutum ve Uygulamalar\u0131n Kesitsel Bir De\u011ferlendirmesi. Mersin \u00dcniversitesi T\u0131p Fak\u00fcltesi Lokman Hekim T\u0131p Tarihi ve Folklorik T\u0131p Dergisi. 2025;15(3):1058-1068. doi:10.31020\/mutftd.1742270.<\/p>\n\n\n\n

                      5. Taylor H, Musey P, Hirsh A, Thyvalikakath T, Vest JR. Association Between Socioeconomic Status and Emergency Department Use for Non-traumatic Dental Conditions. West J Emerg Med. 2026;27(2):471-482. doi:10.5811\/westjem.47316.<\/p>\n\n\n\n

                      6. Serna CA, Arevalo O, Tomar SL. Dental-Related Use of Hospital Emergency Departments by Hispanics and Non-Hispanics in Florida. Am J Public Health. 2017;107(Suppl 1):S88-S93. doi:10.2105\/AJPH.2017.303746.<\/p>\n\n\n\n

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                      17. Toman M, Toksavul S, \u00c7al E, T\u00fcrk\u00fcn M. Geriatrik hastalar\u0131n dental tedavileri s\u0131ras\u0131nda g\u00f6r\u00fclebilecek acil durumlar. Ege T\u0131p Dergisi. 2012;51(Ek Say\u0131):65-68.<\/p>\n\n\n\n

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                      19. Kim PC, Zhou W, McCoy SJ, et al. Factors Associated with Preventable Emergency Department Visits for Nontraumatic Dental Conditions in the U.S. Int J Environ Res Public Health. 2019;16(19):3671. doi:10.3390\/ijerph16193671.<\/p>\n","protected":false},"excerpt":{"rendered":"

                      Edit\u00f6r: Prof.Dr. Arzu Denizba\u015f\u0131 Yazar: Do\u00e7. Dr. Mehmet Altunta\u015f Giri\u015f Di\u015f a\u011fr\u0131s\u0131, di\u015f eti kanamas\u0131 ya da proteze ba\u011fl\u0131 bir yara acil…<\/p>\n","protected":false},"featured_media":781,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","_tatd_show_on_main_site":"1","footnotes":""},"categories":[1,10014],"tags":[10020,10071,10018],"class_list":["post-774","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","tag-acil-tip","tag-dis-hastaliklari","tag-geriatri"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/774","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"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=774"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/774\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media\/781"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=774"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=774"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=774"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}