{"id":500,"date":"2024-02-27T11:00:00","date_gmt":"2024-02-27T08:00:00","guid":{"rendered":"https:\/\/tatd.org.tr\/havayolu\/?p=500"},"modified":"2024-02-27T10:10:28","modified_gmt":"2024-02-27T07:10:28","slug":"cerrahi-hava-yolu-yonetimi","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/havayolu\/genel\/cerrahi-hava-yolu-yonetimi\/","title":{"rendered":"CERRAH\u0130 HAVA YOLU Y\u00d6NET\u0130M\u0130"},"content":{"rendered":"\n<p><strong>&nbsp;&nbsp;&nbsp; <\/strong>Cerrahi hava yolu ile ilgili yaz\u0131m\u0131za ba\u015flamadan \u00f6nce sizlerle 3 g\u00fcn i\u00e7erisinde 106 Acil t\u0131p asistan\u0131na ula\u015farak yapm\u0131\u015f oldu\u011fumuz anket \u00e7al\u0131\u015fmas\u0131n\u0131 payla\u015fmak istiyorum. Gelin hep birlikte cerrahi hava yolu neden \u00f6nemli ve bu konuda kendimizi yeterli hissediyor muyuz, bir bakal\u0131m..<\/p>\n\n\n\n<p><strong>Soru 1:<\/strong> Cerrahi hava yolu tekniklerine hakim misiniz?<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img fetchpriority=\"high\" decoding=\"async\" width=\"352\" height=\"184\" src=\"https:\/\/tatd.org.tr\/havayolu\/wp-content\/uploads\/sites\/13\/2024\/02\/78805a221a988e79ef3f42d7c5bfd418.png\" alt=\"\" class=\"wp-image-501\" srcset=\"https:\/\/tatd.org.tr\/havayolu\/wp-content\/uploads\/sites\/13\/2024\/02\/78805a221a988e79ef3f42d7c5bfd418.png 352w, https:\/\/tatd.org.tr\/havayolu\/wp-content\/uploads\/sites\/13\/2024\/02\/78805a221a988e79ef3f42d7c5bfd418-300x157.png 300w\" sizes=\"(max-width: 352px) 100vw, 352px\" \/><\/figure>\n<\/div>\n\n\n<p><strong>Soru 2:<\/strong> Daha \u00f6nce zor hava yolu y\u00f6netiminde cerrahi hava yoluna ba\u015fvurdu\u011funuz oldu mu?<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img decoding=\"async\" width=\"360\" height=\"176\" src=\"https:\/\/tatd.org.tr\/havayolu\/wp-content\/uploads\/sites\/13\/2024\/02\/78805a221a988e79ef3f42d7c5bfd418-1.png\" alt=\"\" class=\"wp-image-502\" srcset=\"https:\/\/tatd.org.tr\/havayolu\/wp-content\/uploads\/sites\/13\/2024\/02\/78805a221a988e79ef3f42d7c5bfd418-1.png 360w, https:\/\/tatd.org.tr\/havayolu\/wp-content\/uploads\/sites\/13\/2024\/02\/78805a221a988e79ef3f42d7c5bfd418-1-300x147.png 300w\" sizes=\"(max-width: 360px) 100vw, 360px\" \/><\/figure>\n<\/div>\n\n\n<p><strong>Soru 3:<\/strong> Cerrahi krikotiroidotimi\u00a0i\u00e7in gerekli haz\u0131rl\u0131k ve anatomik lokalizasyonlar\u0131 biliyor musunuz?<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img decoding=\"async\" width=\"358\" height=\"200\" src=\"https:\/\/tatd.org.tr\/havayolu\/wp-content\/uploads\/sites\/13\/2024\/02\/78805a221a988e79ef3f42d7c5bfd418-2.png\" alt=\"\" class=\"wp-image-503\" srcset=\"https:\/\/tatd.org.tr\/havayolu\/wp-content\/uploads\/sites\/13\/2024\/02\/78805a221a988e79ef3f42d7c5bfd418-2.png 358w, https:\/\/tatd.org.tr\/havayolu\/wp-content\/uploads\/sites\/13\/2024\/02\/78805a221a988e79ef3f42d7c5bfd418-2-300x168.png 300w\" sizes=\"(max-width: 358px) 100vw, 358px\" \/><\/figure>\n<\/div>\n\n\n<p><strong>Soru 4:<\/strong> Cerrahi hava yolu e\u011fitimi almak ister miydiniz?<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"340\" height=\"188\" src=\"https:\/\/tatd.org.tr\/havayolu\/wp-content\/uploads\/sites\/13\/2024\/02\/78805a221a988e79ef3f42d7c5bfd418-3.png\" alt=\"\" class=\"wp-image-504\" srcset=\"https:\/\/tatd.org.tr\/havayolu\/wp-content\/uploads\/sites\/13\/2024\/02\/78805a221a988e79ef3f42d7c5bfd418-3.png 340w, https:\/\/tatd.org.tr\/havayolu\/wp-content\/uploads\/sites\/13\/2024\/02\/78805a221a988e79ef3f42d7c5bfd418-3-300x166.png 300w\" sizes=\"(max-width: 340px) 100vw, 340px\" \/><\/figure>\n<\/div>\n\n\n<p><strong><br><\/strong><\/p>\n\n\n\n<p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Havayolu y\u00f6netimi, acil servislerde kritik hastalar\u0131n bak\u0131m\u0131nda res\u00fcsitasyonun temelidir. \u0130leri havayolu y\u00f6netiminde \u00f6ncelikle endotrakeal ent\u00fcbasyon d\u00fc\u015f\u00fcn\u00fclmelidir. Zor havayolu durumlar\u0131nda endotrakeal ent\u00fcbasyon ba\u015far\u0131s\u0131z olmaktad\u0131r. Bu durumlarda farkl\u0131 havayolu y\u00f6ntemleri (supraglottik cihazlar, fiberoptik cihazlar ve cerrahi havayolu gibi) tercih edilmektedir.<\/p>\n\n\n\n<p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;Cerrahi havayolu acil servis, hastane d\u0131\u015f\u0131, yo\u011fun bak\u0131m ve ameliyathanelerde solutulamayan ve ent\u00fcbe edilemeyen hastalarda son se\u00e7enek hayat kurtar\u0131c\u0131 i\u015flemdir. National Emergency Airway Registry (NEAR) cerrahi hava yolunun en b\u00fcy\u00fck endikasyonu olarak daha az invaziv y\u00f6ntemlerin ba\u015far\u0131s\u0131z olu\u015funu belirtmi\u015ftir. Cerrahi hava yolu; can\u2019t intubate, can\u2019t oxygenate (CICO) olarak tan\u0131mlad\u0131\u011f\u0131m\u0131z senaryolarda kurtar\u0131c\u0131 olarak devreye girer. Nadiren tercih edilir. Literat\u00fcrde acil servislerde kullan\u0131m s\u0131kl\u0131\u011f\u0131 %0,1 ila %0,5 olarak bildirilmi\u015ftir. Video laringoskop ve di\u011fer yard\u0131mc\u0131 hava yolu y\u00f6ntemleri ile bu oran son y\u0131llarda d\u00fc\u015fmektedir.<\/p>\n\n\n\n<p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Cerrahi hava yolu, hastan\u0131n akci\u011ferleri ile d\u0131\u015far\u0131 aras\u0131nda kesin ba\u011flant\u0131 sa\u011flamak amac\u0131yla cerrahi aletler yard\u0131m\u0131yla \u00f6n boyun b\u00f6lgesi prosed\u00fcr\u00fc uygulamalara (front of neck airway) krikotiroid membran veya trakeya do\u011fru a\u00e7\u0131lan invaziv yoldur. Cerrahi krikotirotomi, i\u011fne krikotirotomi, perk\u00fctan krikotirotomi, cerrahi trakeotomi ve perk\u00fctan trakeotomi gibi farkl\u0131 tekniklerden birini kullanarak cerrahi havayolu a\u00e7\u0131lmaktad\u0131r.<\/p>\n\n\n\n<p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ATLS ve Amerikan Anesteziyoloji Derne\u011finin ortak g\u00f6r\u00fc\u015f\u00fc de acil serviste cerrahi hava yolu tercih edilecekse krikotirotominin, trakeotomiye \u00fcst\u00fcn oldu\u011funu savunmaktad\u0131r. Ayr\u0131ca hem uygulama kolayl\u0131\u011f\u0131 ve g\u00fcvenli\u011fi hem de i\u015fleme ba\u011fl\u0131 kanama riski ve i\u015flem s\u00fcresi g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda&nbsp; krikotirotominin zor hava yolunda yapan hekimin tecr\u00fcbesine g\u00f6re se\u00e7ilmi\u015f hastalarda ilk s\u0131rada olmas\u0131 gerekti\u011fini vurgulamaktad\u0131r. Bu noktada krikotirotominin hangi teknikle yap\u0131ld\u0131\u011f\u0131 da \u00f6nem kazanmaktad\u0131r. Geleneksel krikotirotomi ve skalpel buji y\u00f6ntemi bu a\u015famada en \u00e7ok tercih edilen y\u00f6ntemlerdir. Difficult Airway Society (DAS) de acil servis ko\u015fullar\u0131nda krikotirotomi a\u00e7\u0131l\u0131rken skalpel krikotirotomi tekni\u011fini \u00f6nermekte ve mevcut y\u00f6ntemler aras\u0131nda en h\u0131zl\u0131 ve g\u00fcvenlisi oldu\u011funu vurgulamaktad\u0131r. Yine de bu i\u015flemler yap\u0131l\u0131rken ve se\u00e7im a\u015famas\u0131nda hekimin tecr\u00fcbesinin ve hasta karakteristi\u011finin g\u00f6z \u00f6n\u00fcnde bulundurulmas\u0131 gerekti\u011fi unutulmamal\u0131d\u0131r.<\/p>\n\n\n\n<p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Acil cerrahi hava yolu, t\u00fcm modern hava yolu algoritmalar\u0131n\u0131n son ad\u0131m\u0131d\u0131r ve ileri d\u00fczey acil hava yolu y\u00f6netimi sa\u011flayan t\u00fcm personelin bu prosed\u00fcr\u00fc h\u0131zl\u0131 bir \u015fekilde ger\u00e7ekle\u015ftirebilmesi hayati \u00f6nem ta\u015f\u0131r. Bir\u00e7ok nedenle, cerrahi hava yolunun en zorlu k\u0131sm\u0131, prosed\u00fcr\u00fcn ayr\u0131nt\u0131lar\u0131n\u0131 ba\u015far\u0131yla tamamlamaktan ziyade, bunu yapma karar\u0131n\u0131 vermektir. Ancak, klinisyenin bilmesi gereken \u015fey, uygun \u015fekilde uygulanan cerrahi hava yolunun hastalar\u0131n\u0131 hayatta tutan tek m\u00fcdahale olabilece\u011fidir.<\/p>\n\n\n\n<p>Evet gelelim Krikotirotomi \u00f6ncesi sormam\u0131z gereken sorulara\u2026<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Krikotirotomi hava yolu obstr\u00fcksiyonunu etkin bir \u015fekilde ge\u00e7ebilecek mi?<\/li>\n\n\n\n<li>Hangi krikotirotomi tekni\u011fi uygulanacak?<\/li>\n\n\n\n<li>\u00d6n boyun b\u00f6lgesi prosed\u00fcr\u00fc i\u00e7in hasta ve anatomisi uygun mu, bu y\u00f6ntem i\u015flemi zor ve uzun bir hale getirecek mi ?&nbsp;<\/li>\n<\/ul>\n\n\n\n<p>&nbsp; Sizlere \u00f6ncelikle bir Acil hekimi olarak zor ve ba\u015far\u0131s\u0131z hava yolunda krikotirotominin uygulan\u0131\u015f\u0131 anatomik lokalizasyonlar, endikasyon ve kontrendikasyonlar\u0131ndan bahsedece\u011fim. Krikotirotomiye karar verirken acil hekimlerinin zor krikotirotomiye yol a\u00e7an durumlar\u0131 bilmesinde fayda vard\u0131r. Bunun i\u00e7in SMART olarak k\u0131saltt\u0131\u011f\u0131m\u0131z mnemonic kullan\u0131l\u0131r;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Surgery (Cerrahi)<\/li>\n\n\n\n<li>Mass (Kitle)<\/li>\n\n\n\n<li>Access\/anatomy (Eri\u015fim\/Anatomi)<\/li>\n\n\n\n<li>Radiation (Radyasyon \u00f6yk\u00fcs\u00fc)<\/li>\n\n\n\n<li>Trauma (Boyun travmas\u0131 varl\u0131\u011f\u0131)<\/li>\n<\/ul>\n\n\n\n<p><strong>Endikasyonlar\u0131: <\/strong>Oksijenize ve ventile edilemeyen hastalar<\/p>\n\n\n\n<p><strong>Kontrendikasyonlar:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Cerrahi sonras\u0131 komplikasyonlar\u0131n daha s\u0131k g\u00f6r\u00fcld\u00fc\u011f\u00fc \u00e7ocuk hastalar (8-10 ya\u015f alt\u0131).<\/li>\n\n\n\n<li>Larengeal yerle\u015fimli t\u00fcm\u00f6r\/kitle<\/li>\n\n\n\n<li>D\u00fczeltilemeyen koag\u00fclapati\/ trombositopeni varl\u0131\u011f\u0131<\/li>\n\n\n\n<li>\u0130\u015flemi yapan\u0131n deneyimi<\/li>\n\n\n\n<li>Ge\u00e7irilmi\u015f boyun cerrahisi veya sternotomi \u00f6yk\u00fcs\u00fc<\/li>\n<\/ul>\n\n\n\n<p><strong>Skalpel Buji Krikotirotomi Tekni\u011fi<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Hasta, boynu ekstansiyonda olacak \u015fekilde s\u0131rt\u00fcst\u00fc yatar.<\/li>\n\n\n\n<li>Laringeal handshake y\u00f6ntemi ile krikotiroid membran tespit edilir.<\/li>\n<\/ol>\n\n\n\n<p>Larengeal handshake;<\/p>\n\n\n\n<p>a) \u0130\u015faret parma\u011f\u0131 ve ba\u015fparmak larenksin \u00fcst k\u0131sm\u0131n\u0131 kavrar ve onu bir yandan di\u011fer yana yuvarlar.<\/p>\n\n\n\n<p>b) Parmaklar ve ba\u015fparmak tiroid laminalar\u0131 \u00fczerinde a\u015fa\u011f\u0131 do\u011fru kayar.<\/p>\n\n\n\n<p>c) Orta parmak ve ba\u015fparmak krikoid k\u0131k\u0131rdak \u00fczerinde durur, i\u015faret parma\u011f\u0131 krikotiroid membran\u0131 palpe eder.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Krikotiroid membrana transvers gelecek \u015fekilde bir insizyon a\u00e7\u0131l\u0131r.<\/li>\n\n\n\n<li>Bist\u00fcri veya skalpel 90 derece \u00e7evrilerek kesi alan\u0131 kaudal olarak geni\u015fletilir.<\/li>\n\n\n\n<li>Buji trakeaya do\u011fru kaudal olarak geni\u015fletilen bo\u015fluktan ilerletilir.<\/li>\n\n\n\n<li>Buji \u00fczerinden 6 numaral\u0131 kafl\u0131 t\u00fcp g\u00f6nderilir. Kaf \u015fi\u015firilir ve t\u00fcp yeri kapnograf ile do\u011fruland\u0131ktan sonra sabitlenir.<\/li>\n<\/ul>\n\n\n\n<p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; \u0130\u015flemin literat\u00fcrde bahsedilen en s\u0131k komplikasyonlar\u0131 kanama ve yanl\u0131\u015f yere yerle\u015ftirme \u015feklindedir. Dikey cilt kesisinden kaynakl\u0131 ortaya \u00e7\u0131kabilecek kanama riskine i\u015flem \u00f6ncesi hasta ve hava yolu de\u011ferlendirilerek dikkat edilmelidir. Aspirat\u00f6r ve hemostaz sa\u011flay\u0131c\u0131 klemp veya bantlar\u0131n haz\u0131rda tutulmas\u0131nda fayda vard\u0131r. \u0130\u015flem sonras\u0131 yerle\u015ftirmeyi do\u011frulamak i\u00e7in akci\u011fer grafisi \u00e7ekilebilir. Yatak ba\u015f\u0131 ultrason ile t\u00fcp yeri do\u011frulanabilir. Krikotirotomi genellikle, geleneksel olarak ilk acil krikotirotomiden sonraki 72 saat i\u00e7inde yap\u0131lan daha kal\u0131c\u0131 bir trakeostomiye giden bir k\u00f6pr\u00fc olarak g\u00f6r\u00fcl\u00fcr.<\/p>\n\n\n\n<p><strong>Kaynaklar:<\/strong><\/p>\n\n\n\n<p><strong>1)<\/strong> DeVore EK, Redmann A, Howell R, Khosla S. Best practices for emergency surgical airway: A systematic review. Laryngoscope Investig Otolaryngol. 2019 Nov 19;4(6):602-608.<\/p>\n\n\n\n<p><strong>2)<\/strong> ATLS Subcommittee; American College of Surgeons&#8217; Committee on Trauma; International ATLS working group. Advanced trauma life support (ATLS): the ninth edition. J Trauma Acute Care Surg. 2013;74(5):1333\u20131366.<\/p>\n\n\n\n<p><strong>3)<\/strong> McGill J, Clinton JE, Ruiz E. Cricothyrotomy in the emergency department. Ann Emerg Med 1982;11(7):361\u2013364.<\/p>\n\n\n\n<p><strong>4)<\/strong> <a href=\"https:\/\/www.msdmanuals.com\/professional\">https:\/\/www.msdmanuals.com\/professional<\/a>. Son Eri\u015fim tarihi:05.01.2024<\/p>\n\n\n\n<p><strong>5)<\/strong> Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022 Jan 1;136(1):31-81<\/p>\n\n\n\n<p><strong>6)<\/strong> Frerk C, Mitchell VS, McNarry AF, Mendonca C,Bhagrath R, Patel A et al. Difficult Airway Society intubation guidelines working group. Difficult Airway Society 2015 guidelines for managemnet of unanticipated difficult intubation in adults. Br J Anaesth 2015 Dec;115(6):827-48.&nbsp;<\/p>\n\n\n\n<p><strong>7)<\/strong> Walls, R. M., &amp; Murphy, M. F. Sixth edition. Manual of emergency airway management. Lippincott Williams &amp; Wilkins.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp;&nbsp;&nbsp; Cerrahi hava yolu ile ilgili yaz\u0131m\u0131za ba\u015flamadan \u00f6nce sizlerle 3 g\u00fcn i\u00e7erisinde 106 Acil t\u0131p asistan\u0131na ula\u015farak yapm\u0131\u015f oldu\u011fumuz anket \u00e7al\u0131\u015fmas\u0131n\u0131&hellip;<\/p>\n","protected":false},"author":2418,"featured_media":505,"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":[1,10022],"tags":[10034,10036,10035],"class_list":["post-500","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-havayolu-haber-ve-duyuru","tag-cerrahi-havayolu","tag-havayolu-yonetimi","tag-zor-havayolu"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/havayolu\/wp-json\/wp\/v2\/posts\/500","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/havayolu\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/havayolu\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/havayolu\/wp-json\/wp\/v2\/users\/2418"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/havayolu\/wp-json\/wp\/v2\/comments?post=500"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/havayolu\/wp-json\/wp\/v2\/posts\/500\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/havayolu\/wp-json\/wp\/v2\/media\/505"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/havayolu\/wp-json\/wp\/v2\/media?parent=500"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/havayolu\/wp-json\/wp\/v2\/categories?post=500"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/havayolu\/wp-json\/wp\/v2\/tags?post=500"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}