{"id":2146,"date":"2017-04-04T00:00:00","date_gmt":"2017-04-03T21:00:00","guid":{"rendered":"https:\/\/tatd.org.tr\/tatdus\/2020\/02\/27\/odaklanmis-kardiyak-ultrasonda-suprasternal-centik-penceresinden-aortik-arkin-degerlendirilmesi\/"},"modified":"2022-03-02T17:02:24","modified_gmt":"2022-03-02T14:02:24","slug":"odaklanmis-kardiyak-ultrasonda-suprasternal-centik-penceresinden-aortik-arkin-degerlendirilmesi","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/tatdus\/2017\/04\/04\/odaklanmis-kardiyak-ultrasonda-suprasternal-centik-penceresinden-aortik-arkin-degerlendirilmesi\/","title":{"rendered":"Odaklanmi\u015f Kardiyak Ultrasonda Suprasternal \u00c7entik Penceresinden Aortik Ark\u0131n De\u011ferlendirilmesi"},"content":{"rendered":"\r\n\r\n\r\n

Giri\u015f:<\/strong><\/p>\r\n\r\n\r\n\r\n

Acil servise nefes darl\u0131\u011f\u0131, g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 veya hipotansiyon ile gelen hastalar\u0131n hayat\u0131n\u0131 tehdit eden ay\u0131r\u0131c\u0131 tan\u0131lar\u0131n ara\u015ft\u0131r\u0131lmas\u0131nda acil hekimlerince yap\u0131lan odaklanm\u0131\u015f kardiyak ultrason (FOCUS- Focused Cardiac Ultrasound) \u00f6nemli bir rol oynar. FOCUS\u2019un 4 standart penceresi bulunmaktad\u0131r: subksifoid, parasternal uzun aks, parasternal k\u0131sa aks ve apikal 4 odac\u0131k. Ayr\u0131ca suprasternal \u00e7entik penceresi (SSNV), kardiyologlar taraf\u0131ndan s\u0131k\u00e7a kullan\u0131lmas\u0131na ve Amerikan Ekokardiyoloji Cemiyeti taraf\u0131ndan \u00f6nerilmesine ra\u011fmen Acil hekimlerince standart olarak kullan\u0131lmayan ek bir g\u00f6r\u00fcnt\u00fcleme penceresidir. Bu pencere sayesinde aortik ark, innominat arter, sol ana karotis ve sol subklavien arter g\u00f6r\u00fcnt\u00fclenebilir. Bu \u00e7al\u0131\u015fman\u0131n primer amac\u0131 Acil hekimlerince SSNV\u2019nin kolayca ve do\u011fru olarak de\u011ferlendirilebilir mi sorusuna yan\u0131t aramak ve ayr\u0131ca sekonder olarak FOCUS\u2019da elde edilen torakal aort \u00e7aplar\u0131n\u0131n toraks bt anjio\u2019da elde edilen de\u011ferlere uygunlu\u011funu kar\u015f\u0131la\u015ft\u0131rmak. \u00c7al\u0131\u015fma 1 y\u0131l boyunca tek merkezde prospektif g\u00f6zlemsel olarak planlanm\u0131\u015f. Ultrasonlar \u00e7al\u0131\u015fmaya k\u00f6r olan, biri acil t\u0131p e\u011fitimi almakta olan k\u0131demli asistan olmak \u00fczere, 4 acil t\u0131p uzman\u0131 taraf\u0131ndan yap\u0131lm\u0131\u015f. Uzmanlar\u0131n ve k\u0131demli asistan\u0131n ultrason e\u011fitimi, hastanenin kardiyolo\u011fu olan ekokardiyografi \u015fefi taraf\u0131ndan \u00e7al\u0131\u015fma \u00f6ncesinde 30 dakikal\u0131k 2 set \u015feklinde verilmi\u015f.<\/p>\r\n\r\n\r\n\r\n

P (Population):<\/strong><\/p>\r\n\r\n\r\n\r\n

2014 Nisan ve 2015 Mart aylar\u0131 aras\u0131nda acil serviste yap\u0131lan de\u011ferlendirmeye g\u00f6re klinik olarak toraks anjio bt \u00e7ekilmesi planlanan yeti\u015fkin hastalar \u00e7al\u0131\u015fmaya dahil edilirken d\u0131\u015f merkezde toraks anjio bt \u00e7ekilmi\u015f olan hastalar \u00e7al\u0131\u015fmaya al\u0131nmam\u0131\u015f.<\/p>\r\n\r\n\r\n\r\n

I (\u0130ntervention):<\/strong><\/p>\r\n\r\n\r\n\r\n

\u00c7al\u0131\u015fmaya k\u00f6r olan ara\u015ft\u0131rmac\u0131lar Toraks Anjio Bt (TAB) \u00e7ekilmi\u015f olan hastalara SSNV dahil FOCUS uygulam\u0131\u015f. SSNV i\u00e7in eko probu kullan\u0131lm\u0131\u015f ve indikat\u00f6r sa\u011f kal\u00e7ay\u0131 g\u00f6sterecek \u015fekilde suprasternal \u00e7enti\u011fe yerle\u015ftirilmi\u015f (\u015eekil 1). Sin\u00fcs valsalva, sinot\u00fcb\u00fcler kav\u015fak ve asendan aortan\u0131n g\u00f6r\u00fcnt\u00fclenebilen en geni\u015f \u00e7ap\u0131 \u00f6l\u00e7\u00fclerek not al\u0131nm\u0131\u015f (\u015eekil 2-A). SSNV\u2019de yine aortun g\u00f6r\u00fcnt\u00fclenebilen en geni\u015f \u00e7ap\u0131 \u00f6l\u00e7\u00fclm\u00fc\u015f (\u015eekil 2-B). Hastalar ile ilgili bilgisi olmayan 2 radyolog taraf\u0131ndan TAB\u2019lar de\u011ferlendirilmi\u015f ve ayn\u0131 seviyelerden \u00f6l\u00e7\u00fcmler al\u0131nm\u0131\u015f. Acil hekimleri SSNV\u2019yi g\u00f6r\u00fcnt\u00fcledikten sonra i\u015flemin zorlu\u011fu a\u00e7\u0131s\u0131ndan kolay, orta zor, zor ve uygun g\u00f6r\u00fcnt\u00fcleme yap\u0131lamad\u0131 gibi 4 \u00f6l\u00e7ekli bir puanlama yapm\u0131\u015f.<\/p>\r\n\r\n\r\n\r\n

\"\"\r\n
\u015eekil 1<\/strong>. SSNV g\u00f6r\u00fcnt\u00fcs\u00fcn\u00fcn al\u0131nd\u0131\u011f\u0131 pozisyon<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n
\"\"\r\n
\u015eekil 2<\/strong>.\u00a0A<\/strong>. Parasternal uzun aks;1. Sin\u00fcs valsalva, 2. Sinot\u00fcb\u00fcler kav\u015fak, 3. Asendan aort.\u00a0B.<\/strong>\u00a0SSNV; en geni\u015f aorta \u00e7ap\u0131.<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n

C (Comparison):<\/strong><\/p>\r\n\r\n\r\n\r\n

Ultrasonda elde edilen \u00f6l\u00e7\u00fcmler TAB\u2019da elde edilen \u00f6l\u00e7\u00fcmler ile kar\u015f\u0131la\u015ft\u0131r\u0131lm\u0131\u015f.<\/p>\r\n\r\n\r\n\r\n

O (Outcome):<\/strong><\/p>\r\n\r\n\r\n\r\n

SSNV hastalar\u0131n %97\u2019sinde ba\u015far\u0131yla g\u00f6r\u00fcnt\u00fclenmi\u015f. Elde edilmeleri kolay ve zor olarak de\u011ferlendirilen g\u00f6r\u00fcnt\u00fclemelerin oranlar\u0131 s\u0131ras\u0131 ile %64.5 ve %7.6\u2019 imi\u015f (\u015eekil 3). Acil hekimlerince bak\u0131lan SSNV\u2019de yap\u0131lan \u00f6l\u00e7\u00fcmlerde olgular\u0131n %61\u2019inde TAB ile tam do\u011fruluk saptanm\u0131\u015f. %3.8\u2019inde ise uygunsuz \u00f6l\u00e7\u00fcmler oldu\u011fu g\u00f6r\u00fclm\u00fc\u015f. SSNV\u2019de 7 olguda TAB\u2019da g\u00f6r\u00fcnen aort anevrizmas\u0131 saptanamam\u0131\u015f. Saptanamayan aort anevrizmalar\u0131ndan en k\u00fc\u00e7\u00fck \u00e7apl\u0131 olan\u0131 4.1 cm iken en b\u00fcy\u00fck \u00e7apl\u0131 olan\u0131 ise 4.38 cm imi\u015f.\u00a0<\/p>\r\n\r\n\r\n\r\n

\"\"\r\n
\u015eekil 3<\/strong>. G\u00f6r\u00fcnt\u00fclerin elde edilmesinin kolayl\u0131\u011f\u0131n\u0131n de\u011ferlendirildi\u011fi anketin sonu\u00e7lar\u0131.<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n

Sonu\u00e7:<\/strong><\/p>\r\n\r\n\r\n\r\n

Ara\u015ft\u0131rmac\u0131lar \u00e7al\u0131\u015fma sonucunda SSNV\u2019nin acil hekimlerince pek kullan\u0131lmad\u0131\u011f\u0131n\u0131 oysa ki k\u0131sa bir e\u011fitim sonras\u0131nda kolayca bak\u0131labilece\u011fini ve hasta hakk\u0131nda ekstra bilgi verebilece\u011fini, bu y\u00fczden FOCUS pencerelerine ek olarak bak\u0131lmas\u0131 gerekti\u011fini \u00f6nermektedir. Bu pilot \u00e7al\u0131\u015fmada SSNV ile aort \u00f6l\u00e7\u00fcmleri TAB\u2019da \u00f6l\u00e7\u00fclen de\u011ferlere olduk\u00e7a yak\u0131n sonu\u00e7lar vermektedir. Yazarlar, daha fazla \u00e7al\u0131\u015fma ile bu konunun irdelenmesi taraftar\u0131d\u0131r.<\/p>\r\n\r\n\r\n\r\n

Kinnaman KA, Kimberly HH, Pivetta E. Evaluation of the Aortic Arch from the Suprasternal Notch View Using Focused Cardiac Ultrasound. The Journal of emergency medicine. 50(4):643-50.e1. 2016. [pubmed<\/a>] 10.1016\/j.jemermed.2015.12.002. Epub 2016 Jan 29.<\/a><\/em><\/p>\r\n","protected":false},"excerpt":{"rendered":"

Giri\u015f: Acil servise nefes darl\u0131\u011f\u0131, g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 veya hipotansiyon ile gelen hastalar\u0131n hayat\u0131n\u0131 tehdit eden ay\u0131r\u0131c\u0131 tan\u0131lar\u0131n ara\u015ft\u0131r\u0131lmas\u0131nda acil hekimlerince yap\u0131lan odaklanm\u0131\u015f…<\/p>\n","protected":false},"author":1529,"featured_media":2148,"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":[19,12],"tags":[10038,43],"class_list":["post-2146","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-literatur-ozetleri-surekli-yayinlar","category-surekli-yayinlar","tag-aorta-usg","tag-eko"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2146","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/users\/1529"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/comments?post=2146"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2146\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media\/2148"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media?parent=2146"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/categories?post=2146"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/tags?post=2146"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}