{"id":2210,"date":"2018-09-11T00:00:00","date_gmt":"2018-09-10T21:00:00","guid":{"rendered":"https:\/\/tatd.org.tr\/tatdus\/2020\/02\/27\/travma-resusitasyonu-sirasinda-hizli-ardisik-entubasyona-rsi-yatak-basi-ultrasonun-pocus-eklenmesi\/"},"modified":"2022-03-02T16:34:11","modified_gmt":"2022-03-02T13:34:11","slug":"travma-resusitasyonu-sirasinda-hizli-ardisik-entubasyona-rsi-yatak-basi-ultrasonun-pocus-eklenmesi","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/tatdus\/2018\/09\/11\/travma-resusitasyonu-sirasinda-hizli-ardisik-entubasyona-rsi-yatak-basi-ultrasonun-pocus-eklenmesi\/","title":{"rendered":"Travma Res\u00fcsitasyonu S\u0131ras\u0131nda H\u0131zl\u0131 Ard\u0131\u015f\u0131k Ent\u00fcbasyona (RSI) Yatak Ba\u015f\u0131 Ultrasonun (POCUS) Eklenmesi"},"content":{"rendered":"\r\n\r\n\r\n<h3 class=\"wp-block-heading\">G\u0130R\u0130\u015e<\/h3>\r\n\r\n\r\n\r\n<p>Hava yolu ve solunum y\u00f6netimi travma res\u00fcsitasyonunda kritik rol oynamaktad\u0131r. Hava yolunu g\u00fcvence alt\u0131na almamak ya da solunum problemlerini tespit edememek \u00f6l\u00fcme ya da sakatl\u0131\u011fa yol a\u00e7abilir. Yatak ba\u015f\u0131 ultrason (POCUS) hemotoraks ve pn\u00f6motoraks gibi solunum problemlerinin belirlenmesinde hayati bir rol oynamaktad\u0131r. Yap\u0131lan \u00e7al\u0131\u015fmalarda \u00f6zefagus ent\u00fcbasyonunun d\u0131\u015flanmas\u0131, endotrakeal t\u00fcp (ETT) yerle\u015ftirilmesinin do\u011frulanmas\u0131 i\u00e7in POCUS&#8217;un yararlar\u0131 g\u00f6sterilmi\u015ftir. Travma res\u00fcsitasyonu s\u0131ras\u0131nda h\u0131zl\u0131 ard\u0131\u015f\u0131k ent\u00fcbasyonda (RSI) yatak ba\u015f\u0131 ultrasonunun faydas\u0131 hakk\u0131nda s\u0131n\u0131rl\u0131 veri bulunmaktad\u0131r. Travma s\u0131ras\u0131nda \u00f6l\u00fcmc\u00fcl durumlar\u0131n ve \u00f6zofagus ent\u00fcbasyonunun erkenden tan\u0131nmas\u0131 \u00f6nemlidir. \u00c7al\u0131\u015fmada travma res\u00fcsitasyonu s\u0131ras\u0131nda RSI&#8217;n\u0131n farkl\u0131 k\u0131s\u0131mlar\u0131na POCUS entegrasyonun faydas\u0131n\u0131 ara\u015ft\u0131rmay\u0131 ama\u00e7lanm\u0131\u015ft\u0131r. <a href=\"http:\/\/dx.doi.org\/10.4103\/JETS.JETS_56_17\" target=\"_blank\" rel=\"noreferrer noopener\">10.4103\/JETS.JETS_56_17<\/a><\/p>\r\n\r\n\r\n\r\n<h3 class=\"wp-block-heading\">METHOD<\/h3>\r\n\r\n\r\n\r\n<p>\u00c7al\u0131\u015fma 1. Basamak travma merkezinde randomize, prospektif ve tek merkezli bir \u00e7al\u0131\u015fmad\u0131r.Birinci ama\u00e7 travma hastalar\u0131nda h\u0131zl\u0131 ard\u0131\u015f\u0131k ent\u00fcbasyon s\u0131ras\u0131nda yatak ba\u015f\u0131 ultrasonun endotrakeal t\u00fcp yerle\u015fimi ve teyidi \u00fczerine etkisini ara\u015ft\u0131rmakt\u0131. \u0130kincil hedefler a)POCUS ile t\u00fcp\u00fcn do\u011frulanmas\u0131nda ge\u00e7en s\u00fcre, b)hava yolu y\u00f6netimini etkileyecek potansiyel \u00f6l\u00fcmc\u00fcl tan\u0131lar\u0131n tan\u0131mlanmas\u0131d\u0131r. \u00c7al\u0131\u015fmaya acil servise kardiyak arrest gelen hastalar, trakeal yaralanmas\u0131 olan hastalar, a\u00e7\u0131k g\u00f6\u011f\u00fcs yaras\u0131 olan hastalar, anormal boyun anatomisi olan hastalar, cerrahi hava yolu ihtiyac\u0131 olan hastalar, di\u011fer merkezlerden ent\u00fcbe \u015fekilde gelen hastalar d\u0131\u015f\u0131nda 1 ya\u015f \u00fcst\u00fc t\u00fcm hastalar dahil edildi. \u00c7al\u0131\u015fma iki a\u015famal\u0131 olarak e\u011fitim ve uygulama\u00a0\u015feklinde tasarland\u0131. E\u011fitim a\u015famas\u0131nda h\u0131zl\u0131 ard\u0131\u015f ent\u00fcbasyon e\u011fitimi ve protokollerden olu\u015fuyordu. \u00c7al\u0131\u015fma ekibi bir k\u0131demli doktor, bir ultrasonu yapacak doktor ve zaman tutucudan olu\u015fuyordu. Y\u00fcr\u00fctme k\u0131sm\u0131nda t\u00fcm hastalar ATLS klavuzuna g\u00f6re res\u00fcsitasyona tabi tutuldu. RSI \u00fc\u00e7 a\u015fama olarak de\u011ferlendirmeye al\u0131nd\u0131; preoksijenizasyon, ent\u00fcbasyon ve ent\u00fcbasyonun do\u011frulanmas\u0131. Preoksijenizasyon a\u015famas\u0131 3 dakika olarak yap\u0131ld\u0131 ve bu a\u015famada yatak ba\u015f\u0131 ultrason ile trakeal hasar, anormal orta hat damar yap\u0131s\u0131, vokal kord patolojisi, hemotoraks ve pn\u00f6motoraks ara\u015ft\u0131r\u0131ld\u0131. 2. Asamada ent\u00fcbasyonun do\u011frulanmas\u0131 i\u00e7in birincil ekip 5 nokta akci\u011fer dinleme ile EtCO2 korelasyonunu kulland\u0131, ikincil ekip ultrason \u00a0ile iki basamakl\u0131 (t\u00fcp\u00fcn yeri, akci\u011fer kaymas\u0131) do\u011frulamay\u0131 kulland\u0131. Prosed\u00fcr\u00fcn ba\u015flang\u0131c\u0131ndan (preoksijenizasyon faz\u0131) do\u011frulanmaya kadar ge\u00e7en s\u00fcre elektronik durdurma saati ile kay\u0131t edildi.<\/p>\r\n\r\n\r\n\r\n<p><em>Preoksijenizasyon s\u0131ras\u0131nda bak\u0131 ultrasonu:<\/em><\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large is-resized\"><img fetchpriority=\"high\" decoding=\"async\" class=\"wp-image-887\" src=\"https:\/\/tatd.org.tr\/tatdus\/wp-content\/uploads\/sites\/5\/2021\/10\/111-1.jpg\" alt=\"\" width=\"707\" height=\"518\" \/>\r\n<figcaption>\u015eekil 1 \u00a0Akci\u011fer kayma hareketi<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large is-resized\"><img decoding=\"async\" class=\"wp-image-888\" src=\"https:\/\/tatd.org.tr\/tatdus\/wp-content\/uploads\/sites\/5\/2021\/10\/222-1.jpg\" alt=\"\" width=\"707\" height=\"538\" \/>\r\n<figcaption>\u015eekil 2 \u201cSeashore sign\u201d<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large is-resized\"><img decoding=\"async\" class=\"wp-image-889\" src=\"https:\/\/tatd.org.tr\/tatdus\/wp-content\/uploads\/sites\/5\/2021\/10\/333-1.jpg\" alt=\"\" width=\"707\" height=\"287\" \/>\r\n<figcaption>\u015eekil 3 \u201cStratosphere sign\u201d<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<p><em>Hava yolu ultrasonu:<\/em><\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-890\" src=\"https:\/\/tatd.org.tr\/tatdus\/wp-content\/uploads\/sites\/5\/2021\/10\/444-1.jpg\" alt=\"\" width=\"707\" height=\"493\" \/>\r\n<figcaption>\u015eekil 4 Trakea ve k\u0131k\u0131rdaklar\u0131n normal uzunlamas\u0131na g\u00f6r\u00fcn\u00fcm\u00fc. Hiperekoik \u00e7izgi hava-mukoza aray\u00fcz\u00fcn\u00fc temsil eder ve k\u0131k\u0131rdaklar hipoekoik halkalar olarak g\u00f6r\u00fcl\u00fcr<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-891\" src=\"https:\/\/tatd.org.tr\/tatdus\/wp-content\/uploads\/sites\/5\/2021\/10\/555-1.jpg\" alt=\"\" width=\"707\" height=\"554\" \/>\r\n<figcaption>\u015eekil 5 Vokal kord seviyesinde enine g\u00f6r\u00fcn\u00fcm.<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-892\" src=\"https:\/\/tatd.org.tr\/tatdus\/wp-content\/uploads\/sites\/5\/2021\/10\/666-1.jpg\" alt=\"\" width=\"709\" height=\"604\" \/>\r\n<figcaption>\u015eekil 6 \u00d6zofagusun (ok) g\u00f6r\u00fcn\u00fcm\u00fc &#8211; tiroid bezi seviyesinin enine g\u00f6r\u00fcn\u00fcm.<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-893\" src=\"https:\/\/tatd.org.tr\/tatdus\/wp-content\/uploads\/sites\/5\/2021\/10\/777-1.jpg\" alt=\"\" width=\"707\" height=\"669\" \/>\r\n<figcaption>\u015eekil 7 \u00d6zofagus ent\u00fcbasyonunu g\u00f6steren tiroid bezi seviyesinde suprasternal \u00e7enti\u011fin hemen yukar\u0131s\u0131nda boyunun enine g\u00f6r\u00fcn\u00fcm. (\u00d6zofagusun posterior duvar\u0131 art\u0131k g\u00f6r\u00fcn\u00fcr de\u011fil)<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<p><em>Do\u011frulama ultrasonu:<\/em><\/p>\r\n\r\n\r\n\r\n<p>2. 4. \u0130nterkostal aral\u0131\u011f\u0131n midklavular \u00e7izgi ile kesim noktas\u0131nda bak\u0131 ultrasonu ile akci\u011fer kaymas\u0131 tespit edildi. Mevcut bak\u0131 taraf\u0131nda kayma varsa tek taraf(sa\u011f veya sol) k\u00f6k ent\u00fcbasyonu d\u0131\u015fland\u0131. Mevcut tarafta kayma yoksa di\u011fer tarafta kaymaya bak\u0131ld\u0131, kayma tespit edildiyse di\u011fer tarafta k\u00f6k ent\u00fcbasyonu tespit edilmi\u015f oldu.<\/p>\r\n\r\n\r\n\r\n<p>Veriler Excel ile toplan\u0131p, STATA kullan\u0131larak analiz edilmi\u015ftir.<\/p>\r\n\r\n\r\n\r\n<h3 class=\"wp-block-heading\">SONU\u00c7LAR<\/h3>\r\n\r\n\r\n\r\n<p>106 hasta kay\u0131t alt\u0131na al\u0131nd\u0131; 53\u2019\u00fc ultrason ekibince, 53\u2019\u00fc 5 nokta dinleme(klinik) ekibince kay\u0131t alt\u0131na al\u0131nd\u0131.<\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-894\" src=\"https:\/\/tatd.org.tr\/tatdus\/wp-content\/uploads\/sites\/5\/2021\/10\/888-1.jpg\" alt=\"\" width=\"706\" height=\"532\" \/><\/figure>\r\n\r\n\r\n\r\n<p>Erkek kad\u0131n oran\u0131 ultrason ekibinde 5.6\/15 nokta dinleme ekibinde 3.8\/1\u2019idi.<\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-896\" src=\"https:\/\/tatd.org.tr\/tatdus\/wp-content\/uploads\/sites\/5\/2021\/10\/999-1-1.jpg\" alt=\"\" width=\"709\" height=\"173\" \/><\/figure>\r\n\r\n\r\n\r\n<p>Trafik kazas\u0131 en s\u0131k yaralanma mekanizmas\u0131yd\u0131<\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-895\" src=\"https:\/\/tatd.org.tr\/tatdus\/wp-content\/uploads\/sites\/5\/2021\/10\/1212-1.jpg\" alt=\"\" width=\"708\" height=\"235\" \/><\/figure>\r\n\r\n\r\n\r\n<p>Ultrason ekibinde, RSI&#8217;n\u0131n preoksijenizasyon safhas\u0131nda USG yard\u0131m\u0131yla birincil bak\u0131da yap\u0131ld\u0131. Bu bak\u0131 s\u00fcresi ortalama 40 sn \u00a0(IQR = 30-55) idi. Ultrason ekibinde ortalama dinamik ent\u00fcbasyon zaman\u0131 (ent\u00fcbasyonun ba\u015flang\u0131c\u0131ndan \u00f6zofageal ent\u00fcbasyona kadar ge\u00e7en s\u00fcre) 14.03 sn (SD = 9.56) idi. Ultrason ekibinde ortalama i\u015flem s\u00fcresi (ent\u00fcbasyonun ba\u015flang\u0131c\u0131ndan sol akci\u011fer kayma i\u015faretinin do\u011fru t\u00fcp yerle\u015ftirme onay\u0131na kadar) 37.3 s (SD = 21.92) idi. Benzer \u015fekilde, ortalama i\u015flem s\u00fcresi (yani, ent\u00fcbasyonun ba\u015flang\u0131c\u0131ndan EtCO2 de\u011feri ile t\u00fcp yerle\u015ftirme teyitini d\u00fczeltmeye kadar) klinik ekibinde 58 sn (SD = 32.04) idi. Ultrason ekibinde 8\u2019tane \u00f6zofagus ent\u00fcbasyonu tespit edildi ve bunlar\u0131 tespit etme s\u00fcresi 18.25 sn\u2019idi. Klinik ekibinde 2\u2019tane \u00f6zofagus ent\u00fcbasyonu tespit edildi ve bunlar\u0131 tespit etme s\u00fcresi 177.5 sn\u2019idi.<\/p>\r\n\r\n\r\n\r\n<h3 class=\"wp-block-heading\">TARTI\u015eMA<\/h3>\r\n\r\n\r\n\r\n<p>5 nokta osk\u00fcltasyon \u00f6zofagus ent\u00fcbasyonu de\u011ferlendirmede genel g\u00f6rm\u00fc\u015f y\u00f6ntemdir. Bu prosed\u00fcr asl\u0131nda zaman al\u0131r ve her ambulamada gastrik i\u00e7erin hava yolunu tehditini i\u00e7eririr. EtCO2 de\u011ferleri, ETT yerle\u015ftirmesinin do\u011frulanmas\u0131 i\u00e7in alt\u0131n standart olarak kabul edilir.\u00d6zofagus ent\u00fcbasyonu ultrason ekibinde 18.25 saniyede, klinik ekibinde 177.5 saniyede tespit edildi.Dinamik yatak ba\u015f\u0131 ultrason, klinik de\u011ferlendirmeden h\u0131zl\u0131 \u00e7\u0131km\u0131\u015f oldu.\u0130\u015flem s\u00fcrelerinin kar\u015f\u0131la\u015ft\u0131rmas\u0131nda ultrason ekibinin daha h\u0131zl\u0131 oldu\u011fu g\u00f6r\u00fcld\u00fc. Literat\u00fcr, eri\u015fkin ve pediatrik hastalarda ultrasonun, be\u015f noktal\u0131 osk\u00fcltasyon ve EtCO2 \u00fczerindeki \u00fcst\u00fcnl\u00fc\u011f\u00fcn\u00fc desteklemektedir.<\/p>\r\n","protected":false},"excerpt":{"rendered":"<p>G\u0130R\u0130\u015e Hava yolu ve solunum y\u00f6netimi travma res\u00fcsitasyonunda kritik rol oynamaktad\u0131r. Hava yolunu g\u00fcvence alt\u0131na almamak ya da solunum problemlerini tespit edememek&hellip;<\/p>\n","protected":false},"author":1213,"featured_media":2221,"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":[86,10029],"class_list":["post-2210","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-literatur-ozetleri-surekli-yayinlar","category-surekli-yayinlar","tag-pocus","tag-rsi"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2210","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\/1213"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/comments?post=2210"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2210\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media\/2221"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media?parent=2210"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/categories?post=2210"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/tags?post=2210"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}