{"id":4466,"date":"2023-04-10T13:43:24","date_gmt":"2023-04-10T10:43:24","guid":{"rendered":"https:\/\/tatd.org.tr\/tatdus\/?p=4466"},"modified":"2023-04-29T13:02:43","modified_gmt":"2023-04-29T10:02:43","slug":"acil-servise-senkop-ile-basvuran-hastalarda-tum-vucut-yaklasimli-hedefe-yonelik-yatak-basi-ultrasonografinin-tanisal-etkinligi","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/tatdus\/2023\/04\/10\/acil-servise-senkop-ile-basvuran-hastalarda-tum-vucut-yaklasimli-hedefe-yonelik-yatak-basi-ultrasonografinin-tanisal-etkinligi\/","title":{"rendered":"Acil Servise Senkop ile Ba\u015fvuran Hastalarda T\u00fcm V\u00fccut Yakla\u015f\u0131ml\u0131 Hedefe Y\u00f6nelik Yatak ba\u015f\u0131 Ultrasonografinin Tan\u0131sal Etkinli\u011fi"},"content":{"rendered":"\n

Senkop, acil servislere her ya\u015f grubundan s\u0131k bir ba\u015fvuru sebebidir. Etiyolojisi ve risk s\u0131n\u0131flamas\u0131 saptanmas\u0131, acil servis hekimleri a\u00e7\u0131s\u0131ndan halen zorlay\u0131c\u0131 olabiliyor. G\u00fcn\u00fcm\u00fczde acil servislerde olduk\u00e7a yayg\u0131nla\u015fan ve acil servis hekimlerinin s\u0131kl\u0131kla kulland\u0131\u011f\u0131 ultrasonografinin (USG) senkop etiyolojisini ayd\u0131nlatmada etkisini \u00f6l\u00e7mek amac\u0131yla yapt\u0131\u011f\u0131m\u0131z ve The American Journal of Emergency Medicine dergisinde yay\u0131nlanm\u0131\u015f \u00e7al\u0131\u015fmam\u0131z\u0131 sizlerle payla\u015faca\u011f\u0131m. Makalenin orijinal haline https:\/\/pubmed.ncbi.nlm.nih.gov\/36774906\/<\/a> adresinden ula\u015fabilirsiniz. Umar\u0131m yararl\u0131 olur, keyifli okumalar diliyorum.<\/p>\n\n\n\n

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

Senkop k\u0131sa s\u00fcreli, serebral hipoperf\u00fczyona ba\u011fl\u0131, herhangi bir giri\u015fime gerek duyulmadan spontan d\u00fczelen ge\u00e7ici bilin\u00e7 ve post\u00fcr kayb\u0131d\u0131r. Senkop, benign nedenlerin yan\u0131nda ya\u015fam\u0131 tehdit eden kritik hastal\u0131klar\u0131n ilk ve tek belirtisi olabilir. Bu nedenle acil servise senkop veya presenkop ile ba\u015fvuran hastalarda acil servis hekimlerinin birincil \u00f6nceli\u011fi senkopa yol a\u00e7an kritik etiyolojileri ortaya \u00e7\u0131karmak ve tedavi etmektir.<\/p>\n\n\n\n

Amerika Birle\u015fik Devletleri verilerine g\u00f6re y\u0131lda senkop nedenli 1-2 milyon aras\u0131 hastane ba\u015fvurusu olmaktad\u0131r ve acil servislere ba\u015fvurular\u0131n\u0131n ise %3-5\u2019i senkop nedenlidir. Senkop i\u00e7in risk s\u0131n\u0131fland\u0131rmas\u0131, etiyoloji ara\u015ft\u0131r\u0131lmas\u0131 ve taburculuk karar\u0131 acil servis hekimleri i\u00e7in halen zorlay\u0131c\u0131d\u0131r ve kesin \u00e7izgilerle ayr\u0131lmam\u0131\u015ft\u0131r. Bir\u00e7ok hasta, d\u00fc\u015f\u00fck tan\u0131sal yararl\u0131l\u0131\u011fa sahip testlere rutin olarak tabi tutulmakta ancak hastalar\u0131n \u00f6nemli bir b\u00f6l\u00fcm\u00fcnde etiyoloji ayd\u0131nlat\u0131lamamaktad\u0131r. G\u00fcncel t\u0131p prati\u011finde senkop\/presenkop hastalar\u0131na standardize bir yakla\u015f\u0131mla de\u011ferlendirilmesi ve y\u00fcksek risk fakt\u00f6r\u00fcne sahip hastalar\u0131n tan\u0131mlanabilmesi i\u00e7in San Francisco Senkop Kural\u0131, OESIL Skoru gibi bir\u00e7ok klinik karar kural\u0131 geli\u015ftirilmi\u015ftir. Bu klinik risk skorlar\u0131 ya\u015f, e\u015flik eden hastal\u0131klar, prodrom olup olmamas\u0131, kan bas\u0131nc\u0131, hematokrit ve EKG bulgular\u0131n\u0131 de\u011ferlendirmeye alarak y\u00fcksek riski belirlemeye \u00e7al\u0131\u015f\u0131r. Ancak g\u00fcncel risk skorlamalar\u0131 hen\u00fcz g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemlerinin yerini alamam\u0131\u015ft\u0131r. G\u00fcn\u00fcm\u00fczde acil t\u0131p prati\u011finde y\u00fcksek riskli acil servis ba\u015fvurular\u0131nda bir\u00e7ok protokol\u00fcn (eFAST, BLUE, RUSH, FEEL, vb.) kullan\u0131m\u0131 standart bak\u0131m\u0131n bir par\u00e7as\u0131 haline gelmi\u015ftir. Ancak acil servise ba\u015fvuran senkop hastalar\u0131nda t\u00fcm v\u00fccut yatak ba\u015f\u0131 USG\u2019nin tan\u0131sal etkinli\u011fi yeterince ara\u015ft\u0131r\u0131lmam\u0131\u015ft\u0131r.<\/p>\n\n\n\n

Biz bu \u00e7al\u0131\u015fmada senkop\/presenkop ile acil servise ba\u015fvuran hastalarda t\u00fcm v\u00fccut yakla\u015f\u0131ml\u0131 hedefe y\u00f6nelik USG tekni\u011finin, y\u00fcksek riskli hastalar\u0131 tan\u0131ma durumunu ve hastan\u0131n tan\u0131\/tedavi s\u00fcre\u00e7lerindeki etkinli\u011fini ortaya koymay\u0131 ama\u00e7lad\u0131k.   <\/p>\n\n\n\n

Y\u00f6ntem<\/strong><\/p>\n\n\n\n

Prospektif ve kesitsel dizayn edilen \u00e7al\u0131\u015fmam\u0131za Acil T\u0131p Klini\u011fi\u2019ne senkop veya presenkop ile ba\u015fvuran 18 ya\u015f ve \u00fczerindeki t\u00fcm hastalar, alt\u0131 ay s\u00fcre ile ard\u0131\u015f\u0131k olarak al\u0131nd\u0131. Herhangi bir nedenden dolay\u0131 USG uygulanamayan, \u00e7al\u0131\u015fmaya kat\u0131lmay\u0131 kabul etmeyen ve acil servis izleminde senkop\/near senkop d\u0131\u015f\u0131nda tan\u0131 alan hastalar \u00e7al\u0131\u015fmadan d\u0131\u015fland\u0131.<\/p>\n\n\n\n

Protokol<\/strong><\/p>\n\n\n\n

Acil servise senkop\/presenkop ile ba\u015fvuran hastalar sorumlu hekimleri taraf\u0131ndan de\u011ferlendirildi. Sonras\u0131nda \u00e7al\u0131\u015fmac\u0131 hekimlere haber verildi. USG yapan hekimler hastan\u0131n klini\u011finden, g\u00f6r\u00fcnt\u00fcleme ve laboratuvar sonu\u00e7lar\u0131ndan haberdar edilmedi ve sonografik incelemenin ilk 15 dakika i\u00e7inde ba\u015flat\u0131lmas\u0131 hedeflendi. <\/p>\n\n\n\n

Sonografik De\u011ferlendirme<\/strong><\/p>\n\n\n\n

T\u00fcm v\u00fccut yatak ba\u015f\u0131 USG tekni\u011fi i\u00e7in hastalarda s\u0131n\u0131rland\u0131r\u0131lm\u0131\u015f karotis, akci\u011fer, kardiyak, abdominal ve DVT incelemesi i\u00e7in alt ekstremitelerin kompresyon USG\u2019si kullan\u0131ld\u0131. G\u00f6r\u00fcnt\u00fcleme sekt\u00f6r, konveks ve lineer prob bir arada kullan\u0131larak d\u00f6rt uygulay\u0131c\u0131 taraf\u0131ndan ger\u00e7ekle\u015ftirildi. Uygulay\u0131c\u0131lardan \u00fc\u00e7\u00fc uzmanl\u0131k e\u011fitiminin d\u00f6rd\u00fcnc\u00fc y\u0131l\u0131ndaki acil t\u0131p uzmanl\u0131k \u00f6\u011frencisi, biri ise \u00f6\u011fretim g\u00f6revlisiydi. Hekimler temel ve ileri USG kursuna kat\u0131lm\u0131\u015flard\u0131. \u00c7al\u0131\u015fma \u00f6ncesinde de \u00e7al\u0131\u015fmaya kat\u0131lan \u00f6\u011fretim \u00fcyesi taraf\u0131ndan 4 saatlik teorik ve pratik odaklanm\u0131\u015f e\u011fitim verildi.<\/p>\n\n\n\n

USG protokol\u00fc de\u011ferlendirme s\u00fcreci, hayat\u0131 tehdit edebilecek patolojilerin saptanmas\u0131 durumunda (aort diseksiyonu, akut miyokard infarkt\u00fcs\u00fcne ba\u011fl\u0131 oldu\u011fu d\u00fc\u015f\u00fcn\u00fclen lokal duvar hareket kusuru vb.) hastan\u0131n hekimine bilgi verilerek sonland\u0131r\u0131ld\u0131.<\/p>\n\n\n\n

Veri toplama formunun ilk b\u00f6l\u00fcm\u00fc hastan\u0131n sorumlu hekimi taraf\u0131ndan dolduruldu. Bu b\u00f6l\u00fcmde hastan\u0131n ya\u015f\u0131, cinsiyeti, acil servis ba\u015fvurusu s\u0131ras\u0131ndaki ya\u015famsal bulgular\u0131, USG g\u00f6r\u00fcnt\u00fcleme \u00f6ncesi ve sonras\u0131 sorumlu hekim \u00f6n tan\u0131s\u0131, 2018 ESC Senkop Y\u00f6netimi ve Tan\u0131 K\u0131lavuzu\u2019ndaki y\u00fcksek risk kriterleri formun ilk sayfas\u0131na kaydedildi. \u0130kinci b\u00f6l\u00fcme ise USG yapan hekim taraf\u0131ndan USG bulgular\u0131 ve uygulama s\u00fcresi kaydedildi. USG s\u0131ras\u0131nda bulunan anormal bulgular, hastalara uygulanan tedaviler ve giri\u015fimler ayr\u0131ca kaydedildi.  <\/strong><\/p>\n\n\n\n

Bulgular<\/strong><\/p>\n\n\n\n

Hasta Karakteristikleri<\/em><\/strong><\/p>\n\n\n\n

\u00c7al\u0131\u015fma s\u00fcresince 184 hasta senkop\/presenkop \u00f6n tan\u0131s\u0131 ile acil servise ba\u015fvurdu. Hastalar\u0131n 16\u2019s\u0131 \u00e7al\u0131\u015fmac\u0131 ekibin acil serviste bulunmamas\u0131, 9\u2019u hastan\u0131n \u00e7al\u0131\u015fmaya kat\u0131lmay\u0131 kabul etmemesi ve 7\u2019si acil serviste senkop\/presenkop d\u0131\u015f\u0131nda bir tan\u0131 almas\u0131 nedeniyle \u00e7al\u0131\u015fmadan d\u0131\u015fland\u0131. \u00c7al\u0131\u015fmaya toplam 152 hasta dahil edildi.<\/p>\n\n\n\n

Hastan\u0131n sorumlu hekimi taraf\u0131ndan d\u00fc\u015f\u00fcn\u00fclen en s\u0131k senkop tipleri s\u0131ras\u0131yla refleks (n=88, %57,9), kardiyak (n=30, %19,7) ve ortostatik (n=20, %13,2) senkoptu. Hastalar\u0131n 44\u2019\u00fcnde anormal EKG bulgusu vard\u0131. Bunlar s\u0131kl\u0131k s\u0131ras\u0131yla sin\u00fcs ta\u015fikardisi (%17,1), sa\u011f dal blo\u011fu (%17,1), nonspesifik ST-T dalga de\u011fi\u015fimleri (%13), sin\u00fcs bradikardisi (%11,4) ve atriyal fibrilasyondu (%10). Hastalar\u0131n 118\u2019i taburcu edilirken 11\u2019i servis, 17\u2019si yo\u011fun bak\u0131m izlemine al\u0131nd\u0131. Alt\u0131 hasta kendi iste\u011fiyle tetkikleri sonu\u00e7lanmadan hastaneden ayr\u0131ld\u0131. \u00c7al\u0131\u015fmaya al\u0131nan hastalar\u0131n 4\u2019\u00fc (%2,6) 30 g\u00fcn i\u00e7erisinde \u00f6ld\u00fc.<\/p>\n\n\n\n

T\u00fcm V\u00fccut Yakla\u015f\u0131ml\u0131 Hedefe Y\u00f6nelik USG Sonu\u00e7lar\u0131<\/em><\/strong><\/p>\n\n\n\n

Hekimlerin USG de\u011ferlendirme s\u00fcresinin ortanca de\u011feri 14 dk (12-16 dk) idi. \u00c7al\u0131\u015fmada hastalar\u0131n 131\u2019ine (%86,1) USG protokol\u00fcn\u00fcn tamam\u0131 uyguland\u0131 ve hedeflenen t\u00fcm g\u00f6r\u00fcnt\u00fclemeler elde edildi. Baz\u0131 alanlarda g\u00f6r\u00fcnt\u00fcleme yap\u0131lamamas\u0131n\u0131n nedenleri; (1) USG ile acil giri\u015fim gerektiren bir tan\u0131 almas\u0131 nedeniyle (aort diseksiyonu gibi) i\u015flemin sonland\u0131r\u0131lmas\u0131 ve (2) incelenen b\u00f6lgede de\u011ferlendirmeye uygun kalitede sonografik g\u00f6r\u00fcnt\u00fc elde edilememesi olarak belirtildi.<\/p>\n\n\n\n

T\u00fcm v\u00fccut yakla\u015f\u0131ml\u0131 USG de\u011ferlendirmesi ise hastalar\u0131n 54\u2019\u00fcnde (%35,5) senkop\/presenkopa yol a\u00e7t\u0131\u011f\u0131 d\u00fc\u015f\u00fcn\u00fclen USG bulgular\u0131 tespit edildi. 26 (%17,1) hastada senkop veya presenkopla ili\u015fki kurulamayan ve rastlant\u0131sal olarak tespit edilen anormal USG bulgular\u0131 (renal kist, kolelitiazis, intakt over kisti, vb.) g\u00f6r\u00fcld\u00fc. \u00c7al\u0131\u015fmaya kat\u0131lan hastalar\u0131n 35\u2019ine (%23) USG bulgular\u0131 nedeniyle giri\u015fim yap\u0131ld\u0131 (Tablo 1).<\/p>\n\n\n\n

Tablo 1. T\u00fcm v\u00fccut yakla\u015f\u0131ml\u0131 hedefe y\u00f6nelik USG sonucu yap\u0131lan giri\u015fimler.<\/p>\n\n\n\n

Maj\u00f6r giri\u015fimler<\/em><\/strong><\/td>n (%)<\/strong><\/td><\/tr>
PE nedeniyle antikoag\u00fclan tedavi<\/td>7 (4,6)<\/td><\/tr>
Karotid stenozu nedeniyle antiagregan tedavi<\/td>6 (3,9)<\/td><\/tr>
Yeni duvar hareket kusuru tespit edilen ve koroner anjiografi uygulamas\u0131<\/td>3 (1,9)<\/td><\/tr>
Kritik aort stenozu tespit edilen ve TAVI* uygulamas\u0131<\/td>3 (1,9)<\/td><\/tr>
Aktif vajinal kanamal\u0131 hastada, myoma uteri tespiti ile acil operasyon<\/td>2 (1,3)<\/td><\/tr>
PE nedeniyle fibrinolitik tedavi<\/td>2 (1,3)<\/td><\/tr>
DVT nedeniyle antikoag\u00fclan tedavi<\/td>1 (0,6)<\/td><\/tr>
Abdominal aortada diseksiyon nedeniyle operasyon<\/td>1 (0,6)<\/td><\/tr>
Juguler ven\u00f6z tromboz ve sol atriyum i\u00e7inde tromb\u00fcs i\u00e7in antikoagulan<\/td>1 (0,6)<\/td><\/tr>
Karaci\u011fer absesi i\u00e7in abse drenaj\u0131<\/td>1 (0,6)<\/td><\/tr>
\u0130leusla uyumlu dilate barsak anslar\u0131 ve bat\u0131n i\u00e7i serbest s\u0131v\u0131 i\u00e7in operasyon<\/td>1 (0,6)<\/td><\/tr>
Karotid stenozu nedeniyle karotis end-arterektomi plan\u0131<\/td>1 (0,6)<\/td><\/tr>
Toplam<\/strong><\/td>29 (19)<\/strong><\/td><\/tr>
Min\u00f6r giri\u015fimler<\/em><\/strong><\/td><\/tr>
VCI kollaps\u0131 nedeniyle s\u0131v\u0131 res\u00fcsitasyonu<\/td>62 (40,8)<\/td><\/tr>
Kalp yetmezli\u011fi ili\u015fkili bulgular** nedeniyle IV di\u00fcretik\/nitrogliserin uygulama<\/td>5 (3,3)<\/td><\/tr>
– Bat\u0131nda serbest s\u0131v\u0131 saptanmas\u0131 nedeniyle parasentez<\/td>1 (0,6)<\/td><\/tr>
Toplam<\/strong><\/td>68 (44,7)<\/strong><\/td><\/tr>
*TAVI: Transkateter Aortik Valv \u0130mplantasyonu, **Kalp yetmezli\u011fi ili\u015fikli bulgular: EF d\u00fc\u015f\u00fckl\u00fc\u011f\u00fc, B-line bulgusu, Plevral ef\u00fczyon, VCI dilatasyonu birisi veya birka\u00e7\u0131 nedeniyle<\/td><\/tr><\/tbody><\/table><\/div><\/figure>\n\n\n\n

Karotis Arter G\u00f6r\u00fcnt\u00fcleme Bulgular\u0131<\/em><\/strong><\/p>\n\n\n\n

Karotis arter g\u00f6r\u00fcnt\u00fclemesinde 12 hastada l\u00fcmeni %50\u2019den fazla daraltan stenoz saptand\u0131. Bu olgular\u0131n 2\u2018sinde arter tam t\u0131kal\u0131yd\u0131. Stenoz saptanan hastalar\u0131n 7\u2019sinde darl\u0131k (3\u2019\u00fc doppler USG, 4\u2019\u00fc BT anjiografi ile) konfirme edildi ve hastalar\u0131n alt\u0131s\u0131na antiagregan tedavi ba\u015fland\u0131, birine ise karotis end-arteroktomisi \u00f6nerildi ancak hasta tedaviyi kabul etmedi. \u0130ki hasta ise stenozu daha \u00f6nceden bilindi\u011fi ve zaten antiagregan tedavi alt\u0131nda oldu\u011fu i\u00e7in ek tedavi uygulanmad\u0131. Kalan \u00fc\u00e7 hastaya ise acil serviste herhangi bir tedavi ba\u015flanmad\u0131. Bu hastalar\u0131n 2\u2019sine poliklinik \u015fartlar\u0131nda tekrarlanan karotis arter g\u00f6r\u00fcnt\u00fclemesinde tedavi gerektiren darl\u0131k saptanmad\u0131, bir hastaya ise 30 g\u00fcnl\u00fck takiplerinde ula\u015f\u0131lamad\u0131.<\/p>\n\n\n\n

Aort G\u00f6r\u00fcnt\u00fcleme Bulgular\u0131<\/em><\/strong><\/p>\n\n\n\n

Aort g\u00f6r\u00fcnt\u00fclemesinde 15 (%9,8) hastan\u0131n aort kapa\u011f\u0131 anormal (a\u00e7\u0131l\u0131m\u0131 k\u0131s\u0131tl\u0131, kalsifik veya her ikisi birden) saptand\u0131. Bu hastalar\u0131n 11\u2019ine kardiyoloji hekimleri taraf\u0131ndan da ekokardiyografik de\u011ferlendirme yap\u0131ld\u0131; 7\u2019sinde aort darl\u0131\u011f\u0131 tespit edildi ve 3\u2019\u00fc yo\u011fun bak\u0131ma yat\u0131r\u0131larak TAVI i\u015flemine al\u0131nd\u0131.<\/p>\n\n\n\n

T\u00fcm V\u00fccut Yakla\u015f\u0131ml\u0131 Hedefe Y\u00f6nelik USG\u2019nin Hasta Sonlan\u0131m Karar\u0131na Etkisi<\/em><\/strong><\/em><\/p>\n\n\n\n

Ba\u015fvurudaki anamnez ve fizik muayene sonras\u0131nda hastalar\u0131n sorumlu hekimleri taraf\u0131ndan \u00e7al\u0131\u015fmaya al\u0131nan 121 hastan\u0131n, hastaneye yat\u0131\u015f\u0131na gerek olmad\u0131\u011f\u0131 y\u00f6n\u00fcnde g\u00f6r\u00fc\u015f bildirildi. T\u00fcm v\u00fccut yakla\u015f\u0131ml\u0131 hedefe y\u00f6nelik USG sonucu \u00f6\u011frenildikten sonra bu hastalar\u0131n 12 (%9,9)\u2019sinde yat\u0131\u015f gereksinimi oldu\u011fu y\u00f6n\u00fcnde karar de\u011fi\u015ftirildi. Ba\u015fvuru s\u0131ras\u0131nda USG \u00f6ncesi yat\u0131\u015f\u0131 gerekti\u011fi d\u00fc\u015f\u00fcn\u00fclen 31 hastan\u0131n ise 9 (%29)\u2019unda t\u00fcm v\u00fccut yakla\u015f\u0131ml\u0131 hedefe y\u00f6nelik USG sonucu \u00f6\u011frenildikten sonra yat\u0131\u015f gereksinimi olmad\u0131\u011f\u0131 y\u00f6n\u00fcnde karar de\u011fi\u015fimi oldu. Sonu\u00e7 olarak hastalar\u0131n %13,8\u2019inde t\u00fcm v\u00fccut yakla\u015f\u0131ml\u0131 hedefe y\u00f6nelik USG protokol\u00fc hastalar\u0131n yat\u0131\u015f gereksinimi \u00fczerindeki karar\u0131 de\u011fi\u015ftirdi.<\/p>\n\n\n\n

Lojistik Regresyon Analizi<\/em><\/strong><\/p>\n\n\n\n

            <\/strong>T\u00fcm v\u00fccut yakla\u015f\u0131ml\u0131 hedefe y\u00f6nelik USG ile tespit edilen senkop\/presenkop ili\u015fkili anormal USG bulgular\u0131n\u0131n (n=54) tespiti i\u00e7in ba\u011f\u0131ms\u0131z risk fakt\u00f6rlerinin ara\u015ft\u0131rmak i\u00e7in tek de\u011fi\u015fkenli lojistik regresyon modelinde 10 de\u011fi\u015fken analiz edildi: ya\u015f, cinsiyet, ba\u015fvuru sistolik kan bas\u0131nc\u0131, ba\u015fvuru nab\u0131z say\u0131s\u0131, ba\u015fvuru periferik oksijen saturasyonu, anormal EKG bulgular\u0131n\u0131n varl\u0131\u011f\u0131, ESC y\u00fcksek risk kriterlerinden herhangi birisinin varl\u0131\u011f\u0131 ve acil servis ba\u015fvurusunda hastan\u0131n semptomatik olmas\u0131. Sonu\u00e7 olarak ya\u015f, nab\u0131z say\u0131s\u0131 ve ESC y\u00fcksek risk kriterlerinin varl\u0131\u011f\u0131, \u201cT\u00fcm v\u00fccut yakla\u015f\u0131ml\u0131 hedefe y\u00f6nelik USG\u2019de senkop\/presenkop ili\u015fkili bulgular\u0131n tespiti\u201d i\u00e7in ba\u011f\u0131ms\u0131z risk fakt\u00f6r\u00fc olarak belirlendi.<\/p>\n\n\n\n

Tart\u0131\u015fma<\/strong><\/p>\n\n\n\n

\u00c7al\u0131\u015fmada t\u00fcm v\u00fccut yakla\u015f\u0131ml\u0131 hedefe y\u00f6nelik USG de\u011ferlendirmenin senkop\/presenkop etiyolojisindeki tan\u0131sal etkinli\u011fini ara\u015ft\u0131rmak ama\u00e7land\u0131 ve hastalar\u0131n \u00f6nemli bir b\u00f6l\u00fcm\u00fcnde USG ile hem senkopa yol a\u00e7an \u00f6nemli etiyolojilerin tespit edildi\u011fi hem de tedavi ve giri\u015fim planlar\u0131nda \u00f6nemli de\u011fi\u015fikliklere neden oldu\u011fu ortaya kondu. Bu tan\u0131lar\u0131n acil serviste tespit edilmesi sonradan ortaya \u00e7\u0131kacak \u00f6l\u00fcmleri ve sakatl\u0131klar\u0131 \u00f6nleyebilir. Nitekim hastalar\u0131m\u0131z\u0131n \u00f6nemli bir b\u00f6l\u00fcm\u00fcnde USG bulgular\u0131 ile tedavi s\u00fcre\u00e7lerinde az\u0131msanmayacak de\u011fi\u015fiklikler uyguland\u0131. Hastalarda senkop ile ili\u015fkili pozitif bulgularda, aort darl\u0131\u011f\u0131, karotis darl\u0131\u011f\u0131, sistolik yetmezlik gibi durumlar\u0131n ileri ya\u015f grubunda daha s\u0131k g\u00f6zlendi\u011fi ve senkopla ili\u015fkilendirildi\u011fi g\u00f6r\u00fcld\u00fc. \u00d6zellikle 60 ya\u015f \u00fczerinde kritik tan\u0131lar\u0131n g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 \u00e7arp\u0131c\u0131 bir \u015fekilde y\u00fcksektir. Lojistik regresyon modelinde anormal USG bulgular\u0131n\u0131n tespiti i\u00e7in ileri ya\u015f, nab\u0131z art\u0131\u015f\u0131 ve ESC y\u00fcksek risk kriterlerinin ba\u011f\u0131ms\u0131z risk fakt\u00f6rleri oldu\u011funu ortaya koyduk. \u00d6zellikle ESC y\u00fcksek risk kriterlerinden herhangi birisinin pozitif olmas\u0131n\u0131n OR de\u011feri 5,77\u2019di. Bu y\u00fczden en az\u0131ndan, ESC y\u00fcksek risk kriterlerine sahip hastalarda t\u00fcm v\u00fccut yakla\u015f\u0131ml\u0131 hedefe y\u00f6nelik USG yap\u0131lmas\u0131 d\u00fc\u015f\u00fcn\u00fclebilir.  <\/p>\n\n\n\n

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

T\u00fcm v\u00fccut yakla\u015f\u0131ml\u0131 hedefe y\u00f6nelik USG de\u011ferlendirmesi hastalar\u0131n yakla\u015f\u0131k 1\/3\u2019\u00fcnde senkop\/presenkop ili\u015fkili USG bulgular\u0131n\u0131 tespit etti ve yakla\u015f\u0131k d\u00f6rtte birinde saptanan anormal bulgulara y\u00f6nelik giri\u015fim uygulanmas\u0131n\u0131 sa\u011flad\u0131. Anormal bulgular\u0131n \u00e7o\u011funlu\u011fu 60 ya\u015f \u00fczerindeki hastalarda g\u00f6r\u00fcld\u00fc. \u0130leri ya\u015f, nab\u0131z art\u0131\u015f\u0131 ve ESC y\u00fcksek risk kriterlerinin varl\u0131\u011f\u0131, anormal bulgular\u0131n g\u00f6r\u00fclmesi i\u00e7in ba\u011f\u0131ms\u0131z risk fakt\u00f6rleri olarak belirlendi.<\/p>\n\n\n\n

TATDUS yazar\u0131n\u0131n yorumu<\/strong><\/p>\n\n\n\n

Acil servise ba\u015fvuran senkop\/presenkop hastalar\u0131nda t\u00fcm v\u00fccut yakla\u015f\u0131ml\u0131 hedefe y\u00f6nelik USG, standart de\u011ferlendirmenin bir par\u00e7as\u0131 olarak acil servis prati\u011fine dahil edilebilir. Bu hastalardan hangilerinin t\u00fcm v\u00fccut yakla\u015f\u0131ml\u0131 hedefe y\u00f6nelik USG daha dazla fayda g\u00f6rebilece\u011fi sonraki \u00e7al\u0131\u015fmalarla daha a\u00e7\u0131k bir \u015fekilde ortaya konulabilir.<\/p>\n\n\n\n

Kaynak: Ucar G, Aksay E, Bayram B, Guzelce MC, Ergun YK. The diagnostic efficiency of whole-body bedside ultrasonography protocol for syncope patients in the emergency department. Am J Emerg Med. 2023 Feb 3;67:17-23. doi: 10.1016\/j.ajem.2023.01.043. Epub ahead of print. PMID: 36774906.<\/p>\n","protected":false},"excerpt":{"rendered":"

Senkop, acil servislere her ya\u015f grubundan s\u0131k bir ba\u015fvuru sebebidir. Etiyolojisi ve risk s\u0131n\u0131flamas\u0131 saptanmas\u0131, acil servis hekimleri a\u00e7\u0131s\u0131ndan halen zorlay\u0131c\u0131 olabiliyor.…<\/p>\n","protected":false},"author":1205,"featured_media":2379,"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":[3,1,19],"tags":[63,86,99],"class_list":["post-4466","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-egitim","category-genel","category-literatur-ozetleri-surekli-yayinlar","tag-kardiyak-usg","tag-pocus","tag-tatdus"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/4466","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\/1205"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/comments?post=4466"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/4466\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media\/2379"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media?parent=4466"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/categories?post=4466"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/tags?post=4466"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}