{"id":708,"date":"2012-07-25T22:45:42","date_gmt":"2012-07-25T19:45:42","guid":{"rendered":"http:\/\/www.hvtd.org\/?p=708"},"modified":"2012-07-25T22:45:42","modified_gmt":"2012-07-25T19:45:42","slug":"hava-ambulansi-operasyonlarina-ait-2-ilginc-olgu","status":"publish","type":"post","link":"https:\/\/www.hvtd.org\/?p=708","title":{"rendered":"Hava ambulans\u0131 operasyonlar\u0131na ait 2 ilgin\u00e7 olgu"},"content":{"rendered":"
\n

\"\"<\/a>OLGU – 1: <\/strong>\u0130\u015f kazas\u0131 ile yaralanan 29 ya\u015f\u0131nda i\u015f\u00e7i. Kazan\u0131n, sanayi hidroliki taraf\u0131ndan g\u00f6\u011f\u00fcs b\u00f6lgesinden s\u0131k\u0131\u015ft\u0131r\u0131lma bi\u00e7iminde oldu\u011fu ve 2 dakika kadar bilin\u00e7 kayb\u0131 ya\u015fand\u0131\u011f\u0131 \u00f6\u011frenildi. Kara ambulans\u0131 ile saha hastanesine kald\u0131r\u0131lan hastan\u0131n KB:80 mm\/Hg, \u015fuuru a\u00e7\u0131k ve koopere idi. Laparatomide hafif dalak yaralanmas\u0131, grade-V sa\u011f lob karaci\u011fer yaralanmas\u0131 ve transvers kolonda hematom tespit edildi. Hastaya toplam 5 lt s\u0131v\u0131, 22 \u00fcnite eritrosit, 4 \u00fcnite TDP, 10 \u00fcnite trombosit ve 800 ml kolloid veridi; 10 mg vencuronium, 150 mg fentanil yap\u0131ld\u0131; ent\u00fcbe edilerek oral gastrik t\u00fcp ve \u00fcriner kateter tak\u0131ld\u0131. Hastan\u0131n 470 km uzakl\u0131kta olan hastaneye nakline karar verilerek u\u00e7ak ambulans haz\u0131rland\u0131.<\/p>\n

U\u00e7a\u011fa al\u0131nd\u0131\u011f\u0131nda karn\u0131nda \u015fi\u015flik olan hastan\u0131n KB:80, Nb:80, O2 Sat: % 92 idi. Yakla\u015f\u0131k 1 saat kadar s\u00fcren u\u00e7u\u015fta hipotermi ve hemodinamik instabilite geli\u015fmesi \u00fczerine 8 \u00fcnite eritrosit, 1 \u00fcnite TDP, 6 \u00fcnite trombosit ve 1500 ml kristaloid s\u0131v\u0131 verildi. Hemodinamik d\u00fczensizli\u011finin devam\u0131 \u00fczerine havaalan\u0131ndan hastaneye helikopter ile ta\u015f\u0131nd\u0131 ve bu u\u00e7u\u015f da 10 dk s\u00fcrd\u00fc. Hasta tekrar opere edilip mekanik ventilat\u00f6re ba\u011fland\u0131, pulmoner \u00f6dem ve sepsis geli\u015fti\u011fi i\u00e7in 20 g\u00fcn yo\u011fun bak\u0131mda ve 13 g\u00fcn genel cerrahi servisinde yatt\u0131ktan sonra antibiyotik tedavisine devam kayd\u0131yla taburcu edildi.
\nHava ambulans operasyonu ve u\u00e7u\u015f fizyolojisi a\u00e7\u0131s\u0131ndan tart\u0131\u015fma<\/strong><\/p>\n

Bu hastan\u0131n transportu s\u0131ras\u0131nda dikkat edilmesi gereken hususlar nelerdir?
\n1. Hipoksi:<\/strong> Mekanik ventilasyon yolu ile hastaya positif bas\u0131n\u00e7l\u0131 % 100 oksijen verildi. B\u00f6ylece hipemik ve stagnant hipoksi engellenmi\u015f oldu.<\/p>\n

2. Nazogastrik Sonda:<\/strong> Bat\u0131n distansyonunun engellenmesi ve s\u00fcrekli drenajin sa\u011flanmas\u0131 i\u00e7in sondan\u0131n a\u00e7\u0131k b\u0131rak\u0131lmas\u0131 gerekir. Bu hastada laparatomi insizyonu da oldu\u011fu i\u00e7in drenajin uygulanmas\u0131 ve bandajlar\u0131n s\u0131k\u0131 ba\u011flanmas\u0131 gerekliydi. (Boyle Kanunu)<\/p>\n

3. Hipotermi: <\/strong>Hastada kanama fazla oldu\u011fundan bol miktarda s\u0131v\u0131 ve kan \u00fcr\u00fcnleri verilmi\u015f; hipotermi de bu y\u00fczden geli\u015fmi\u015ftir. Nakil s\u0131ras\u0131nda nemlendirilmi\u015f oksijen ve \u0131l\u0131t\u0131lm\u0131\u015f s\u0131v\u0131 verilmesi gerekir. Ayr\u0131ca s\u0131cak s\u0131v\u0131 torbalar\u0131n\u0131n aksilla, pelvis gibi b\u00f6lgelere konulmas\u0131 da fayda sa\u011flar.<\/p>\n

4. G\u00fcr\u00fclt\u00fc: <\/strong>G\u00fcr\u00fclt\u00fc yorgunlu\u011fu ve rahats\u0131zl\u0131\u011f\u0131 artt\u0131rd\u0131\u011f\u0131 i\u00e7in hastan\u0131n kulaklar\u0131 kapat\u0131lmal\u0131d\u0131r. Bu uygulama komadaki veya uyutulmu\u015f hastalar i\u00e7in de ge\u00e7erlidir.<\/p>\n

5. Cuff\u2019lar:<\/strong> T\u00fcm cuff\u2019lar ve balonlar hava yerine s\u0131v\u0131 ile \u015fi\u015firilmelidir. (Boyle Kanunu)<\/p>\n

6. Titre\u015fim:<\/strong> Titreme ve sallanma hastada rahats\u0131zl\u0131k yarat\u0131r ve ciltte ekimoz gibi k\u00fc\u00e7\u00fck yaralanmalara neden olabilir. Bunu engellemek i\u00e7in hastalar uygun bi\u00e7imde sabitlenmelidir.
\n<\/strong><\/p>\n

OLGU – 2:<\/strong> 70 ya\u015f\u0131nda CVA ge\u00e7irmi\u015f erkek hasta, sepsis tedavisi i\u00e7in BK-117 tipi helikopter ile transportu planlanm\u0131\u015f. Hastan\u0131n vital bulgular\u0131: KB: 84\/59 Nb:120 (sin\u00fcs ta\u015fikardisi), SS: 14 (entube ve oxyloga ba\u011fl\u0131), Ate\u015f: 36oC.<\/p>\n

Pilot rotor \u00e7evirmeye ba\u015flad\u0131\u011f\u0131nda u\u00e7u\u015f hem\u015firesi hastan\u0131n g\u00f6zlerinin h\u0131zla a\u00e7\u0131p kapand\u0131\u011f\u0131n\u0131 ve tonik-klonik tarzda n\u00f6bet ge\u00e7irmeye ba\u015flad\u0131\u011f\u0131n\u0131 farketmi\u015f. Monit\u00f6rde ventrik\u00fcler fibrilasyon g\u00f6r\u00fcn\u00fcyordu fakat nab\u0131z al\u0131nabiliyordu. Hem\u015fire resusitasyon i\u00e7in hastaneden yard\u0131m istemek \u00fczere pilota motoru durdurmas\u0131n\u0131 istemis. Rotor yava\u015flay\u0131nca hastan\u0131n n\u00f6beti de durmu\u015f. H\u0131zl\u0131 bir muayene ve 2 mg Lorazepam uyguland\u0131ktan sonra tekrar havalanmak \u00fczere pilot motoru \u00e7al\u0131\u015ft\u0131rm\u0131\u015f. Rotor d\u00f6nmeye ba\u015flay\u0131nca hastan\u0131n n\u00f6beti tekrarlam\u0131\u015f. U\u00e7u\u015f hem\u015firesi bunun bir \u201cflicker vertigo\u201d oldu\u011funu anlam\u0131\u015f, hastan\u0131n g\u00f6zlerini kapatarak n\u00f6betin durmas\u0131n\u0131 sa\u011flam\u0131\u015f ve u\u00e7u\u015f boyunca da hastan\u0131n g\u00f6zlerini kapal\u0131 tutmu\u015f.
\n<\/strong><\/p>\n

Tart\u0131\u015fma:<\/strong> Flicker vertigo \u00e7ok s\u0131k g\u00f6r\u00fclen bir olay de\u011fildir. G\u00fcne\u015f \u0131\u015f\u0131\u011f\u0131n\u0131n kesintili olarak g\u00f6z\u00fc uyarmas\u0131 nedeniyle olu\u015fan bu durum, n\u00f6rolojik veya epileptik sorunlar\u0131 olan hastalarda n\u00f6beti tetikleyebilir. Bu hastada;<\/p>\n

– Hastan\u0131n pozisyonu ve y\u00fcz\u00fcn pencereye bak\u0131yor olmas\u0131,<\/p>\n

– G\u00fcne\u015fli bir g\u00fcnd\u00fcz ve pencereden g\u00fcne\u015f yans\u0131yor olmas\u0131,<\/p>\n

– N\u00f6betin rotor d\u00f6nu\u015f\u00fc ile ba\u015flay\u0131p, rotorun durmas\u0131 ile kesilmesi, tan\u0131y\u0131 destekleyen ip u\u00e7lar\u0131d\u0131r.<\/p>\n

Flicker vertigo dakikada 4-20 defa kesintili gelen bir \u0131\u015f\u0131\u011fa maruz kal\u0131nd\u0131\u011f\u0131 zaman ortaya \u00e7\u0131kar. Bulant\u0131-kusma, bazen n\u00f6bet ve bilin\u00e7 kayb\u0131 g\u00f6r\u00fclebilir. Daha \u00f6nce n\u00f6bet ge\u00e7irmi\u015f olanlarda risk y\u00fcksektir. \u015eapka ve g\u00f6zl\u00fck takmak, istirahat ve stresi azaltma metotlar\u0131 flicker vertigoyu engeller.
\n<\/strong><\/p>\n

Haz\u0131rlayanlar:<\/strong><\/p>\n

Dr. Fatih Mehmet G\u00fcl (drfameg@yahoo.com)<\/p>\n

Dr. Ayman Aldarsani Anestezi Uzman\u0131<\/p>\n

Dr. Abdullah \u0130brahim Acil Uzman\u0131, Suudi K\u0131z\u0131lay\u0131 Helikopter Ambulans Projesi<\/p>\n

Kaynaklar: <\/strong>
\n1. Holleran rs. Air and Surface Patient Transport, 2005, Mosby<\/p>\n

2. Anton DJ. Crashdynamics, restraint systems. In: Ernsting J, King P (eds). Aviation Medicine, 2nd ed. London: Butterworths, 1988.<\/p>\n

3. Benson AJ. Motion sickness. In: Ernsting J, King P (eds). Aviation Medicine, 2nd edn. London: Butterworths, 1988.<\/p>\n

4. Bion JF, Wilson IH, Taylor PA. Transporting critically ill patients by ambulance: audit by sickness scoring. Br Med J (Clin Res Ed) 1988; 296(6616): 170.<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

OLGU – 1: \u0130\u015f kazas\u0131 ile yaralanan 29 ya\u015f\u0131nda i\u015f\u00e7i. Kazan\u0131n, sanayi hidroliki taraf\u0131ndan g\u00f6\u011f\u00fcs b\u00f6lgesinden s\u0131k\u0131\u015ft\u0131r\u0131lma bi\u00e7iminde oldu\u011fu ve 2 dakika kadar bilin\u00e7 kayb\u0131 ya\u015fand\u0131\u011f\u0131 \u00f6\u011frenildi. Kara ambulans\u0131 ile saha hastanesine kald\u0131r\u0131lan hastan\u0131n KB:80 mm\/Hg, \u015fuuru a\u00e7\u0131k ve koopere idi. Laparatomide hafif dalak yaralanmas\u0131, grade-V sa\u011f lob karaci\u011fer yaralanmas\u0131 ve transvers kolonda hematom tespit edildi. Hastaya toplam 5 lt […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[6],"tags":[],"class_list":["post-708","post","type-post","status-publish","format-standard","hentry","category-bulten"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/708","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=708"}],"version-history":[{"count":1,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/708\/revisions"}],"predecessor-version":[{"id":710,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/708\/revisions\/710"}],"wp:attachment":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=708"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=708"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=708"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}