Multipl Travmaya Yaklaşımda Yenilikler
Özet
Acil servislerde çoklu travmalı hastalarına yaklaşım, uzman bir ekip çalışmasını, hızlı tanı ve tedavi sürecini, güncel bilgilerle sürekli yenilenen bakımı gerektirmektedir. İleri travma yaşam desteği (ATLS=Adavced Trauma Life Support) 10. Baskı ile güncellenen ve kılavuza yeni eklenen bilgiler arasında travmatik dolaşım arresti tanımı, resüsitasyon sırasında sınırlı sıvı uygulaması, baz açığının hemorajik şok tanımına dahil edilmesi, sekonder bakıya alınan yelken göğüs tanımı, tansiyon pnömotoraksta iğne dekompresyonunun yeni tanımlanan uygulama alanı yer almaktadır. Özellikle ATLS 10. Baskı sonrası yayınlanan güncel literatür verileri arasında ise; travma resüsitasyonunda profilaktik veya yüksek doz Protrombin Kompleks Konsantresi (PCC) / fibrin kullanımının henüz çok faydalı olduğunun gösterilememiş olması, günlük resüsitasyonda sıklıkla kullandığımız traneksamik asit (TXA) kullanımına devam edilmesi, permisif hipotansiyonun net endikasyonları, antikoagülan kullanan ve kanayan hastalarda tedavi için verilecek intravenöz K vitamininin daha yüksek dozda önerildiği, hipoterminin özellikle koagülopatiyi tetiklediği vurgulanmakta ve hemostatik resüsitasyonda eritrosit (Red Blood Cells = RBC) : Taze donmuş Plazma (TDP) : Trombosit oranının 1:1:1 ile en efektif olduğu, masif transfüzyon alacak hastaların kişiye özel koagülopati testleri ile yönetilebileceği, hipokalseminin kanama riskini artırdığı ve resüsite edilmesi gerektiği yer almaktadır.
Referanslar
American College of Surgeons, 2018, ATLS (Advanced Trauma Life Support) Tenth Edition, Chicago.
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