Şoktaki Hastada Ultrasonografi İlkeleri
Özet
Ultrasonagrafi tıp alanında 1942 yılından bu yana kullanılan radyoaktivite içermeyen görüntüleme yöntemedir. Taşınabilir olması ve hasta başında da rahatlıkla kullanılması nedeniyle (Point-of-care ultrasonography (POCUS)) 1990 yıllarından itibaren Acil tıp birimlerinde de kullanılmaya başlamış, 2001 yılında ACEP tarafından kılavuzlara girmiştir. POCUS acil servislerde şok bulguları olan özellikle unstabil hastalar, travma hastaları , gebeler, üriner sistem, abdominal aorta , kardiyak ,safra yolları şikayeti olan hastalar ve derin venöz yapılarla birlikte akciğer patolojilerinin de tespitinde hızlı ve güvenli şekilde kullanılmaktadır. POCUS vital bulgular ışığında unstabil olan hastalarda şok nedenin belirlenmesinde ,kardiyovasküler sistemi ( Perikardiyal efüzyon, sağ sol ventrikül disfonksiyonları), solunum sistemi(pnömoni, pnömotoraks, plevral efüzyon ve interstisyel hastalıklar), intraabdominal yapıları(Abdominal Aort patolojileri, solid organ laserasyonları ,intestinal patolojiler) ve gebeliğe bağlı patolojileri hızlı ve etkin şekilde gözlenmesini sağlayarak uygulanacak tedavi ve işlemlerin en kısa sürede yapılmasına olanak vermektedir. Acil serviste perikardiyal, perisplenik, perihepatik , pelvik ,toraks boşluğu ,akciğer ve Vena Cava İnferiorü değerlendirmeye yarayan E-FAST protokolünün uygulanması bir çok şok türünün(Kardiyojenik,Hipovolemik,Obstrüktif) yüksek spesifite ile hızlı bir şekilde tespitini sağlamaktadır. Bu yazımızda POCUS acil servilerde etkin kullanılmasının avantaları sistemlere ait patolojilerin ultrasonografi bulgularına kapsamlı olarak değinerek, hastaların ilk muayenesinde ultrasonografi kullanımının avantajları ve önemini vurgulamak istedik.
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