KADAT2008 - Kanıta Dayalı Acil Travma Kursu 2008 - Kurs Kitabı

Eskişehir Osmangazi Üniversitesi Yayınları No: 000
Bu kitabın basım, yayım ve satış hakları Eskişehir Osmangazi Üniversitesi’ne aittir.

Bütün hakları saklıdır.
Kitabın tümü ya da bölümü/bölümleri Eskişehir Osmangazi Üniversitesi’nin yazılı izni

olmadan elektronik, optik, mekanik ya da diğer yollarla basılamaz, çoğaltılmaz ve
dağıtılmaz.
Copyright 2008 by Eskişehir Osmangazi University

All rights reserved.
No part of this book may be printed, Reproduced or distributed by any electronical,

optical, mechanical or other means without the written permission of Eskişehir
Osmangazi University.
Kapak Düzeni: Arif Alper Çevik

Eskişehir Osmangazi Üniversitesi, Tıp Fakültesi,
Acil Tıp Anabilim Dalı
Tasarım: Cemalettin Yıldız

Anadolu Üniversitesi, Güzel Sanatlar Fakültesi,
Grafik Tasarım Bölümü
Dizgi: Arif Alper Çevik, Cemalettin Yıldız
ISBN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1. BASKI
ESKİŞEHİR OSMANGAZİ ÜNİVERSİTESİ MATBAASI, ESKİŞEHİR, 2008

1. Baskı
Kanıta Dayalı Acil Travma Yönetimi Kursu

2008
“Kurs Kitabı”
Editörler
Doç.Dr. Arif Alper Çevik

Eskişehir Osmangazi Üniversitesi, Tıp Fakültesi, Acil Tıp Anabilim Dalı
Öğr.Gör.Dr. Nurdan Ergün

Eskişehir Osmangazi Üniversitesi, Tıp Fakültesi, Acil Tıp Anabilim Dalı
Prof.Dr. C. James Holliman

Program Manager, Afghanistan Healthcare Sector Reachback Project
Center for Disaster and Humanitarian Assistance Medicine
Uniformed Services University of the Health Sciences
Bethesda, MD, USA
Kanıta Dayalı Acil Tıp Danışmanı
Yrd.Doç.Dr. Cenker Eken

Akdeniz Üniversitesi, Tıp Fakültesi, Acil Tıp Anabilim Dalı, Antalya
Görsel Tanı Danışmanları
Doç.Dr. Yıldıray Çete

Akdeniz Üniversitesi, Tıp Fakültesi, Acil Tıp Anabilim Dalı, Antalya
Yrd.Doç.Dr. İsa Kılıçaslan

Fırat Üniversitesi, Tıp Fakültesi, Acil Tıp Anabilim Dalı, Elazığ
Eskişehir Osmangazi Üniversitesi

2008
İçerik
1 Travmalı hastanın değerlendirilmesi ve stabilizasyonu
Doç.Dr. Yıldıray Çete 1 - 15
2 Travmalı hastada havayolu yönetimi

Öğr.Gör.Dr. Neşe Çolak Oray 16 - 29
3 Şok’un tanımlanması ve yönetimi

Yrd.Doç.Dr. Cenker Eken 30 - 39
4 Travmalı hastada IV sıvılar ve yollar

Yrd.Doç.Dr. Erkan Göksu 40 - 49
5 Toraks travmasının tanımlanması ve yönetimi

Doç.Dr. Arif Alper Çevik 50 - 61
6 Abdominal travmanın tanımlanması ve yönetimi

Yrd.Doç.Dr. Ahmet Demircan 62 - 73
7 Pelvik travmanın tanımlanması ve yönetimi

Yrd.Doç.Dr. Fırat Bektaş 74 - 83
8 Genitoürner travmanın tanımlanması ve yönetimi

Yrd.Doç.Dr. Mutlu Kartal 84 - 93
9 Kafa travmasının tanımlanması ve yönetimi

Yrd.Doç.Dr. Ayfer Keleş 94 - 105
10 Servikal travmanın tanımlanması ve yönetimi

Öğr.Gör.Dr. Nurdan Ergün Acar 106 - 117
11 Ektremite travması hakkında bilinmesi gereken temel noktalar

12 Üst ekstremitenin ortopedik yaralanmalarının tanımlanması ve yönetimi

Uzm.Dr. Selahattin Kıyan 128 - 147
13 Alt ekstremitenin ortopedik yaralanmalarının tanımlanması ve yönetimi

Uzm.Dr. Ersin Aksay 148 - 165
14 Yanık yaralanmalarının tanımlanması ve yönetimi

Uzm.Dr. Ebru Karaca 166 - 177
15 Elektrik ve Yıldırım yaralanmalarının tanımlanması ve yönetimi

Yrd.Doç.Dr. Ayfer Keleş
178 - 187
16 Pediatrik travma hastasının yönetimi

Yrd.Doç.Dr. Seçgin Söyüncü 188 - 197
i
İçerik
17 Gebe travma hastasının yönetimi
Uzm.Dr. Özlem Yiğit 198 - 207
18 Geriatrik travma hastasının yönetimi

Öğr.Gör.Dr. Neşe Çolak Oray 208 - 215
19 Hipotermi ve donuk
Doç.Dr. Murat Pekdemir 216 - 225
20 Travma hastasında yara bakımı ipuçları ve tetanoz profilaksisi

Yrd.Doç.Dr. İsa Kılıçaslan 226 - 239
21 Maksillofasiyal travmaların tanımlanması ve yönetimi

Uzm.Dr. Ebru Karaca
240 - 255
22 Künt ve penetran boyun travmalarının tanımlanması ve yönetimi

Uzm.Dr. Murat Ersel
256 - 269
23 Ateşli silah yaralanmalarının tanımlanması ve yönetimi

Yrd.Doç.Dr. Serkan Yılmaz
270 - 281
24 Travma resusitasyonunda personelin özel görevleri

Prof.Dr. C. James Holliman 282 - 289
Çeviren: Dr. A. Tuğrul Zeytin
25 Travma hastalarının hastaneler arası transferi

Prof.Dr. C. James Holliman 290 - 295
Çeviren: Dr. A. Tuğrul Zeytin
26 Travma radyografilerinin değerlendirilmesi

Doç.Dr. Cüneyt Ayrık 296 - 309
27 Travmalı hastada beyin tomografisi yorumlanması

Uzm.Dr. Aslıhan Yürüktümen 310 - 317
28 Travmalı hastada toraks BT değerlendirilmesi

Doç.Dr. Levent Avşaroğulları 318 - 325
29 Travmalı hastada abdominal BT değerlendirilmesi

Doç.Dr. Şahin Aslan 326 - 335
30 Acil Ultrasonografiye Giriş - Temel US ve Ekipman Bilgisi

31 Ultrasonografi eşliğinde havayolu stabilizasyonu

ii
İçerik
32 Acil Travma Ultrasonografisi - FAST / E- FAST
33 Ultrasonografi eşliğinde IV girişimler
34 Ultrasonografi ile yabancı cisim araştırılması

Uzm.Dr. Aslıhan Yürüktümen 372 - 377
35 Ultrasonografi ile kemik değerlendirilmesi

Yrd.Doç.Dr. Seçkin Söyüncü 378 - 383
iii
Yazralar
Yrd.Doç.Dr. Ahmet Demircan
Gazi Üniversitesi Tıp Fakültesi, Acil Tıp Anabilim Dalı, Ankara

Acil Tıp Anabilim Dalı Başkanı
Konu 6
Eskişehir Osmangazi Üniversitesi, Acil Tıp Anabilim Dalı, Eskişehir

Konu 5, 11, 33
Uzm.Dr. Aslıhan Yürüktümen
Ege Üniversitesi Tıp Fakültesi, Acil Tıp Anabilim Dalı, İzmir

Konu 27, 34
Gazi Üniversitesi Tıp Fakültesi, Acil Tıp Anabilim Dalı, Ankara

Öğretim Üyesi
Konu 9, 15
Program Manager, Afghanistan Healthcare Sector

Reachback Project
Center for Disaster and Humanitarian Assistance Medicine
Uniformed Services University of the Health Sciences
Bethesda, MD, USA
Konu 24, 25
Akdeniz Üniversitesi Tıp Fakültesi, Acil Tıp Anabilim Dalı, Antalya

Öğretim Üyesi
Türkiye Acil Tıp Dergisi Editörü
Konu 3
Doç.Dr. Cüneyt Ayrık
Mersin Üniversitesi Tıp Fakültesi, Acil Tıp Anabilim Dalı, Mersin

Konu 26
Uzm.Dr. Ebru Karaca
Eskişehir Devlet Hastanesi, Acil Servisi, Acil Servis Direktörü

Konu 14, 21
iv
Yazralar
Yrd.Doç.Dr. Erkan Göksu
Akdeniz Üniversitesi, Acil Tıp Anabilim Dalı, Antalya

Öğretim Üyesi
Konu 4
Uzm.Dr. Ersin Aksay

Konu 13
Yrd.Doç.Dr. Fırat Bektaş

Öğretim Üyesi
Konu 7
Fırat Üniversitesi, Acil Tıp Anabilim Dalı, Elazığ

Öğretim Üyesi
Konu 20
Doç.Dr. Levent Avşaroğulları
Erciyes Üniversitesi Tıp Fakültesi, Acil Tıp Anabilim Dalı, Kayseri

Öğretim Üyesi
Konu 28
Uzm.Dr. Murat Ersel

Konu 22
Doç.Dr. Murat Pekdemir
Kocaeli Üniversitesi, Acil Tıp Anabilim Dalı, Kocaeli

Öğretim Üyesi
Konu 19
Yrd.Doç.Dr. Mutlu Kartal

Öğretim Üyesi
Konu 8
v
Yazralar
Öğr.Gör.Dr. Neşe Çolak Oray
Dokuz Eylül Üniversitesi, Acil Tıp Anabilim Dalı, İzmir

Öğretim Elemanı
Konu 2, 18
Öğr.Gör.Dr. Nurdan Ergün Acar
Dokuz Eylül Üniversitesi, Acil Tıp Anabilim Dalı, İzmir

Öğretim Elemanı
Konu 10, 30, 31, 32
Uzm.Dr. Özlem Yiğit

Konu 17
Doç.Dr. Şahin Aslan
Atatürk Üniversitesi, Acil Tıp Anabilim Dalı, Erzurum

cu Acil Tıp Anabilim Dalı Başkanı
an Konu 29
z
Yrd.Doç.Dr. Seçgin Söyüncü

Öğretim Üyesi
Konu 16, 35
Uzm.Dr. Selahattin Kıyan

Konu 12
Kocaeli Üniversitesi, Acil Tıp Anabilim Dalı, Kocaeli

Öğretim Üyesi
Konu 23

Konu 1
vi
Kurs İçeriği
Teorik Konular
1 Travmalı hastanın değerlendirilmesi ve stabilizasyonu

2 Travmalı hastada havayolu yönetimi
3 Şok’un tanımlanması ve yönetimi
4 Travmalı hastada IV sıvılar ve yollar
5 Toraks travmasının tanımlanması ve yönetimi
6 Abdominal travmanın tanımlanması ve yönetimi
7 Pelvik travmanın tanımlanması ve yönetimi
8 Genitoürner travmanın tanımlanması ve yönetimi
9 Kafa travmasının tanımlanması ve yönetimi
10 Servikal travmanın tanımlanması ve yönetimi
11 Ektremite travması hakkında bilinmesi gereken temel noktalar
12 Üst ekstremitenin ortopedik yaralanmalarının tanımlanması ve yönetimi
13 Alt ekstremitenin ortopedik yaralanmalarının tanımlanması ve yönetimi
14 Yanık yaralanmalarının tanımlanması ve yönetimi
15 Elektrik ve Yıldırım yaralanmalarının tanımlanması ve yönetimi
16 Pediatrik travma hastasının yönetimi
17 Gebe travma hastasının yönetimi
18 Geriatrik travma hastasının yönetimi
19 Hipotermi ve donuk
20 Travma hastasında yara bakımı ipuçları ve tetanoz profilaksisi
21 Maksillofasiyal travmaların tanımlanması ve yönetimi
22 Ateşli silah yaralanmalarının tanımlanması ve yönetimi
23 Travma resusitasyonunda personelin özel görevleri
24 Travma hastalarının hastaneler arası transferi
25 Travma radyografilerinin değerlendirilmesi
26 Travmalı hastada beyin tomografisi yorumlanması
27 Acil Ultrasonografiye Giriş - Temel US ve Ekipman Bilgisi
28 Ultrasonografi eşliğinde havayolu stabilizasyonu
29 Acil Travma Ultrasonografisi - FAST / E- FAST
30 US eşliğinde IV girişimler
31 US ile yabancı cisim araştırılması
32 US ile kemik değerlendirilmesi
Pratik Uygulama ve Tartışmalar
1 Travmalı Hastada Omurga Stabilizasyonu

2 Havayolu ve Zor Havayolu Yönetimi
3 IV ve IO damar yolu girişimleri
4 Cerrahi Havayolu Girişimleri
5 Tüp torakostomi ve perikardiyosentez
6 Büyük Eklemlerin Acil Redüksiyonu
7 Video tartışma 1, 2, 3
8 Kanıta Dayalı Tıp Literatürü ile tartışma 1, 2, 3, 4
9 Görsel Tanı 1
10 Olgu senaryoları 1, 2, 3
vii
Eğitmenler
Kurs Direktörleri

Kurs “Kanıta Dayalı Tıp” Danışmanı
Kurs “Görsel Tanı” Danışmanı

Eğitmenler

Yrd.Doç.Dr. isa Kılıçaslan
Kursun Organizasyonunda Görev Alanlar

Dr. Filiz Baloğlu
Dr. Şeyhmus Kaya
Dr. A. Tuğrul Zeytin
Dr. Hamit Özçelik
viii
Çağımızın hızla gelişen uzmanlık alanı olan Acil Tıp, ülkemizde de son 15 yılda önemli
Önsöz
aşamalar kaydetti. 1993 yılında uzmanlığımızın ayrı bir uzmanlık alanı olarak kabul
edilmesinden bu yana geçen sürede travma hastalarının da bu yeni uzmanlık alanı ile
birlikte Acil Servislerde aldıkları hizmetin kalitesi yükseldi.
Bugün Acil Servislerde değerlendirilen travma hastalarının önemli bir çoğunluğu Acil
Servis şartlarında Acil Tıp Uzmanlarınca yönetilebilecek sorunlarla gelmektedir. Bu
hastaları ilk karşılayan uzmanlık alanı olarak, travma konusundaki eğitimimizi derin-
leştirmeli, konuyla ilgili olan diğer uzmanlık alanlarıyla iletişim ve paylaşımlarımızı
artırmalıyız.
Bu kurs tek başına travma konusunda asla yeterlilik kazandıran bir kurs değildir.
Travma yönetimi konusunda yeterli düzeye ulaşabilmek sürekli eğitim ve deneyimlerin
artmasıyla mümkün olur. Bu kurs sadece travma yönetimi yapan biz Acil Tıp
Uzmanlarına farklı bir değerlendirme ve bakış açısı sunmayı amaçlamaktadır. Her kur-
sun özelliği olan o konuyla ilgili formatlanmış temel bilgiler bu kursta da yer alacaktır.
Bununla birlikte kursta çok sayıda görsel uyaran, fotoğraf, video ve uygulama ile
yoğun fakat net bilgi akışı da hedeflenmektedir. Kursun asıl çıkış noktası ise bilgilerin
her geçen gün yeni olarak karşımıza çıkması gerçeğidir ki, bu nedenle kurs “Kanıta
Dayalı Acil Travma Yönetimi” başlığı altında sizlere sunulmaktadır. Kurs esnasında
konularla ilgili aklımıza gelen herhangi bir soru uzman eğitmenlerce güncel uygula-
malarımız çerçevesinde tartışılacak, ek olarak konuya ilişkin kanıtlar online olarak
taranıp güncel, en yeni bilgiye ulaşılacaktır.
Kursun kitapçığının hazırlanmasında çok sayıda öğretim üyesi, uzman ve asistanın

emeği geçti. Son derece yoğun çalışma programlarına rağmen kursun başarılı ola-
bilmesi için destek veren tüm Acil Tıp Uzman ve Asistanlarına teşekkür ederiz. Ek
olarak, verdikleri destek ile kursun ve kitapçığın başarıyla sunulmasına katkıda bulu-
nan Anabilim Dallarına, tüm diğer branşlardaki hocalarımıza, uzman arkadaşlarımıza
da minnettarız. Arşivlerini ve bilgilerini bizlerle paylaştılar, kursa ciddi katkı sağladılar.
Bu kursun gerçekleşmesi için olanaklarını seferber eden Eskişehir Osmangazi Üniver-

sitesi Rektörlüğü ve Tıp Fakültesi Dekanlığına da çok teşekkür ederiz.
Bu kurs her yıl bir kez Eskişehirde, Acil Tıp Anabilim Dalımızda tekrarlanacak, en son
güncel bilgilerle donatılmış, yeni basım kitapçık ve görsel materyallerle sunulacaktır.
Bu kursun gerçekleşmesinin asıl nedeni olan değerli katılımcılara da gösterdikleri ilgi
nedeniyle teşekkür eder, saygılar sunarız.
Prof. Dr. C. James Holliman Doç.Dr. Arif Alper Çevik Öğr.Gör.Dr. Nurdan Ergün Acar
ix
x
2008
Eskişehir Osmangazi Üniversitesi, Tıp Fakültesi

Eskişehir
xi
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Travmalı Hastanın Değerlendirilmesi ve Stabilizasyonu
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Otomo Y, et al. New diagnostic peritoneal lavage criteria for diagnosis of intestinal injury. J Trauma. 1998;44:991-999.
Kemmeter PR, et all. Dilemmas in the diagnosis of blunt enteric trauma. Am Surg. 1998;64:750-754.
Meredith JW, et al. Computed tomography and diagnostic peritoneal lavage. Am Surg. 1992;58:44-58.
Henneman PL, et al. Diagnostic peritoneal lavage: accuracy in predicting necessary laparotomy. J Trauma. 1990;30:1345-1355.
Sozuer EM, et al. Diagnostic peritoneal lavage in blunt abdominal trauma victims. Eur J Emerg Med. 1998;5:231-2
Hodgson NF, et all. Open or closed diagnostic peritoneal lavage for abdominal trauma? A meta-analysis. J Trauma. 2000;48:1091-
1095.
15
002
Öğr.Gör.Dr.Neşe Çolak Oray
01.12.1979 tarihinde Rize’nin Çayeli ilçesinde doğdu. İlk ve orta öğrenimini Trabzon’da tamam-
ladıktan sonra 1995 yılında Karadeniz Teknik Üniversitesi Tıp Fakültesine girdi. 2001 yılında
mezun olduktan sonra 4 ay T.C. Sağlık Bakanlığı Of Sıraağaç Sağlık Ocağı’nda pratisyen hekim
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Fakültesi Acil Tıp Anabilim Dalı’nda araştırma görevlisi olarak çalışmaya başladı. Mart 2006’da
“Sedatif-hipnotik İlaç Alımları:12 Yıllık Analiz” konulu tezimi tamamlayarak uzman oldu. 2006-
2007 yıllarında Uşak Devlet Hastanesi’ne devlet hizmeti yükümlülüğü görevini tamamladı. Ocak
2008 itibariyle Dokuz Eylül Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı’nda öğretim görevlisi
olarak çalışmaktadır.
Travmalı Hastada Havayolu Yönetimi
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mi ise Bursa’da tamamladı. 1993-1999 yılları arasında Akdeniz Üniversitesi’nde Tıp Fakültesi
eğitimimi tamamladıktan sonra 2000 yılında yine Akdeniz Üniversitesi Acil Tıp Anabilim Dalı’nda
ihtisasa başladı. 2004 yılında Acil Tıp Uzmanı olarak tamamladığı AÜTF Acil Tıp Anabilim
Dalı’nda öğretim üyesi olarak görev yapmaktadır.
Travmalı Hastada Şokun Tanımlanması ve Yönetimi
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Anabilim Dalı İSO sorumlusu olup Gazi Hastanesinde İç denetimci olarak görev yapmaktadır.
Toksikoloji ve acil serviste şiddet ilgi alanlarıdır.
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unstable cervical spine in a cadaver model of intubation. Ann Emerg Med 2000;36(4):293-300.
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13.07.1977 yılında Adana’da doğdu. İlkokul, ortaokul ve lise öğrenimimi Adana’da tamamladı.
Tıp eğitimimi 1994–2000 yılları arasında Çukurova Üniversitesi Tıp Fakültesinde sürdürerek
mezun oldu. Eylül 2000’de Dokuz Eylül Üniversitesi Acil Tıp Anabilim Dalında araştırma görevlisi
olarak çalışmaya başladı. Haziran 2004 yılında “Acil Tıp Hekimlerince İstenen Kardiyoloji
Konsültasyonlarının Uygunluğunun Araştırılması” konulu tezini tamamlayarak Acil Tıp Uzmanı
oldu. 1 yıl Dokuz Eylül Üniversitesi Acil Tıp Anabilim Dalında uzman doktor olarak çalıştı. 8 ay
özel bir tıp merkezinde çalıştıktan sonra Ağustos 2005 tarihinde Ege Üniversitesi Acil Tıp
Anabilim Dalı’nda uzman olarak göreve başladı. Halen Ege Üniversitesinde çalışmaktadır.
Üst Ekstremitenin Ortopedik Yaralanmalarının

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Muelleman RL, Wadman MC. İnjuries Hand And Digits. Tintinalli JE, Kelen GD, Stapczynski JS, eds. A Comprehensive Study Guide:
Textbook of Emergency Medicine, 6 th edi. North Carolina: Mc Graw-Hill; 2004;1670-4.
Smith P (ed): Lister's the Hand: Diagnosis and Indications, 4th ed. London, Churchill Livingstone, 2002.
Uehara DT, Robert DW, Escarza H. Wrist injuries. Tintinalli JE, Kelen GD, Stapczynski JS, eds. A Comprehensive Study Guide:
Textbook of Emergency Medicine, 6 th edi. North Carolina: Mc Graw-Hill; 2004;1674-84.
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Ritchie JV, Munter DW: Emergency department evaluation and treatment of wrist injuries. Emerg Med Clin North Am 1999;17:823.
Goldfarb CA, Yuming Y, Gilula LA, et al: Wrist fractures: What the clinician wants to know. Radiology 2001;219:11.
Perron AD, Brady WJ, Keats TE, et al: Orthopedic pitfalls in the ED: Lunate and perilunate injuries. Am J Emerg Med 2001;19:157.
Krasin E, Goldwirth M, Gold A, et al: Review of the current methods in the diagnosis and treatment of scaphoid fractures. Postgrad
Med J 2001;77:23 5.
Bredenkamp H., Uehara DT. Injuries to the elbow and forearm. Tintinalli JE, Kelen GD, Stapczynski JS, eds. A Comprehensive
Study Guide: Textbook of Emergency Medicine, 6 th edi. North Carolina: Mc Graw-Hill; 2004;1684-94.
Cohen MS, Hastings H: Acute elbow dislocation: Evaluation and management. J Am Acad Orthop Surg 1998;6:15.
Villarin LA, Belk KE, Freid R: Emergency department evaluation and treatment of elbow and forearm injuries. Emerg Med Clin
North Am 1999;17:843.
Uehara DT, Rudzinski JP. Injuries to the shoulder complex and humerus. Tintinalli JE, Kelen GD, Stapczynski JS, eds. A
Comprehensive Study Guide: Textbook of Emergency Medicine, 6 th edi. North Carolina: Mc Graw-Hill; 2004;1694-1702.
Holliman CJ. Extremity Trauma. Emergency Trauma Care Course.2003;102-111.
Newton EJ. Acute Complications of Extremity TraumaEmerg Med Clin N Am 25 2007;751–761.
Newton EJ, Love J. Emergency Department Management of Selected Orthopedic Injuries. Emerg Med Clin N Am 25 2007;763–793.
Perron AD, Brady WJ. Evaluation and management of the high-risk orthopedic emergency. Emerg Med Clin N Am 21
2003;159–204.
Carl R. Menckhoff, Cherie Welter, Orthopedic Pearls and Pitfalls. Emerg Med Reports. 2007;28:181-192
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Uzm.Dr. Ersin Aksay
1974 yılında Gaziantep’te doğdu. İlk ve orta öğretimimi Ankara’da tamamladı. Tıp eğitimimi
1992–1999 yılları arasında Ankara Üniversitesi Tıp Fakültesinde aldı. Dokuz Eylül Üniversitesi
Acil Tıp Anabilim Dalında araştırma görevlisi olarak çalışmaya başladı. 2003 yılında “Anstabil
Anjina Pektoris Olgularında Olasılık Sınıflamasının Koroner Anjiografi ile Değerlendirilmesi” konu-
lu tezini tamamlayarak Acil Tıp Uzmanı oldu. Bir yıl Dokuz Eylül Üniversitesi Acil Tıp Anabilim
Dalında çalıştı, son 4 yıldır ise Ege Üniversitesi Acil Tıp Anabilim Dalında acil tıp uzmanı olarak
çalışmakta. 2007 yılında Türkiye Acil Tıp Derneği yönetim kurulu üyeliği yaptı.
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Travma Hastasında Yara Bakımı İpuçları ve

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KAYNAKLAR
Stewart C,. Maxillofacial Trauma: Challenges In ED Diagnosis And Management. Emergency Medicine Practice. 2008;10(2):1-20.
Holliman CJ. Facial Trauma. Emergency Trauma Care Course. 2003;94-101.
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Uzm.Dr. Murat Ersel
04.10.1970 tarihinde İzmir’de doğdu. İlk ve orta öğrenimini İzmir’de tamamladıktan sonra 1988
yılında Ege Üniversitesi Tıp Fakültesi’ne girdi ve 1995 yılında mezun oldu. Mezuniyet sonrası
1996-1999 yılları arasında Kayseri ve İzmir’de pratisyen hekim olarak çalıştı. Bu arada Ege
Üniversitesi Sağlık Bilimleri Enstitüsü Halk Sağlığı Ana Bilim Dalında Doktora Eğitimine başladı.
Mart 2003’de Halk Sağlığı Doktoru (Ph. D) unvanını kazandı. 1999 Ocak ayında Dokuz Eylül
Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı’nda araştırma görevlisi olarak çalışmaya başladı.
Mart 2002 tarihinde “Dokuz Eylül Üniversitesi Acil Servisinin Kullanım Özellikleri ve Hasta
Aciliyetinin Hekim ve Hasta Açısından Değerlendirilmesi” konulu tezini tamamlayarak uzman
oldu. Mart 2002 – Ekim 2004 tarihleri arasında İzmir Atatürk Eğitim ve Araştırma Hastanesi Acil
Servisinde Acil Tıp Uzmanı olarak görev yaptı. Ekim 2004 – Mayıs 2005 tarihleri arasında Kocaeli
Üniversitesi Acil Tıp Anabilim Dalında Yardımcı Doçent olarak görev yaptı. Haziran 2005 tari-
hinde Ege Üniversitesi Acil Tıp Anabilim Dalında Uzman Doktor olarak göreve başladı. Halen bu
görevde çalışıyor. Türkiye Acil Tıp Derneği’nde 2004-2005 ve 2005-2007 tarihleri arasında iki
dönem Yönetim Kurulu Üyesi ve Afet Komisyonu Başkanı olarak görev yaptı. İyi derecede
İngilizce ve çok iyi derecede Almanca biliyor. Evli ve bir çocuk babası.
Künt ve Penetran Boyun Yaralanmalarının

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KAYNAKLAR
Baron BJ. Penetrating and Blunt Neck Trauma: In Tintinalli JE, Emergency medicine a comprehensive study guide, 6th edition, Mc
Graw Hill, 2004;1590-1595.
Newton K. Neck: In rosen’s emergency medicine concepts and clinical practice, 6th edition, Mosby Elsevier, 2006;441-451.
Airway and Ventilatory Management. Advanced Trauma Life Support, Program for doctors, ATLS. 7th edition. Chicago: American
College of Surgeons. 2004;42-43.
Eggen JT, Jorden RC. Airway management, penetrating neck trauma. J Emerg Med 1993;11(4):381-385.
Rathlev NK, Medzon R, Bracken ME. Evaluation and Management of Neck Trauma. Emerg Med Clin N Am. 2007;25:679–694.
Levy DB, Gruber BS. Neck Trauma. Url at: http://www.emedicine.com/emerg/ topic331.htm. Last updated 10 July 2008.
Schaider J, Bailitz J. Neck Trauma: Don’t Put Your Neck On The Line. Emergency Medicine Practice. An Evidence-Based Approach
To Emergency Medicine. 2003;7:1-28.
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023
Ankara’a 1973 yılında doğdu. Atatürk Üniversitesi Tıp Fakültesini 1996 yılında bitirdikten sonra
Nevşehir’in Gülşehir İlçesi Merkez Sağlık Ocağı’nda pratisyen hekimlik yaptı. Atatürk Üniversitesi
Tıp Fakültesi Acil Tıp Anabilim Dalı’nda uzmanlık eğitimi aldıktan sonra 2003 yılında GATA’da
askerlik görevini yaptı. Mayıs 2005’de Kocaeli Tıp Fakültesi Acil Tıp Anabilim Dalı’nda Öğretim
Üyesi olarak göreve başladı ve halen bu görevi sürdürmektedir.
Mesleki ve bilimsel kuruluşlardan Türkiye Acil Tıp Derneği ve Türk Tabipleri Birliği Kocaeli Tabip
Odası üyesidir. Halen evli, 9 ve 4 yaşında 2 çocuk babasıdır.
Ateşli Silah Yaralanmalarının Tanımlanması ve

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KAYNAKLAR
Holleran JJ, Fackler ML. Wound Ballistics. In: Tintinalli JE, ed. Emergency Medicine: A Comprehensive Study Guide. McGraw Hill,
2004; 1633-1638
Volgas DA, Stannard JP, Alonso JE. Ballistics: a primer for the surgeon. Injury, Int. J. Care Injured 2005; 36: 373-379
Özcebe H. Türkiye’de Ateşli Silah Yaralanma Ve Ölümleri Ne Boyutta ?. VIII. Ulusal Halk Sağlığı Kongresi, Kongre Kitapçığı
Uzar Aİ, Güleç B, Kayahan C et al. Yara Balistiği-I: Kalıcı ve Geçici Yara Boşluğu (kavite) Etkileri. Turkish J Trauma & Emerg Surg.
1998; 4:225-229
Uzar Aİ, Kayahan C, Güleç B et al. Yara Balistiği-II "Yara balistiği (II) Mermideki şekil bozuklukları ve parçalanma etkileri"Turkish J
Trauma & Emerg Surg. 1998; 4: 235-239
Fackler ML. Cıvılıan gunshot wounds and ballıstıcs: dıspellıng the myths. Emerg Med Clin NA 1998; 16: 17-28.
Bartlett CS. Clinical Update: Gunshot Wound Ballistics. Clin Orthop 2003;408:28–57
Koç S. Atipik Ateşli Silah Yaralanmaları. BALİSTİK. II:Adli Bilimler Sempozyumu 1997; 28-35
Şam B. Ateşli Silah Yaraları. Adli Otopsi Atlası 2003; 76-102.
Jack CF Chong. Gunshot Wounds - ED Management. http://elc.skh.org.tw/elc/er119/sked/95lecture/1002.pdf Erişim tari-

hi:18/09/2008
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KAYNAKLAR
American College of Surgeons. Advanced trauma life support instructor manual. Chicago, IL. 1997;389-416.
Moylan JA. Trauma injuries: triage and stabilization for transfer. Postgrad Med. 1985;78:166-167.
American College of Emergency Physicians. Guidelines for trauma care systems. Ann Emerg Med. 1987;16:459-463.
American College of Surgeons. Resources for optimal care of the injured patient. Chicago, IL. 1993;133.
Runge JW. The cos of injury. Emerg Med Clin NA. 1993;11:241-253.
Hargarten SW, Karlson T. Injury control. a crucial aspect of emergency medicine. Emerg Med Clin NA. 1993;11:255-62.
294
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026
1970 yılında Mersin'de doğdu. İlk ve orta öğrenimimi Mersin’de tamamladıktan sonra 1988 yılın-
da Dokuz Eylül Üniversitesi Tıp Fakültesi’ne girdi. Dokuz Eylül Üniversitesi Tıp Fakültesi’nden
1994 yılında üçüncülükle mezun oldu. Aynı yıl Dokuz Eylül Üniversitesi Tıp Fakültesi Acil Tıp
Anabilim Dalı’nda Araştırma Görevlisi olarak göreve başladı. Mart 1999'da "Acil servise senkop
atağı ile gelen hastalara yaklaşımın değerlendirilmesi" konulu uzmanlık tezi ile Acil Tıp Uzmanı
oldu. Yaklaşık 6 yıl DEÜTF Acil Tıp AD’da uzman kadrosunda çalıştıktan sonra 2006 yılı nisan
ayında Mersin Üniversitesi Tıp Fakültesi Acil Tıp AD’na yardımcı doçent olarak atandı. 2007 yılı
aralık ayında yapılan doçentlik sınavında başarılı olarak doçent unvanı almaya hak kazandı. Bu
süre içinde pek çok kongre, sempozyum ve kurslarda görev aldı. 2006 yılında Mersin Tıp
Fakültesi Acil Tıp AD Başkanlığı kadrosuna atandı. Acil Tıp Uzmanları derneği yönetim kurulunda
ve Akademik acil tıp dergisi ve Toksikoloji dergisi yayın kurulunda görevler yaptı. Üniversitemiz
bünyesinde ambulans ve acil bakım teknikerliği program koordinatörü, İlk Yardım Uygulama ve
Araştırma Merkezi Yönetim Kurulu Üyesi olarak çeşitli akademik ve idari görevleri üstlendi.
Uluslararası ve ulusal pek çok bilimsel çalışma ve bildiride katkıları oldu.
Travma Radyografilerinin Değerlendirilmesi
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361
KAYNAKLAR
032
Emergency Ultrasound Guidelines. ACEP Policy Statement approved by the ACEP Board of Directors 2001.
MA OJ, Mateer JR. Trauma. In: MA OJ, Mateer JR, editors. Emergency Ultrasound.1st ed. New York: McGrawHill;2003. p. 67-88.
362
032
Sorular / Yanıtlar
363
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Ultrasonografi Eşliğinde Vasküler Girişimler
364
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369
KAYNAKLAR
033
Emergency Ultrasound Guidelines. ACEP Policy Statement approved by the ACEP Board of Directors 2001.
MA OJ, Mateer JR. Trauma. In: MA OJ, Mateer JR, editors. Emergency Ultrasound.1st ed. New York: McGrawHill;2003. p. 349-361.
370
033
Sorular / Yanıtlar
371
034
Ultrasonografi İle Yabancı Cisim Araştırılması
372
034
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KAYNAKLAR
Jones R, Blaivas M. The Handbook of Ultrasound in Trauma and Critical İllness. Ohio Chapter of the American Collage of
Emergency Physicians 2003;241-247.
Shiels WE, Soft Tissue Foreign Bodies Sonographic Diagnosis and Therapeutic Management. Ultrasound Clin 2007;2: 669-681.
Dean AJ, Gronczewski CA, Costantino TG. Technique For Emergency Medicine Bedside Ultrasound Identification Of A Radiolucent
Foreign Body The Journal of Emergency Medicine, 2003;24(3):303–308.
Soudack M, Nachtigal A, Gaitini D. Clinically Unsuspected Foreign Bodies The Importance of Sonography. J Ultrasound Med,
2003;22:1381–1385,
Boyse TD, Fessel DP, Jacobson JA, Lin JA, Van Holsbeeck MT, Hayes CW. US of Soft-Tissue Foreign Bodies and Associated
Complications with Surgical Correlation. RadioGraphics, 2001; 21:1251–1256
Levy AD, Harcke T. Handheld Ultrasound Device for Detection of Non-Opaque and Semi-Opaque Foreign Bodies in Soft Tissues Clin
Ultrasound, 2003;31:183–188.
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035
10.04.1973 Antalyada doğdu. İlk-orta-lise öğrenimini Antalya’da tamamladıktan sonra 1997

yılında Akdeniz Üniversitesi Tıp Fakültesi’nden mezun oldu. 16.06.1998 tarihinde Akdeniz
Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı’nda Araştırma Görevlisi olarak göreve başladı ve
18.03.2002 yılında Acil Tıp Anabilim Dalı’ndan Acil Tıp Uzmanlığını aldı. 2006 yılında Girne Asker
Hastanesi-Kıbrıs’da Acil Servis sorumlusu olarak askerlik görevini tamamladı. Halen Akdeniz
Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı’nda Yardımcı Doçent olarak görev yapmaktadır.
Evli ve iki çocuğu var.
Ultrasonografi İle kemik Değerlendirilmesi
378
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KAYNAKLAR
Griffith JF, Rainer TH, Ching ASC, et al.: Sonography compared with radiography in revealing acute rib fracture. AJR 173:1603-
1609, 1999.
Marshburn T, Legome E, Sargsyan A, et al.: Goal-directed ultrasound in the detection of long-bone fractures. J Trauma 57:329-
332, 2004.
Thiede O, Kromer JH, Rudack C, et al.: Comparison of ultrasonography and conventional radiography in the diagnosis of nasal
fractures. Arch Otolaryngol Head Neck Surg 131:434-439, 2005.
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Son
384
2008
Eskişehir Osmangazi Üniversitesi, Tıp Fakültesi

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Eskişehir Osmangazi Üniversitesi Yayınları No: 000

Bu kitabın basım, yayım ve satış hakları Eskişehir Osmangazi Üniversitesi’ne aittir.

Kitabın tümü ya da bölümü/bölümleri Eskişehir Osmangazi Üniversitesi’nin yazılı izni

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Kapak Düzeni: Arif Alper Çevik

Tasarım: Cemalettin Yıldız

Dizgi: Arif Alper Çevik, Cemalettin Yıldız

ESKİŞEHİR OSMANGAZİ ÜNİVERSİTESİ MATBAASI, ESKİŞEHİR, 2008

Kanıta Dayalı Acil Travma Yönetimi Kursu

Doç.Dr. Arif Alper Çevik

Öğr.Gör.Dr. Nurdan Ergün

Prof.Dr. C. James Holliman

Kanıta Dayalı Acil Tıp Danışmanı

Yrd.Doç.Dr. Cenker Eken

Görsel Tanı Danışmanları

Doç.Dr. Yıldıray Çete

Yrd.Doç.Dr. İsa Kılıçaslan

Eskişehir Osmangazi Üniversitesi

2 Travmalı hastada havayolu yönetimi

3 Şok’un tanımlanması ve yönetimi

4 Travmalı hastada IV sıvılar ve yollar

5 Toraks travmasının tanımlanması ve yönetimi

6 Abdominal travmanın tanımlanması ve yönetimi

7 Pelvik travmanın tanımlanması ve yönetimi

8 Genitoürner travmanın tanımlanması ve yönetimi

9 Kafa travmasının tanımlanması ve yönetimi

10 Servikal travmanın tanımlanması ve yönetimi

11 Ektremite travması hakkında bilinmesi gereken temel noktalar

12 Üst ekstremitenin ortopedik yaralanmalarının tanımlanması ve yönetimi

13 Alt ekstremitenin ortopedik yaralanmalarının tanımlanması ve yönetimi

14 Yanık yaralanmalarının tanımlanması ve yönetimi

15 Elektrik ve Yıldırım yaralanmalarının tanımlanması ve yönetimi

16 Pediatrik travma hastasının yönetimi

18 Geriatrik travma hastasının yönetimi

20 Travma hastasında yara bakımı ipuçları ve tetanoz profilaksisi

21 Maksillofasiyal travmaların tanımlanması ve yönetimi

22 Künt ve penetran boyun travmalarının tanımlanması ve yönetimi

23 Ateşli silah yaralanmalarının tanımlanması ve yönetimi

24 Travma resusitasyonunda personelin özel görevleri

25 Travma hastalarının hastaneler arası transferi

26 Travma radyografilerinin değerlendirilmesi

27 Travmalı hastada beyin tomografisi yorumlanması

28 Travmalı hastada toraks BT değerlendirilmesi

29 Travmalı hastada abdominal BT değerlendirilmesi

30 Acil Ultrasonografiye Giriş - Temel US ve Ekipman Bilgisi

31 Ultrasonografi eşliğinde havayolu stabilizasyonu

34 Ultrasonografi ile yabancı cisim araştırılması

35 Ultrasonografi ile kemik değerlendirilmesi

Gazi Üniversitesi Tıp Fakültesi, Acil Tıp Anabilim Dalı, Ankara

Doç.Dr. Arif Alper Çevik

Eskişehir Osmangazi Üniversitesi, Acil Tıp Anabilim Dalı, Eskişehir

Uzm.Dr. Aslıhan Yürüktümen

Ege Üniversitesi Tıp Fakültesi, Acil Tıp Anabilim Dalı, İzmir

Yrd.Doç.Dr. Ayfer Keleş

Gazi Üniversitesi Tıp Fakültesi, Acil Tıp Anabilim Dalı, Ankara

Prof.Dr. C. James Holliman

Program Manager, Afghanistan Healthcare Sector

Yrd.Doç.Dr. Cenker Eken

Akdeniz Üniversitesi Tıp Fakültesi, Acil Tıp Anabilim Dalı, Antalya

Doç.Dr. Cüneyt Ayrık

Mersin Üniversitesi Tıp Fakültesi, Acil Tıp Anabilim Dalı, Mersin

Eskişehir Devlet Hastanesi, Acil Servisi, Acil Servis Direktörü

Akdeniz Üniversitesi, Acil Tıp Anabilim Dalı, Antalya