Hastane dışı kardiyopulmoner arrest gelişen hastalarda temel ve ileri yaşam destek uygulamaları: 27 aylık analiz

Behçet AL, Suat ZENGİN, Sinem KABUL, Remzi GÜZEL, Emine SARCAN, Cuma YILDIRIM
595 202

Öz


Bu çalışmada acil servisimize 112 acil servis aracılığı ile getirilen hastane dışı kardiyopulmoner arrest hastalarda temel ve ileri yaşam destek müdahalelerinin değerlendirilmesi amaçlanmıştır. 30 Ocak 2009 ve 15 Mart 2011 tarihleri arasında Gaziantep Üniversitesi Tıp Fakültesi Hastanesi Acil Tıp Anabilim Dalına 112 Acil Servis ekibi tarafından kardiyopulmoner arrest olarak getirilen 61 hasta çalışmaya dâhil edildi. Hastaların cinsiyeti, yaşı, tanısı; doktor eşliğinde olup olmadığı, endotrakeal entübasyon ve kardiyopulmoner resusitasyon gibi temel ve ileri yaşam desteğinin yapılıp yapılmadığı değerlendirildi ve sonuçlar prospektif olarak kayıt edildi. Hastaların %60.7'si (n=37) erkek, %39.3'ü (n=24) kadın idi ve ortalama yaşları 65.5 (yaş aralığı 18–90) idi. En fazla hasta grubu (n=23) koroner arter haslığı olanlar oluşturuyordu. Hastaların %34.4'ü doktor eşliğinde, %65.6'sı paramedik eşliğinde acil servise getirildi. Temel yaşam desteği olarak sadece hastaların damar yolu açılmış ve oksijen verilmişti. Kardiyopulmoner arrest olup endotrakeal entübasyon yapılmadan getirilen hastaların oranı %86.9 idi (n=53). Tamamı paramedikler tarafından olmak üzere sadece 8 (%13.1) hastaya endotrakeal entübasyon yapılmıştı (p=0.028). Hiçbir hastaya kardiyopulmoner resusitasyon ve defibrilasyon uygulanmamıştı. Acil servise girişte hiçbir hastada nabız, tansiyon, kardiyak tepe atımı alınamamıştır. Acil serviste tüm hastalara kardiyopulmoner resusitasyon yapılmış; sadece birisinden olumlu cevap alınmış; o da yoğun bakımda 20 gün takipten sonra kayıp edilmiştir. 112 Acil Servis hizmetlerinde çalışan sağlık ekipleri temel ve ileri yaşam desteği sağlamada yeterli deneyime ve bilgi birikimine sahip değillerdir. Paramedikler hastane dışında kardiyopulmoner arrest olmuş hastaya endotrakeal entübasyon yapma konusunda doktorlara göre istatistiksel olarak daha başarılı bulunmuştur.

Anahtar kelimeler


Doktor; endotrakeal entübasyon; hastane dışı kardiyopulmoner arrest; paramedik; temel ve ileri yaşam desteği.

Tam metin:

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