Child Traumas

Çocuk Travmalarında İlk Müdahale
Initial Approach in Child Traumas
Damla HANALİOĞLUa , Can Demir KARACANa
aAnkara Bilkent Şehir Hastanesi, Çocuk Acil Kliniği, Ankara, Türkiye
Hanalioğlu D, Karacan CD. Çocuk travmalarında ilk müdahale. Şenel E, editör. Çocuk Travmaları. 1. Baskı. Ankara: Türkiye Klinikleri; 2024. p.18-25.
Article Language: TR
ÖZET
Travma çocukluk çağında ölüm ve kalıcı sakatlıkların önde gelen nedenidir. Travmaya bağlı mortalitenin en sık nedenleri başarısız havayolu yönetimi ve yetersiz sıvı resüsitasyonudur. Bu nedenle çocuk travma hastalarıyla ilgilenen tüm hekimlerin travma yönetimi konusunda tam donanımlı olması hayati öneme sahiptir. Çocuklarda travma yönetiminde Travmada İleri Yaşam Desteği (Advanced Trauma Life Support, ATLS) kılavuzu çerçevesinde havayolu, solunum, dolaşım ve kanama kontrolü yaparak hasta stabilizasyonuna öncelik verilir. Travma yönetimi çocukların kendilerine has çeşitli anatomik ve fizyolojik farklılıkları göz önünde bulundurularak yapılmalı, uygulanacak tedavi ve müdahalelerde yaş ve vücut ağırlığı dikkate alınmalıdır. İleri havayolu için endotrakeal entübasyon tercih edilir. Cerrahi havayolu gerektiğinde 12 yaşından küçüklerde trakeostomi açılana dek iğne kritotiroidotomi uygulanması önerilir. Taşikardik ve perfüzyonu bozulmuş bir hastada şok mutlaka akla gelmeli ve ivedilikle sıvı resüsitasyonuna başlanmalıdır. İki kez 20 ml/kg'dan kristaloid yüklemesine rağmen şok bulguları devam eden hastalara eritrosit süspansiyonu, masif transfüzyon ihtiyacı halinde 1:1:1 oranında dengeli kan ürünü takviyesi yapılmalıdır.

Anahtar Kelimeler: İleri travma yaşamı desteği; pediatrik acil tıp; canlandırma
ABSTRACT
Trauma is the leading cause of death and disability in childhood, often due to inadequate airway management and insufficient fluid resuscitation. Therefore, healthcare professionals dealing with pediatric trauma must be fully equipped in trauma management. Priorities in managing pediatric trauma include stabilizing the airway, breathing, circulation, and hemorrhage control following Advanced Trauma Life Support (ATLS) guidelines. Treatment should consider the anatomical and physiological differences in children, including age and body weight. Endotracheal intubation is preferred advanced airway management technique, with needle cricothyroidotomy recommended for surgical tracheostomy is performed in children under 12 years old. Shock should always be considered in a tachycardic and hypoperfused patient, and fluid resuscitation should be initiated promptly. Patients showing ongoing signs of shock despite two 20 ml/kg crystalloid boluses should receive erythrocyte suspension, and in case of massive transfusion requirement, balanced blood product replacement should be given in a 1:1:1 ratio.

Keywords: Advanced trauma life support care; pediatric emergency medicine; resuscitation

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