H A Z R L A Y A N : A R . G R V. D R .

AY C A Z E L
MO D E R AT R : D O . D R . A Y F E R K E L E
SUNUM PLANI
1. TANIM
2. PATOFZYOLOJ
3. LABORATUAR
4. BOULMA ALGORTM
5. TEDAVDE NEML NOKTALAR
6. PROGNOZ
7. EK BLGLER

KAYNAKLAR
1. TNTNELL ANA KTAP 7. BASKI
2. TNTNELL EL KTABI 6. BASKI
3. ACLS 2010CIRCULATION
4. WWW(EMEDCNE, PUBMED, http://www.buyutec.net/p-havuzda-
bogulma-40365.html)
TANM

Boulma genel olarak btn su altnda kalma ie oluan yaralanmalar..

BOULMA: 24 saat altnda lmle sonulanan
boulma

BOULAYAZMA:24 saatten fazla yaamsa hasta
boulayazma
3 YA GRUBUNDA PIK YAPAR:
1. Yeni yrmeye balayan ve kk ocuk(tuvalet, kova iinde ve banyo
kvetinde de)
2. Adolesan ve gen erikinlerde
3. Yallarda (banyo kvetinde)



Sahil kenarnda bile boulmalarn ou lk taze sularda olur.(zellikle
yzme havuzlarnda!)
BOULMAYLA ILIKILI DURUMLAR
S suya dallar ve tekne kazalarnda spinal kord yaralanmalar
Hipotermi
Panikleme
Senkop (rn: su alt dallarda hiper ventilasyona bal)
Epileptik atak
Dier premorbid durumlar (disritmiler, kalp hastalklar )
PATOFIZYOLOJI
Prognozu pulmoner ve SSS tutulumunun derecesi belirler.
Dalma reflexi: 6 aydan kk infantlarda en kuvvetlidir, ya ilerledike
etkisi azalr.
Souk su beyin korunmas kardiak disritmi gelimeden SSS nin
hzl soutulmas
Kuru Boulma : (%10-20) laringospazm hipoksi bilin kayb
Ya B oulma : suyun akcierlere aspirasyonu ile olur.
srfaktan dile olur azalralveol gaz transferi azalr
atelektaziventilasyon perfzyon oran bozulur!
Orta iddetli aspirasyon sonras Nonkardiyojenik Pulmoner dem geliir.

Ilk suda dalmada bile hipotermi riski mevcut!!
PATOFIZYOLOJI
Taze su aspirasyonu:
geici hemodilsyonbyk oranda su aspirasyonubelirgin hemoliz+
hiponatremi
Tuzlu su boulmas:
Hemokonsantrasyon+hipernatremi+hiperkalemi

Kontamine yabanc materyal ( partikll madde, bakteri, kusmuk, kimyasal
irritan)
PULMONER YLEMEY ETKLER!
HPOKSEM+ METABOLK ASDOZ END ORGAN HASARI
Hipoksik yaralanma+hemoglobinri+ miyoglobinri ( belirgin renal hasar
yapar) yoksa elektrolit anormallikleri geicidir.
Masif hemolizi yoksa hematolojik deerler normal.
Nadiren DC geliir..
LAB BULGULAR
Metabolik asidoz
Elektrolit anormallikleri (renal tutulumlarda )
Masif hemoliz (taze suyun ok byk hacimde aspire edilmesiyle )
DC geliimi nadir.

GEREKL TANI TESTLER: PAAC GRAFS (generalize pulmoner dem/
perihiler infiltrat/ normal)
ARTER KAN GAZI (o2 sat ve metabolik asidoz)
Boulma ALGORTM
HASTANE NCES BAKIMHIZLI DKKATL KURTARMA,SERVKAL VERTEBRA
KORUNMASI, ENDKEYSE CPR A BALA, TRANSPORT( TM HASTALAR),
OKSJEN VER(TM HASTALAR)
ACL SERVS BAKIMI ABC, GKS NI BELRLE, LGL DURUMLARI TEDAV
ET!(HPOVOLEM, HPOTERM, EPLEPS, AMI VS.)

GKS > 13 + O2 SAT > %95 GKS <13 YA DA
O2 SAT<%95
SERVKAL VERTEBRALARI NETLETR!
O2 SAT U MONTERZE ET!
LAB TESTLER(GENELDE ENDKE DEL)

4-6 SAAT GZLEMLE

O2 SAT NORMAL O2 SAT<%95
+AC MUAYENES DOAL AC MUAYENES ANORMAL

TABURCU GKS<13 GB DAVRAN
GKS < 13 / O2 SAT <%95
SERVKAL VERTEBRAYI NETLETR
OKSJEN DESTE( ETE+ CPAP/PEEP , POZTF BASINLI
VENTLASYON)
OCUKTA pa O2 80 MMHG ALTI VE ERKNDE pa O2 60 MMHG ALTI SE
(YKSEK AKIMLI O2 E RAMEN)
LABORATUAR (PAAC GRAFS, CBC, ELEKTROLTLER, GLUKOZ, CK,
TROPONN I,PT/PTT, TT, DRARDA MYOGLOBN VE DRARDA MADDE
PANEL)
MONTARZASYON ( p H , ATE, DRAR IKII, CVP)
YOUN BAKIM NTESNE TRANSPORT
TEDAVDE
BAKTERYEL PNMON GELME RSK OK AZ PROFLAKTK
ANTBOTK ENDKE DEL
BEYN RESSTASYONU ABALARININ (MANNTOL, LOOP DRETK,
HPERTONK SALN, SIVI KISITLAMASI, MEKANK
HPERVENTLASYON, KONTROLL HPOTERM, BARBTRAT
KOMASI,KB MONTARZASYONU) ETKNL HENZ
KANITLANMAMI..
TAZE SU LE BOULMALARDA PEDATRK HASTALARIN OK AZINDA
DLSYONEL HPONATREM VE EPLEPTK ATAK GRLR, EPLEPS
ELEKTROLT NORMALZASYONU LE KOLAYCA KONTROL ALTINA
ALINIR.
PROGNOZ
ILIK SU BOULMALARINDA
ASSTOL SONRASI CPR YAPILAN
OCUK HASTA

= KT PROGNOZ
(HPOKSK SKEMK ENSEFALOPAT)
SAHADA UZAMI CPR
ACL SERVSTE CPR
ILIK SU BOULMALARINDA ACLDE/SAHADA ASSTOL
EK BLGLER
OK SOUK SUYUN ALTINDA KISA SREL SUYUN ALTINDA KALMA
VE KISA SREL TRANSPORTTA ASSTOL SONRASI TAM TAMA YAKIN
NROLOJK YLEME BLDRLM.
ABC!!! ( MMKNSE SERVKAL VERTEBRA KORUNMASI VE
KURTARICI SOLUK SUYUN NDE..)
SU ASPRE EDEN HASTADA ABDOMNAL THRUST YA DA
HEIMLICH GB MANEVRALAR GEREKSZ VE TEHLKELDR( KLAS
III, KANIT DZEY C)
OTOMATK EKSTERNAL DEFBRLATR PADLERN UYGULARKEN
GS KURULA!!
AVUSTURALYADAK 10 YILLIK ALIMA GSTERMTR K
KURTARILANLARIN 2/3 , CPR YAPILANLARIN %86 SI
KUSMUTUR.KUSAN HASTAYI YANA EVR, KUSMUU TEMZLE,
SERVKAL VERTEBRAYI KORU!!
OCUKKEN BOULAYAZMI HASTALARDA
SALIKLA LKL HAYAT KALTES(HRQOL)
Abstract
AIM OF THE STUDY:
To describe health-related quality of life (HRQoL), quality-adjusted life years (QALYs)
gained and school performance in subjects having received either bystander or
emergency medical service personnel initiated cardiopulmonary resuscitation
(CPR) after a drowning incident in childhood.
MATERIALS AND METHODS:
64 children admitted to pediatric intensive care (PICU) after successful CPR between
1985 and 2007. Eleven died in the PICU, 9 other within 6 months. In 2009 all long-
term survivors, except for two, lived at home. Of the 40 patients eligible for the
study, 29 (73%) responded to a questionnaire. HRQoL was assessed with the
generic 15D, or its versions for adolescents (16D) or children (17D), and compared
to that of general population. These HRQoL scores, age-specific survival
probabilities, and HRQoL scores of the general population were used in a Markov
model to estimate the number of QALYs gained.
RESULTS:
Median age of the respondents was 17.3 (range: 3.0-28.4) years and 62% were male. At
the time of drowning their median age had been 3.0 (range: 1.2-15.7) years. The
drowning incident was associated with a significant loss in HRQoL in the oldest
age group (total HRQoL total score 0.881 compared to 0.971 in the general
population, P<0.01) but not in children (HRQoL score 0.944 vs. 0.938). When
submersion time exceeded 10min mean HRQoL score was significantly lower than
in patients with a shorter submersion (0.844 vs. 0.938, P=0.032). The mean
undiscounted and discounted (at 3%) number of QALYs gained by treatment were
40.8 and 17.0, respectively.
CONCLUSIONS:
A good HRQoL will be achieved in the majority of patients surviving long-term after a
drowning incident in childhood, although HRQoL is affected by the submersion
time.