Ulus Travma Acil Cerrahi Derg. 2017; 23(6): 459-465 | DOI: 10.5505/tjtes.2017.71670

Savaþ alanýnda hayat kurtarýcý prosedürlere yeni bir bakýþ: Gece görüþ gözlükleri ile acil krikotroidotomi, iðne torakostomi ve göðüs tüp torakostomi

Sedat Bilge¹, Attila Aydýn¹, Meltem Bilge³, Cemile Aydýn⁴, Erdem Çevik², Mehmet Eryýlmaz^1
1Gülhane Eðitim ve Araþtýrma Hastanesi, Acil Týp Kliniði, Ankara
²Sultan Abdülhamit Eðitim ve Araþtýrma Hastanesi, Acil Týp Kliniði, Ýstanbul
³Dýþkapý Eðitim ve Araþtýrma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniði, Ankara
⁴Ankara Etimesgut Devlet Hastanesi, Ýç Hastalýklarý Kliniði, Ankara

AMAÇ: Aðýr ve çoklu travma hastalarýnda, hayat kurtarýcý prosedürlerin erken uygulanmasý artmýþ sað kalým ile iliþkilidir. Gece yapýlan savaþ senaryosunda bu hayat kurtarýcý giriþimlerin gece görüþ gözlüðü (GGG) yardýmýyla uygulanabilirliðini deneysel olarak saptamaya çalýþtýk.
GEREÇ VE YÖNTEM: Göðüs tüp torakostomi (GTT), acil krikotroidotomi (AK) ve iðne torakostomi (IT) giriþimleri 10 adet askeri saðlýk personeli tarafýndan gerçekleþtirildi. Çalýþmada giriþimlerin baþarý ve süreleri incelendi. Prosedürler, hazýrlanan maket/model üzerinde gündüz aydýnlýk odada ve GGG yardýmý ile karanlýk odada yaptýrýldý. Operatörler giriþimlerin kolaylýðýný derecelendirdi.
BULGULAR: Tüm giriþimler baþarýlý bulundu. Operatörler, gece yapýlan GTT ve AK giriþimlerini gündüz saatlerinde yapýlan giriþimlere göre zor buldu (p<0.05). Ýðne torakostomi gruplarý arasýnda zorluk açýsýndan anlamlý fark yoktu. Giriþimlerin tamamlanma süreleri açýsýndan karþýlaþtýrýldýðýnda, gündüz ve gece senaryolarý arasýnda fark yoktu.
TARTIÞMA: Gece görüþ gözlüðü kullanan operatörler, taktik ve medikal aktivitelerini yaparken gece görüþ gözlüklerini çýkarmalarýna ve ekstra ýþýk kaynaðý kullanmalarýna gerek olmadýðý konusunda uyanýk olmalýdýrlar.

Anahtar Kelimeler: Acil krikotroidotomi, gece görüþ gözlükleri, iðne torakostomi, karanlýk, savaþ alaný, tüp torakostomi.

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A new perspective on life-saving procedures in a battlefield setting: Emergency cricothyroidotomy, needle thoracostomy, and chest tube thoracostomy with night vision goggles

Sedat Bilge¹, Attila Aydýn¹, Meltem Bilge³, Cemile Aydýn⁴, Erdem Çevik², Mehmet Eryýlmaz^1
1Department of Emergency Medicine, Gülhane Training and Research Hospital, Ankara-Turkey
²Department of Emergency Medicine, Sultan Abdülhamit Training and Research Hospital, Ýstanbul-Turkey
³Department of Anesthesiology and Reanimation, Dýþkapý Training and Research Hospital, Ankara-Turkey
⁴Department of Internal Medicine, Ankara Etimesgut State Hospital, Ankara-Turkey

BACKGROUND: In the patients with multiple and serious trauma, early applications of life-saving procedures are related to improved survival. We tried to experimentally determine the feasibility of life-saving interventions that are performed with the aid of night vision goggles (NVG) in nighttime combat scenario.
METHODS: Chest tube thoracostomy (CTT), emergency cricothyroidotomy (EC), and needle thoracostomy (NT) interventions were performed by 10 combatant medical staff. The success and duration of interventions were explored in the study. Procedures were performed on the formerly prepared manikins/models in a bright room and in a dark room with the aid of NVG. Operators graded the ease of interventions.
RESULTS: All interventions were found successful. Operators stated that both CTT and EC interventions were more difficult in dark than in daytime (p<0.05). No significant difference was observed in the difficulty in the NT interventions. No significant difference was observed in terms of completion times of interventions between in daytime and in dark scenario.
CONCLUSION: The operators who use NVGs have to be aware of that they can perform their tactic and medical activities without taking off the NVGs and without the requirement of an extra light source.

Keywords: Battlefield, darkness nighttime, emergency cricothyroidotomy, needle thoracostomy, night vision goggles, tube thoracostomy.

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