Toraks travmalar\u0131n\u0131n mekanizmas\u0131 geni\u015f iki ba\u015fl\u0131k alt\u0131nda toplanabilmektedir: K\u00fcnt ve penetran travmalar. K\u00fcnt travmalar\u0131n en \u00f6nemli sebebi a\u00e7\u0131k arayla motorlu ara\u00e7 kazalar\u0131yken penetran kazalarda bu, kur\u015fun ve b\u0131\u00e7ak yaralar\u0131 kaynakl\u0131d\u0131r. Bu yaralanmalar kalp, ana damarlar, trakeobron\u015fial a\u011fa\u00e7 ve g\u00f6\u011f\u00fcs kafesini i\u00e7erebilir. G\u00f6\u011f\u00fcs kafesi yaralanmalar\u0131 genellikle kaburga k\u0131r\u0131klar\u0131, kaza yaralanmalar\u0131, b\u0131\u00e7ak ve kur\u015fun gibi a\u00e7\u0131k g\u00f6\u011f\u00fcs yaralar\u0131 olabilmektedir. En \u00f6nemli toraks yaralanmalar\u0131 aort y\u0131rt\u0131lmas\u0131, kardiyak kont\u00fczyon, kalp tamponad\u0131, yelken g\u00f6\u011f\u00fcs, hemotoraks, pn\u00f6motoraks ve pulmoner kont\u00fczyondur.<\/p>\n\n\n\n
Toraks travmas\u0131na ba\u011fl\u0131 durumlarda en \u00f6nemli morbidite ve mortalite sebebi olu\u015fan hasar\u0131n respirasyon, dola\u015f\u0131m ya da her ikisini birden etkilemesiyle ortaya \u00e7\u0131kar. G\u00f6\u011f\u00fcs duvar\u0131 yaralanmalar\u0131nda genelde hasta i\u00e7in nefes almak zorla\u015f\u0131r, bu y\u00fczden hastalar da nefes al\u0131m\u0131n\u0131 k\u0131s\u0131tlar. Bu durumun s\u0131k g\u00f6r\u00fclen bir komplikasyonuysa atelektazidir.<\/p>\n\n\n\n
Haydi gelin basit bir kot k\u0131r\u0131\u011f\u0131ndan pn\u00f6motoraksa kadar geni\u015f bir skalas\u0131 olan g\u00f6\u011f\u00fcs travmalar\u0131n\u0131n birka\u00e7\u0131n\u0131 birlikte inceleyelim.<\/p>\n\n\n\n
Sternumun K\u0131r\u0131lmas\u0131<\/h2>\n\n\n\n
Stermum di\u011ferlerine oranla daha b\u00fck\u00fclebilir kostal kartilaj ve kostalarla pozisyonel esnek bir yap\u0131d\u0131r. Bu sebepten dolay\u0131 k\u0131r\u0131\u011f\u0131 yayg\u0131n g\u00f6r\u00fclmemektedir, ancak y\u00fcksek h\u0131zl\u0131 motor ta\u015f\u0131t kazalar\u0131nda meydana gelebilmektedir. Kalbin sternumun posteriorunda bulundu\u011funu ve k\u0131r\u0131k durumunda sternum taraf\u0131ndan a\u011f\u0131r bir \u015fekilde kont\u00fczyona u\u011frayabilece\u011fini unutmay\u0131n\u0131z.<\/p>\n\n\n\n Yayg\u0131n g\u00f6\u011f\u00fcs yaralanmalar\u0131ndand\u0131r. \u00c7ocuklarda y\u00fcksek oranda elastik oldu\u011fundan nadir g\u00f6r\u00fcl\u00fcr. Ancak esnek g\u00f6\u011f\u00fcs kafesi bask\u0131 alt\u0131nda kolayca komprese olup akci\u011fer ve kalbe zarar verebilir. Artan ya\u015fla birlikte kalsiyum deposunun kostal kartilajda art\u0131\u015f\u0131 onlar\u0131 daha kat\u0131 hale getirir, daha k\u0131r\u0131lgan olurlar. Genelde en zay\u0131f noktalar\u0131 olan angulus b\u00f6lgelerinden k\u0131r\u0131lmaya yatk\u0131nd\u0131rlar. En s\u0131k g\u00f6r\u00fclenler 5-10. kaburgalar aras\u0131nda olu\u015fan k\u0131r\u0131klard\u0131r. En az 1, 2, 11 ve 12. kostalarda g\u00f6r\u00fcl\u00fcr. \u0130lk 4 kaburga klavikula, anterior pektoral kaslar, skapula ve onunla ba\u011f\u0131nt\u0131l\u0131 posterior kaslar taraf\u0131ndan korunmaktad\u0131r. 11 ve 12. kaburgalar\u0131nsa mobilitesi y\u00fcksek oldu\u011fundan kaynakl\u0131 k\u0131r\u0131lmak yerine hareket ederler.<\/p>\n\n\n\n Kosta k\u0131r\u0131klar\u0131 plevraya zarar vererek pn\u00f6motoraks olu\u015fumuna sebep olabilir.<\/p>\n\n\n\n En \u00f6nemli semptomu genellikle lokalize y\u00fcksek a\u011fr\u0131lard\u0131r. Her kosta alt\u0131ndaki ve \u00fcst\u00fcndeki sinirler sebebiyle a\u011fr\u0131y\u0131 azaltmak i\u00e7in interkostal sinir blokaj\u0131 uygulanabilmektedir.<\/p>\n\n\n\n A\u011f\u0131r kaza yaralanmalar\u0131nda birden fazla kosta k\u0131r\u0131labilir. G\u00f6\u011f\u00fcs duvar\u0131n\u0131n belli bir b\u00f6l\u00fcm\u00fcn\u00fcn geriye kalan k\u0131sm\u0131yla ba\u011flant\u0131s\u0131 kesilirse yelken g\u00f6\u011f\u00fcs olu\u015fabilmektedir. G\u00f6\u011f\u00fcs duvar\u0131n\u0131n stabilitesi kaybolur; paradoksik g\u00f6\u011f\u00fcs duvar\u0131 hareketi olarak adland\u0131r\u0131lan durum olu\u015fur ve respirat\u00f6rel hareketlerin i\u015fe yaramas\u0131na engel olur.<\/p>\n\n\n\n \u00d6zellikle a\u011f\u0131r travmalarda vertebral k\u0131r\u0131klarla ba\u011flant\u0131l\u0131 spinal kord yaralanmalar\u0131 ve skapulan\u0131n konumu ve gelebilecek zararlar g\u00f6z \u00f6n\u00fcnde bulundurulmal\u0131d\u0131r. Skapula 7 adet kostan\u0131n arka k\u0131sm\u0131n\u0131 \u00f6rten ve d\u0131\u015ftan kaslarla kapl\u0131 bir yap\u0131 oldu\u011fu i\u00e7in k\u0131r\u0131klar\u0131na daha a\u011f\u0131r travmalarda rastlan\u0131r.<\/p>\n\n\n\n Toraks\u0131n anatomisine bak\u0131ld\u0131\u011f\u0131nda meme ucu alt\u0131nda kalan kostalardaki k\u0131r\u0131klar\u0131n \u00fcst abdomendeki organlara -karaci\u011fer, dalak ve mide- zarar verebilece\u011fi g\u00f6z \u00f6n\u00fcnde bulundurulmal\u0131d\u0131r.<\/p>\n\n\n\n Kaynak\u00e7a:<\/em><\/strong><\/p>\n\n\n\n Edit\u00f6rler: Nurbanu Okur ve G\u00fcnsu G\u00fcrg\u00fcn<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":" Toraks yaralanmalar\u0131 g\u00fcnl\u00fck hayat\u0131m\u0131zda s\u0131kl\u0131kla g\u00f6r\u00fclen travmalardand\u0131r. Travma sonucu \u00f6l\u00fcmlerin Amerika\u2019da yakla\u015f\u0131k %35\u2019inden sorumludur. O y\u00fczden ilk travma de\u011ferlendirmesinde en<\/p>\n","protected":false},"author":1192,"featured_media":12868,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[73,2380,727,265,66,2379,356],"acf":[],"views":418,"_links":{"self":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/12866"}],"collection":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/users\/1192"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/comments?post=12866"}],"version-history":[{"count":1,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/12866\/revisions"}],"predecessor-version":[{"id":12871,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/12866\/revisions\/12871"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/media\/12868"}],"wp:attachment":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/media?parent=12866"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/categories?post=12866"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/tags?post=12866"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"\"](\"https:\/\/blog.ulubat.org\/wp-content\/uploads\/2022\/09\/image-35-1024x1024.png\")
<\/figure>\n\n\n\nKosta K\u0131r\u0131klar\u0131<\/h2>\n\n\n\n
Yelken G\u00f6\u011f\u00fcs<\/h2>\n\n\n\n
![\"\"](\"https:\/\/blog.ulubat.org\/wp-content\/uploads\/2022\/09\/image-36-1024x1024.png\")
<\/figure>\n\n\n\nPosterior travmatik yaralanmalar<\/h2>\n\n\n\n
Travmatik abdominal viscera<\/em> ve g\u00f6\u011f\u00fcs yaralanmalar\u0131<\/em><\/h2>\n\n\n\n
![\"\"](\"https:\/\/blog.ulubat.org\/wp-content\/uploads\/2022\/09\/image-37-1024x1024.png\")
<\/figure>\n\n\n\n