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TEMEL YAŞAM DESTEĞİ (TYD)

CPR – KARDİYOPULMONER RESÜSİTASYON

 

TYD/CPR, kalp masajı ( KM ) ve suni solunumun ( SS ) birlikte, tek veya iki kişi ile yapılmasıdır.

 

TEK KİŞİ VEYA İKİ KİŞİ İLE TYD: Önce tepki var mı araştırılır, yoksa bağırarak yardım istenir. Sonra başı geriye yatırma çeneyi ileri ittirme hareketiyle soluk yolu açılır. Solunum var mı araştırılır; solunum yoksa ya da normal değilse hemen 30 kez göğüs bastırılır. 2 suni solunum 30 göğüs basısı olacak şekilde, döngü (30:2 ) tekrarlanır. AED varsa 1 kere şok verilir ardından hemen 30:2 şeklinde devam edilir. TYD, kişi kendine gelene kadar(hareket etme, gözlerini açma, normal soluma), yardım gelene yada yapan tükenene kadar sürdürülür.

 

TIKLAYIN: Erişkinde TYD algoritması, çocukta TYD algoritması

 

DİKKATİNİZE: 2005 resüsitasyon toplantılarından sonra, AHA(ABD) ve ERC(AVRUPA) GUİDELİNES olmak üzere iki yeni yayın ortaya çıkmıştır. Bu yayınlara göre bazı farklılıklar var. Algoritmalarda da görüleceği gibi biri solunum yoksa hemen göğüs basısına başlatırken diğeri 2 soluk sonrası göğüs basısına başlatıyor. Her ikisinde de ilkyardımcı (sağlık personeli hariç) nabız kontrolü yapmıyor. Her ikisinde de AED haricinde ara verilmeden TYD sürekli yapılıyor. Çocuklarda-bebeklerde ERC beş soluk vermeyi önerirken, AHA 2 soluk vermeyi öneriyor.  O nedenle iş akış şemalarını izlerken bu farklılıklar gözünüze çarparsa bu kaynakların farklılığındandır.

2010 yılı toplantılarında ise TYD nde fazla bir değişiklik yok. En önemli değişiklik ABC sıralamasında: CAB olarak değiştirilmiştir. Aşağıda yeni TYD adımları yer almaktadır, dikkatlice okumanızı öneririm.

European Resuscitation Council Guidelines for Resuscitation 2010; Resuscitation 81 (2010) 1219–1276; journal homepage:www.elsevier.com/locate/resuscitation

ERİŞKİNDE TEMEL YAŞAM DESTEĞİ (ETYD) nde İzlenecek Adımlar:

  • 1.  Hastanın/yaralının (kişinin) ve yanındakilerin (kendiniz dahil) güvende olduğundan (herhangi bir tehlikeye maruz olmadığınızdan: gaz, alev, çökme tehlikesi, araba çarpma olasılığı vs olmadığından) emin olun.
  • 2.  Hastada/yaralıda(kişide) tepki var mı araştır: omuzlarından ellerinizle kavrayarak hafifçe sarsın ve yüksek sesle “iyi misin?” diye sorun.
  • 3.  A. Tepki verirse(ses çıkarma, gözlerini açıp-kapama, elini/kolunu hareket ettirme gibi): herhangi bir tehlike söz konusu değilse, onu bulduğunuz halde bırakın; herhangi bir sorunu/yardıma ihtiyacı olup olmadığını araştırın; yardım gelene kadar düzenli aralıklarla solunumunu ve genel durumunu izleyin.
  •      B. Eğer tepki vermiyorsa: bağırarak yardım isteyin, kişiyi dikkatlice sırt üstü yatırın, soluk yolunu açın: bir eliniz alnında iken diğer elinizin parmakları çenesinde, başını geriye yatırın. Baş geriye doğru yatırıldığında çenenin de yukarı kalktığını görürsünüz. Soluk yolu böylece açılmış olur.
  • 4.  Soluk yolunu açık tutmaya devam ederken, bak-dinle-hisset yöntemiyle solunumunun olup olmadığını araştır: göğüs kafesinin iniş-kalkışına bak; kişinin ağzından nefesini dinle; yanaklarınızı kişinin ağzına yaklaştırarak nefesin sıcaklığını/nemini hisset; bu şekilde nefesi var mı-yok mu ya da normal mi karar verin. Kalp durmasını takip eden birkaç dakika sonrasında, kişi zorlanarak, yetersiz ya da yavaş ama gürültülü nefes alabilir. Bunları normal nefes almayla karıştırmayın. Bak-dinle- hisset yöntemiyle kişinin normal solunumu olup olmadığına karar vermek için 10 saniyeden fazla zaman harcamayın. Eğer, solunumun normal olup olmadığı konusunda şüpheniz olursa, bu durumda, solunum normal değilmiş gibi hareket edin.
  • 5A. Eğer kişinin solunumu normal ise: yan yatırın(recovery position); yardım isteyin, 112 yi arayın/aratın ki ambulans gelsin; siz solunumu izlemeye devam edin, halen normal mi?
  •       B. Eğer kişinin solunumu normal değilse ya da yoksa: mümkünse birini yardım istemekle görevlendirin, yine mümkünse AED isteyin ya da kimse yoksa ve bulunduğunuz yerde AED varsa gidip getirin-kişiyi sadece, başka hiçbir seçeneğinizin olmadığı durumlarda yalnız bırakın; eğer yalnızsanız cep telefonuyla 112 yi arayın; göğüsten bastırmaya başlayın. Göğüsten bastırmak için: kişinin yanına diz çökün, elinizin tabanını (bileğe yakın olan etli ve güçlü kısım) kişinin göğsünün merkezine yerleştirin (kişinin göğüs kemiğinin/sternumun alt yarısına), ikinci elinizin tabanını da birinci elinizin üstüne yerleştirin, iki elinizin parmaklarını birbirine geçirin; bu arada kişinin kaburgalarına, karnına ya da göğüs kemiğinin alt ucuna baskı yapmadığınızdan emin olun! Elleriniz sadece göğüs kemiğinin üzerinde olmalı ve baskıyı göğüs kemiğine yapmalısınız! Kollarınız düz olmalıdır(dirsekten bükülmemelidir). Kişinin göğsüne dik bastırabilecek şekilde duruşunuzu ayarlayın, göğüs en az 5 cm(ama 6 cm den fazla olmayacak) içeri girecek şekilde bastırın. Her bastırmanın ardından, göğüs kemiğinin üzerinden ayırmamak koşuluyla elinizi serbest bırakın ki göğüs kafesi eski yüksekliğine gelsin. Bu şekilde dakikada 100 kere göğüsten bastırma eylemini tekrarlayın(bastırma sayısı dakikada 120 yi geçmemeli). Bastırma ve serbest bırakma süreleri eşit olmalıdır ki kalp her bastırmada yeterince boşalsın ve her serbest bırakmada kanla dolabilsin.
  •  6. A. Göğüsten bastırma eylemine kurtarıcı soluk eylemini de ekleyin. Her 30 göğüsten bastırma eyleminin ardından, baş-çene manevrasıyla soluk yolunu açıp, burun kanatlarını alındaki elinizin baş ve işaret parmaklarıyla sıkıca kapattıktan sonra çene yukarıda iken ağzını açın. Normal nefes alın ve kişinin ağız çevresini, dışarı hava kaçmayacak şekilde dudaklarınızla sıkıca kapatın. Aldığınız nefesi kişiye 1 saniyede verin, bu arada göğüs kafesinin yükselip yükselmediğini izleyin, bu etkili kurtarıcı soluk verme yöntemidir. Ağzınızı kişinin ağzından uzaklaştırın bu arada göğüs kafesinin inmesini izleyin, baş-çene manevrasını bozmadan ve tekrar nefes alın, aynı şekilde ikinci nefesi de verin. İki nefesi 5 saniyede vermelisiniz, daha uzun sürmemelidir. Hiç gecikmeden elinizi göğüs kemiğine yerleştirip vakit kaybetmeden 30 kez göğüs bastırma eylemini sürdürmelisiniz. Yukarda anlatılan kurallara uyarak ve mümkün olduğunca hiç denebilecek kadar az ara vererek 30:2 oranında göğüsten bastırma ve kurtarıcı soluk eylemlerini sürdüreceksiniz.
  •       Sadece, kişide kendine gelme belirtileri görülürse(hareket etme, gözlerini açıp-kapama, soluk alma gibi) ara verip kişi değerlendirilir. Aksi halde TYD ne ara vermeden devam edilir.
  •       Eğer, kişiye verdiğiniz ilk kurtarıcı solukta göğüs kafesi normal solunumda olduğu gibi yükselmiyorsa, ikinci soluğu vermeden önce kişinin ağzının içine bakarak herhangi bir tıkayan yabancı cisim olup olmadığını araştırın eğer varsa çıkarın; baş-çene duruşuna tekrar dikkat ettikten sonra ikinci soluğu verin. Her göğüs basısı öncesi iki kereden fazla soluk verme girişiminde bulunmayın. Eğer, birden fazla kurtarıcı varsa, 2 dakikada bir kurtarıcı değiştirilirse yorgunluğun önüne geçilmiş ve başarılı TYD yapılmış olur. Burada dikkat edilecek husus: aynen göğüs basısı ile kurtarıcı soluk verme arasında nasıl göğüs basısına hiç denecek kadar az ara vermeye çalışıyorsak, kurtarıcı değiştirirken de ara vermemeye gayret etmek zorundayız.
  • B. TYD nde sadece göğse bası uygulama koşulları: eğitimini almamışsanız ya da soluk vermeye gönüllü değilseniz sadece göğse bası uygulayabilirsiniz, sadece göğse bası uygulamanız halinde yapacağınız bası sayısı dakikada 100 olmalıdır(120 yi aşmamalıdır).
  • 7.   TYD ne, profesyonel yardım gelip sizden devralana kadar, kişi kendine gelene kadar(hareket ettiğinde, gözlerini açtığında veya normal solunuma başladığında) veya siz tükenene kadar ARA VERMEYİN,

DİKKATİNİZE : Yurt dışında uzun yıllardır ilkyardımcılar tarafından portatif defibrilatör ya da asıl adıyla automatic external defibrillation(AED) uygulanmaktaydı. Ülkemizde çok sıcak bakılmayan bu uygulama 2005 kararları doğrultusunda ülkemizde de öğretilmek durumundadır. Algoritmalarda gördüğünüz AED uygulamaları sizi şaşırtmasın bunlar ilkyardımcılara yönelik uygulamalardır. AED iş akış şeması için tıklayın.

TYD  için uygulama kuralları tablosu :

 YAŞ GRUBU Erişkin Çocuk Bebek TYD / Suni Solunum
8 yaş üstü 1-8 yaş 1-12 ay
ADIMLAR Bilinç düzeyini sapta
SOLUK  YOLU

(Baş pozisyonu)

Baş-çene Baş-çene, Baş-çene
SOLUNUM Bak-dinle-hisset Bak-dinle-hisset Bak-dinle-hisset Solunumu  değerlendir
Solunum yoksa suni solunumu başlat  Her biri bir saniye sürecek şekilde

2 soluk verilir

Her biri bir saniye sürecek şekilde

5 soluk verilir

Her biri 1-1.5 saniye sürecek şekilde

5 soluk verilir

Solunumu varsa,

Koma pozisyonu ver

Suni solunum sayısı En az, dakikada

8-10

en az, dakikada 12-20 en az, dakikada

12-20

Yabancı cisim

Tıkanmasında

Uygulamalar

5 sırttan darbe

5 karından itme

5 sırttan darbe

5 karından itme

5 Sırttan darbe

5 göğüsten bastırma

 

 

 

 

DOLAŞIM

Diğer yaşam bulgularını değerlendir
Nabız alma  YOK YOK  YOK Solunum yoksa,

30 göğüs basısı

2 suni solunum

Göğse basısının

Uygulandığı yer

Göğüs kemiğinin      tam ortası /

İki meme başının ortası

Göğüs kemiğinin    tam ortası  /

İki meme başının ortası

Göğüs kemiğinin     tam ortası /

İki meme başının ortası

Göğse basısının

Uygulanışı

İki el tabanı üst üste konarak Tek veya iki

el tabanı ile

2 parmak ile
Göğse Bastırma sayısı

Dakikada (ortalama)

100 kez 100 kez 100 kez
Göğse Bastırma  /

Suni solunum oranı

30 : 2 30 : 2 30 : 2
Göğsü Bastırma Derinliği Göğüs, yüksekliğinin 1/3 oranında içeri doğru çöktürülecek

(çökme 5 cm den az 6 cm den çok olmayacak)

Göğüs, yüksekliğinin 1/3 oranında içeri doğru çöktürülecek

(çökme 5 cm civarında olacak)

Göğüs, yüksekliğinin 1/3 oranında içeri doğru çöktürülecek

(çökme 4 cm civarında olacak)

AVRUPA YENİDEN CANLANDIRMA (ERC) KURULU, 2005-2010 YILI YENİDEN CANLANDIRMA REHBERLERİne uygun değiştirilmiştir. 

 

KURTARICI İÇİN TEHLİKE VAR MI?

TYD esnasında, hem kurtarıcı hem K/H için güvenlik en önemli unsurdur. Sadece tüberküloz ve SARS(akut respiratuar distres sendromu) gibi enfeksiyonların tespit edildiği tek tük verilere bakarak, kurtarıcıların TYD ni uygulamaktan çekindiği bilinen birkaç olay mevcut. TYD esnasında HIV bulaşması ile ilgili bildirilen herhangi bir veri yok. TYD nde soluturken kullanılan koruyucu araçların (barrier devices) etkinliği konusunda insanlarla yapılmış çalışmalar yok; ancak tek yönlü kapağı olan çeşitli filtrelerin ve koruyucu araçların, ağızdan ağza suni solunum yaparken K/H nın ağzındaki bakterilerin kurtarıcıya geçmesini önlediği laboratuar çalışmalarıyla gösterilmiştir. Kurtarıcılar, TBC veya SARS gibi bilinen bir bulaşıcı hastalığı olan hastalarda uygun bir koruyucu kullanmalıdır. Eğer SARS salgını veya benzeri bulaşıcı salgın varsa kurtarıcıların enfeksiyon kontrolü önlemlerine tam olarak uymalıdırlar.

 

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