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ATLS: Advanced Trauma Life ............................ Support' 2 -Acute Ischemic Stroke ...............................................................................' 8 ....................................................................................... ........................... ' 21 .4 Acute ...........' 81 ........................................................................................Shock ............................' 12 : Alcohol abuse The ER ........................................................ approach' 03 " ........................................................................................' 04 VT\ Pulseless VF ...................................................................................................' 64 ABDOMINAL ........................................................................................... TRAUMA ' 94 .01 ACUTE CORONARY

1. 2. 3. 4.

............................................................................................ Dyspnea 5. 6. 7.

8.

9.

01. 11. 21. 76

............................................................................... SYNDROM' 65 ..................................................................................... ...........................' 26 .................................................................................................'

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......................................................................................................... ' 67 ....................................................................................................... ' 68 .................................................................................................' 99 ..............................................................................................' 701 .........................................................................................' 311 ....................................................................' 221 ......................................................................................................... ' 921 ": ...........................................................' 431 ..................................................................................... TRIAGE ..........................' 731 - ................................................................................................ COPD ...' 931 22. 12. 02. 91. 81. 71. 61. 51. 41.

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ATLS: Advanced Trauma Life Support : , , , . : )(, , , , : . 44 . %97 42-51. . %04 " ". : . Valetudinaria " " " . Dominic Jean Larre . " . : %05 03 . 1. ) , , (. %06-03 : The Golden Hour , ". 2. ) , ( , %02. ), (. 3. : 2991, 6 )1 (level . -ATLS . . " ". , .- :Triage ---- --- --- . :ATLS Primary Survey and Resuscitation Secondary survey Post-resuscitation monitoring Definitive Care ": . : . " . . " )01 ( ". : " " 4991 . - .ATLS 3

1. 2. 3. 4.

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. . , , , . \ . . .

.Primary Survey and Resuscitation: ABC airway and cervical spine control 1. breathing 2. circulation and hemorrhage control 3. disability- brif neurologic evaluation 4. exposure\environment- prevent hypothermia 5. : : )(. : . : , . : . : "" )\(. : , , . " " ) \( GCS 41 ) "( -popliteal fossaCoronary HD -06 021 : ", , , . 55COPD ) (" ) (BP -09 2 ." 190mmhg ) (RR -21 42 , , SAT -09 IDDM -33 :Airway and cervical control , , : .AW 7. , , , , , = . 8. : ), , , , ..(, , , ), ( : 9. Chin Lift or Jaw Thrust maneuvers Suction Oral\Nasal AW Laryngeal Mask Intubation Cricothyroidotomy or Tracheostomy 1. 2. 3. 4. 5. 6.

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!!!! " - . , , , " . :Breathing \ ! AW - - ambu )" 8888( . , , . : . . . . . . . : Subcutaneous emphysema . : Hyperresonance, Dullness : : :Apnea . :Tension Pneumothorax . ) :Flail Chest ( Hemo\pneumothorax\ . -"Open Pneumothorax- "Sucking chest wound . Massive Hemothorax . : \. . . Chest tube Needle decompression pf chest :ED Thoracotomy . :Circulation and Hemorrhage Control , . . . " . - : : hypotension- hypoxia . : - -vasoconstriction , . - . : , . = " 08 , = " 07 , )(= " 06 . : 3 . ) " ( 5 1. 2. 3. 4. 5. .a .b .c .d .e .f .g 5. .h .i .j 6. 7. 8. .a .b .c .d .e 9. .a .b .c .d .e 6.

1. 2. 3. 4. 5. 6.

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: , ", , , 7. , . : = - , , , , 8. . : , . FAST .US 9. : , , , . 01. : , . 11. : , , . 21. :Disability : alert V- voice P- pain U- unresponsive ), , ( )(GCS Exposure\Environment: prevent hypothermia . ) ( . : %001. 2 . 2-1 )+( )04-93 ( \ )" ( 2 -(Capnograph (end tidal CO . . . : . Needle cricoidotomy Needle thorax decompression Tube thoracostomy Pericardiocentesis Emergency department thoracotomy : . ) ( massive hemothorax pericardial tamponade massive bleeding ED thoracotomy Epidural hematoma . :Secondary Survey 6 1. 2. 3. 4. 1. 2. 3. 4. 5. 6. 7. 8. 9. 1. 2. 3. 4. 5. 6. 1. 2. 3. 4. 5. 6. 7. -A

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: . 1. : . 2. . 3. : 4. . 5. \ . 6. . 7. . 8. . 9. : 01. : - . \ , , . FAST\DPL (US)dT Toxoid .. AB )(bhcg ) FFP ( VTE prophylaxis \ ":"AMPLE Allergies Medications Past illnesses\pregnancy Last meal Events\Environment related to the injury . \: : , . : , , . : , , , . CSF , , . . GCS ICP . : . , . . : " . . \ . . : . Hemo\pneumothorax Bronchial injury Pulmonary contusion Aortic disruption Heart injury\contusion Subcutaneous emphysema \ : , . , ". . 7 7. .a .b .c .d .e .f .g 8. .a .b .c 9. .a .b .c .d 01. .a .b .c .d .e .f .g 11. .a .b .c

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: . , , . . :Definitive Care Damage control procedures . . . , . : . . " . : . . . . . . . . : . . . , , . : . . - \ . , . 8

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, 7. . 8. \ . 9. . 01. 11. , , . , , 21. , . : . : , , , . . \ . . * 4 . . _______________________________________________________________________________ -Acute Ischemic Stroke )( )WHO): a neurological deficit of sudden onset accompanied by focal dysfunction and symptoms lasting more then 24 hours that are presumed to be .of a non traumatic vascular origin ), ,( . -TIA -42 . ) TPA , ,BBB ( . TIA . : -3 . %07 %03 -.ADL %57 56 55 . . %04-02 5 . 1. 2. 3. 4. 5. 6. 7. 1. 2. 3. 4. 5. 6.

: )( %58 : 1. . %02 . - CT . :thrombotic - , , 2. . :Embolic ) (, , 3. , ) ( . 9

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)( %51. . - CT . -intracerebral: ICH , %01 " . -Subarachnoid: SAH , " LP , %5. : :anterior circulation, %08 - .internal carotid ar :Posterior circulation, %02 - vertebral system - (MCA ( middle cerebral ar , " , MCA .

: ) ( : . 31. : . 31. : . 41. : . 41. : . 51. , , , : . 61. : : %51. : %05 SAH-%08 .ICH .

: :infarct . 1. :Penumbra 2. . : : ", , , , . 1. : 55, ) (, , , 2. . : : thrombotic ) --- ( :embolic - . : Hemorrhagic . ) SAH(: , , , ) nuchal rigidity ( , , , \. : -paralysis . )(, ) ( :Aphasia :dysarthria , . . :Diplopia , :ocular palsy . 01 1. 2. 3. 4.

1. 2. 3. 4. 5.

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: , . : , . :MCA: middle cerebral artery- :hemiplegia . :Hemianesthesia . " :"gaze preference . global aphasia . :Hemianopia . . :Hemineglect . , TPA . - TPA . TPA - ICH . :The 7 "D"s :Detection :Dispatch . :Delivery . :Door . :Data , ,CT :Decision - TPA . :Drug .

" : : Cincinnati ) , (, 1. ) (, . ) ( %27 . :Los angeles 54, , 42 , 2. , 004-08, . ": 01 : ,ABS", ) -%29(, .. - , ) (. " -022 021 022 " . I.V , , .CT 52 : 5 : . . ), ( : . + 52 , 22 - TPA . 52 - CT , 54 " . -11 : :NIH 11 1.

2. 3. .a .b .c .d .e

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. . . . . . -ataxia . . . - -dysarthria ,

. - -neglect . 11- ?Does CT scan show ICH or SAH - - : , CT . . : 01 . 1. CT 52 . 2. 54 CT. 3. ) (TPA 06 . 4. 3 . 5. : ": - ) mean atrial pressure) MAP - 1. %03. - %01. . 002 2. . : 3. :Nursing interventions in ED , , . 1. : , . 2. : . 3. " )(V\S- voteal sings 4. .I.V 5. . 6. . 7. ICP: , " , , , 8. . ) , , 9. ( =. 01. TPA : . 1. . 2. , 3 . 3. -41 . 4. . 5. " 185mmhg 6. 21

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" .110mmhg 7. ". 8. -.SAH 9. -12 . 01. -7 . 11. -84 - PTT. 21. PT 51 . 31. -000.001 41. -05 004. 51. :TPA 3 . 1. CT . 2. 81. 3. . 4.

)( : ) ( . : . . . . : )", 4002(: 1 093 %62.0 928,496 " 2.2 51 %7.25 -6 : %67 . %01 . %8 . %6 . : %24 . %73 . %41 . %5 . %2 .

1. 2. 3. 4. 5. 1. 2. .a 3. 4. 5.

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: " , . %3.2 : : . . )(decontamination . . . \. ) ABCD , , , "( : 5 "": ? . ? . ? . ? . ? . :Toxidromes . : ) , , ( ) ( - ) , ( -Toxidromes . . : : , , , , , , : , ,-HCG : Digoxin, Lithium, Dantoin : ... : . - . - . - . : , ) (, . -Ipecac Cephaelis ipecacuanha, . . - , , 250cc, , , . 2. 3. 4. 1. 2. 3. 4. 5. 6.

1- 2- 3- 4- 5- 6- 7- 1- 2- 1. 2. 3. 4. 5. 1- 1. 2. 3. 4. 5. 6. 2- 1.

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"": ) ,(Imodium )(, : ) (, ) (Hydrocarbones , ) ( : , Kayexalate) , (Cholestyramine ((Starch : : : , , Paralytic ileum ) ( : . : , , -, , , ) ( : : 27-42 ), , (. , , : , - , )(, / / , . : : 1- - . 3- - 4- - : 5- - , , 1- - , , . 2- : )(. )/ / (: . . : , , , . : ), , ( ) ( ) ; ( ) ( ) ( ) ' II( : ABCD, . , , ... . , :Decontamination ) , ( ) ( 51 1. 2. 3. 4. 5. 6. 7.

11. 21. 31.

41. 51.

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) 03 ( / ) , ( ) ( : )(. 3 : . )) (Elliptic , , , (: : ) ( , - )( ) ( ) ( : , " 03 6-2 - , , , , , 6-4 )( 27-84 : ) (Sat 6-4 ), ,CPAP, BiPAP ( ) ( ECMO )(Extracorporeal membrane oxygenation : ) (, , , , . : . . / , ) , , , (, , , , . . )") (Halogen", (: . : : . ) ( )(Myocard , , , : - CNS ), , ( , 61

1. 2.

1- 2- 3-

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, , , , , : , , , , )(, ) - ( . )) (Aromatic , , ( . : : : -NAPQI (N-acetyl-p 1. (benzo-quinone imine . : NAPQI NAPQI . : 5.7 , 051 " . 2. : , , , 3. , 4 : 4. 42-5.01 , , , , . 2-12 I. , 4-33 ), (, , . 4 4 4 . !!! : 1. 4 2. 4 3. , , 4. ) Parvolex ( 5. )( 6. , , 7. - ((N-Acetilcystein Parvolex , - 8. NAPQI )%41-3( , , , , . 9. : : %5 150mg/Kg + 250cc Glucose 03 01. : %5 50mg/Kg + 500cc Glucose 4 11. :%5 100mg/Kg + 1000cc Glucose 61 21. . : ,Xanax, XanagisAlprazolamServium, NirvaxalClordiazepoxideClonex ,RivotrilClonazepamValium AssivalDiazepamLorivanLorazepamDormicumMidazolamVabenOxazepamHalico nTriazolam : )(Valium ' . - %05 " %5 -

1.

2.2.

1. 2. 3. 4. 5.3. 4.

) - %02 - 1. ( . . 2. .

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/ ) %09( 5 . BAC ADH - -A. MEOS " ,ALDH .

3. 4.2. 3. 4.

(Alcohol Dehydrogenase (ADH

: Alcohol

(Acetaldehyde Dehydrogenase (ALDH

Acetaldehyde

) Acetat + CO2+ H2O( :Acetaldehyde . . . -Gluconeogenesis .Hypoglycemia -poor intake and liver dysf Ketoacidosis , insulin + H !

o o oo

, , , , . 1. , 02/ mg/dl/hr . 2. )04-03( . / , . ADH 1. , . . 2. 3. -Alcohol abuse and dependence, 1. -Hepatic effect 2. -Cardiovascular Disease 3. -Cancer 4. -Diabetes 5. -Birth defect 6. -Genetic and related effects 7. 43

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-Injury/Accident/ -Psychiatric, Suicide, -Mortality

8. 9. 01.

3 (a Wernicke-Korsakoff syndrome .i -Disruption of neurotransmitters .ii -Cerebral atrophy .iii Wernicke-Korsakoff Syndrome : (B1 (Thiamine , ) cells/mm 005 3 > mm /, , - Indication Contraindications DPL - CT : : 3. )Computed Tomography (CT : 06

1. 2. 3. 4. 5. 6. 1. 2. 1. 2. 3. 1. 2. 3. 4. 5.

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- 4. Diagnostic Laparoscopy . . : ) Evisceration ( , ) ( : DPL, . - , 1. 2. - 3. AW 4. IV 5. 6. 7. Intravenous Lines, Tubes and Spinal Precautions 8. )(AB Tetanus 1. 2. 3. .. 4. 5. CT -Damage Control . : 1. 2. 3. : 1. - , , 2. 84-42 . , , . 3.

1. 2. 3. 4. 5. 6.

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,Packing , , ) ( ) ( _______________________________________________________________________________ ACUTE CORONARY SYNDROM ) ( . - . INTIMA )( ,, . . -.ACS : - , , ,HTN, , , , '. - - : . - fatty streak . - fatty streak = - .FOAM CELLS . fibro fatty ateroma , , -(ECM (Extracellular matrix , . .

1. 2. 3. 4. 5.

" - ?MI - . )"- ( %07 . : : : 1. " "), ( . . . . : 2. = . .

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- . " )061-003 " (. 1.\ 2. 3. 4., - 5. . 6. " - == ACS = 4-2 ' : ) . - (. ),,- - PRINCEMETAL ( 46

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)(),,, ( : - - )( LEFT MAIN - . MI ) .(VT/VF ACS .AED -ACS 1. ) (- . ) " (. 2. " , . 3. \ - unstable angina )-061 .(320mg . .MI 4. /. - - 1. ," 1. "+ 2. , . 2. - 3. 03 ' " 3. 4.

-MONA 1. - 2. . ?- . .a ?- - ) .b (4L/min

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