Birinci Basamakta Gözden Kaçırılmaması Gereken Acil Durumlar: Aile Hekimi İçin Kırmızı Bayrak Belirtileri
Özet
Yaşamı tehdit eden birçok hastalık, birinci basamağa sık görülen ve hastalığa özgü olmayan yakınmalarla başvurabilir. Tipik tablonun bulunmaması ise bu hastalıkların gözden kaçmasına yol açabilir. Bu bölümde erişkinlerde zamanında tanınmadığında ağır sonuçlar doğurabilecek seçilmiş acil durumlar, hastanın başvuru yakınması esas alınarak ele alınmıştır. Göğüs ağrısı ve nefes darlığı başlığında akut koroner sendrom, akut aort sendromu ve pulmoner emboli, baş ağrısı ve nörolojik yakınmalar başlığında subaraknoid kanama, inme ve geçici iskemik atak ile hipertansif acil durum incelenmiştir. Karın ağrısı başlığında mezenter iskemi, rüptüre abdominal aort anevrizması, ince bağırsak tıkanıklığı, ektopik gebelik ve diyabetik ketoasidoz, ateş ve genel durum bozukluğu başlığında ise sepsis yer almaktadır. Her durum için kırmızı bayrak bulguları, yanıltıcı başvuru biçimleri ve sevkin aciliyeti güncel kılavuzlar ve araştırmalar ışığında özetlenmiştir. Klinik karar araçlarının hangi hasta gruplarında değerlendirildiği ve hangi durumlarda tek başına yeterli olmadığı da belirtilmiştir. Bölümde tanısal hataların kaynakları, güvenli izlem ve sevk sırasında aktarılması gereken bilgiler de tartışılmaktadır. Amaç, aile hekiminin kesin tanıyı beklemeden hangi hastanın ne kadar hızla yönlendirilmesi gerektiğine karar vermesini kolaylaştırmaktır.
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