Türkiye’deki Deprem Sonrası Acil Dahiliye Servisi Yatışlarının Analizi: Mağdurların Demografik ve Klinik Sonuçları
Öz
Amaç: 6 Şubat 2023’te Türkiye’nin güneydoğu bölgesini etkileyen yıkıcı bir deprem meydana geldi ve on bir büyük şehri etkiledi. Binlerce insan
hayatını kaybetti ve birçok kişi yıkılan binaların altında kaldı. Bu çalışmanın amacı, deprem sonrasında acil dahiliye servislerine başvuran mağdurların
demografik özelliklerini, klinik sonuçlarını, laboratuvar bulgularını ve yaralanmalarını incelemektir.
Gereç ve Yöntem: Bu çalışmada, deprem sonrası Ankara Bilkent Şehir Hastanesi Dahiliye Acil Servisi’ne başvuran ve crush sendromu olan 60
hastanın tıbbi kayıtları sistem üzerinden retrospektif olarak değerlendirildi.
Bulgular: Hastaların %56,67’si erkek, ortalama yaş 37,35, enkaz altında kalma süresi ortalama 28,39 saat ve 40 hastada (%66,67) ekstremite
travması vardı. Yirmi iki hastaya (%36,67) fasiyotomi ve 15 hastaya (%25) ampütasyon yapıldı. Hastalarda çeşitli komplikasyonlar gelişti; 36 akut
böbrek hasarı (ABH) (%60) ve 15 (%25) yara enfeksiyonu tespit edildi. ABH nedeniyle 32 hastaya (%53,33) hemodiyaliz uygulandı. Fasiyotomi
Anahtar Kelimeler
Etik Beyan
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Destekleyen Kurum
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Proje Numarası
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Teşekkür
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Kaynakça
- 1. World Health Organization. Emergencies Türkiye and Syria Earthquakes. https://www.who.int/europe/emergencies/situations/turkiye-and-syriaearthquakes. Accessed March 1, 2023.
- 2. Liu S, He C. Related factors associated with earthquake inpatient mortality. Disaster Med Public Health Prep. 2022;16:65-70.
- 3. Heppenstall RB, Scott R, Sapega A, et al. A comparative study of the tolerance of skeletal muscle to ischemia. Tourniquet application compared with acute compartment syndrome. J Bone Joint Surg Am. 1986;68:820- 828.
- 4. Michaelson M. Crush injury and crush syndrome. World J Surg. 1992;16:899- 903.
- 5. Gonzalez D. Crush syndrome. Crit Care Med. 2005;33(1 Suppl):S34-S41.
- 6. Reis ND, Better OS. Mechanical muscle-crush injury and acute muscle-crush compartment syndrome: with special reference to earthquake casualties. J Bone Joint Surg Br. 2005;87:450-453.
- 7. Via AG, Oliva F, Spoliti M, et al. Acute compartment syndrome. Muscles Ligaments Tendons J. 2015;5:18-22.
- 8. Schmidt AH. Acute compartment syndrome. Injury. 2017;48 Suppl 1:S22-S25.
- 9. McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk?. J Bone Joint Surg Br. 2000;82:200-203.
- 10. Bulut M, Fedakar R, Akkose S, et al. Medical experience of a university hospital in Turkey after the 1999 Marmara earthquake. Emerg Med J. 2005;22:494-498.
- 11. Kang P, Zhang L, Liang W, et al. Medical evacuation management and clinical characteristics of 3,255 inpatients after the 2010 Yushu earthquake in China. J Trauma Acute Care Surg. 2012;72:1626-1633.
- 12. Sever MS, Erek E, Vanholder R, et al. The Marmara earthquake: epidemiological analysis of the victims with nephrological problems. Kidney Int. 2001;60:1114-1123.
- 13. Richards NT, Tattersall J, McCann M, et al. Dialysis for acute renal failure due to crush injuries after the Armenian earthquake BMJ. 1989;298:443-445.
- 14. Tattersall JE, Richards NT, McCann M, et al. Acute haemodialysis during the Armenian earthquake disaster. Injury. 1990;21:25-33.
- 15. Armenian HK, Melkonian A, Noji EK, et al. Deaths and injuries due to the earthquake in Armenia: a cohort approach. Int J Epidemiol. 1997;26:806-813.
- 16. Oda J, Tanaka H, Yoshioka T, et al. Analysis of 372 patients with Crush syndrome caused by the Hanshin-Awaji earthquake. J Trauma. 1997;42:470- 476.
- 17. Tanida N. What happened to elderly people in the great Hanshin earthquake. BMJ. 1996;313:1133-1135.
- 18. Frink M, Hildebrand F, Krettek C, et al. Compartment syndrome of the lower leg and foot. Clin Orthop Relat Res. 2010;468:940-950.
- 19. McQueen MM, Duckworth AD, Aitken SA, et al. The estimated sensitivity and specificity of compartment pressure monitoring for acute compartment syndrome. J Bone Joint Surg Am. 2013;95:673-677.
- 20. Safari S, Najafi I, Hosseini M, et al. Outcomes of fasciotomy in patients with crush-induced acute kidney injury after Bam earthquake. Iran J Kidney Dis. 2011;5:25-28.
- 21. Huang KC, Lee TS, Lin YM, et al. Clinical features and outcome of crush syndrome caused by the Chi-Chi earthquake. J Formos Med Assoc. 2002;101:249-256.
- 22. Rush DS, Frame SB, Bell RM, et al. Does open fasciotomy contribute to morbidity and mortality after acute lower extremity ischemia and revascularization?. J Vasc Surg. 1989;10:343-350.
- 23. Görmeli G, Görmeli CA, Güner S, et al. [Article in Turkish] [A clinical analysis of patients undergoing fasciotomy who experienced the 2011 Van earthquake]. Eklem Hastalik Cerrahisi. 2012;23:156-160.
- 24. Duman H, Kulahci Y, Sengezer M. Fasciotomy in crush injury resulting from prolonged pressure in an earthquake in Turkey. Emerg Med J. 2003;20:251- 252.
- 25. Li W, Qian J, Liu X, et al. Management of severe crush injury in a front-line tent ICU after 2008 Wenchuan earthquake in China: an experience with 32cases. Crit Care. 2009;13:R178.
- 26. Guner S, Guner SI, Isik Y, et al. Review of Van earthquakes form an orthopaedic perspective: a multicentre retrospective study. Int Orthop. 2013;37:119-124.
- 27. Togawa S, Yamami N, Nakayama H, et al. The validity of the mangled extremity severity score in the assessment of upper limb injuries. J Bone Joint Surg Br. 2005;87:1516-1519.
- 28. Greenberg A. Hyperkalemia: treatment options. Semin Nephrol. 1998;18:46-57.
- 29. Parham WA, Mehdirad AA, Biermann KM, et al. Hyperkalemia revisited. Tex Heart Inst J. 2006;33:40-47.
- 30. Atef MR, Nadjatfi I, Boroumand B, et al. Acute renal failure in earthquake victims in Iran: epidemiology and management. Q J Med. 1994;87:35-40.
- 31. Erek E, Sever MS, Serdengeçti K, et al. An overview of morbidity and mortality in patients with acute renal failure due to crush syndrome: the Marmara earthquake experience. Nephrol Dial Transplant. 2002;17:33-40.
- 32. Kantarci G, Vanholder R, Tuglular S, et al. Acute renal failure due to crush syndrome during Marmara earthquake. Am J Kidney Dis. 2002;40:682-689.
- 33. Zhang H, Zeng JW, Wang GL, et al. Infectious complications in patients withcrush syndrome following the Wenchuan earthquake. Chin J Traumatol. 2013;16:10-15.
- 34. Childs BR, Verhotz DR, Moore TA, et al. Presentation coagulopathy and persistent acidosis predict complications in orthopaedic trauma patients. J Orthop Trauma. 2017;31:617-623.
- 35. Kazancioglu R, Pinarbasi B, Esen BA, et al. The need for blood products in patients with crush syndrome. Am J Disaster Med. 2010;5:295-301.
Analysis of Emergency Internal Medicine Hospitalization after the Earthquake in Türkiye: Demographic and Clinical Results of Victims
Öz
Objectives: On February 6, 2023, a devastating earthquake struck the southeastern part of Türkiye that affected eleven major cities. Thousands of
people lost their lives, and many were buried under collapsed buildings. The aim of this study is to examine the demographic characteristics, clinical
results, laboratory findings and injuries of the victims who applied to the emergency internal medicine service after the earthquake.
Materials and Methods: In this study, medical records of 60 patients with crush syndrome who applied to Ankara Bilkent City Hospital Emergency
Department of Internal Medicine after the earthquake were evaluated retrospectively through the system.
Results: 56.67% of the patients were male, the mean age was 37.35, the mean duration of stay under the rubble was 28.39 hours, and 40 (66.67%)
patients had extremity trauma. Twenty-two patients (36.67%) had fasciotomy and 15 (25%) had amputation. Various complications developed in
patients; 36 acute kidney injury (AKI) (60%) and 15 (25%) wound infections were detected. Hemodialysis was applied to 32 patients (53.33%) due
to AKI. AKI was detected in 17 of the patients who underwent fasciotomy, and wound infection was observed in 9 of them. Wound infection was
detected in 13 of the patients with AKI. Mortality developed in 3 patients. In the comparison between patients with and without fasciotomy, it
was found that there was a significant difference in terms of length of hospitalization, number of transfusions, AKI, wound infection, hemodialysis,
myoglobin on admission value. In patients with acute renal failure; wound infection, hemodialysis, transfusion rates, myoglobin value >1000 (μg/L)
at admission and urea at admission, creatinine at admission, creatine kinase rate at admission were higher.
Conclusion: Rapid determination of demographic characteristics, laboratory findings and clinical results of earthquake patients are critical for the
development of future disaster preparedness, response and recovery policies.
Anahtar Kelimeler
Proje Numarası
-
Kaynakça
- 1. World Health Organization. Emergencies Türkiye and Syria Earthquakes. https://www.who.int/europe/emergencies/situations/turkiye-and-syriaearthquakes. Accessed March 1, 2023.
- 2. Liu S, He C. Related factors associated with earthquake inpatient mortality. Disaster Med Public Health Prep. 2022;16:65-70.
- 3. Heppenstall RB, Scott R, Sapega A, et al. A comparative study of the tolerance of skeletal muscle to ischemia. Tourniquet application compared with acute compartment syndrome. J Bone Joint Surg Am. 1986;68:820- 828.
- 4. Michaelson M. Crush injury and crush syndrome. World J Surg. 1992;16:899- 903.
- 5. Gonzalez D. Crush syndrome. Crit Care Med. 2005;33(1 Suppl):S34-S41.
- 6. Reis ND, Better OS. Mechanical muscle-crush injury and acute muscle-crush compartment syndrome: with special reference to earthquake casualties. J Bone Joint Surg Br. 2005;87:450-453.
- 7. Via AG, Oliva F, Spoliti M, et al. Acute compartment syndrome. Muscles Ligaments Tendons J. 2015;5:18-22.
- 8. Schmidt AH. Acute compartment syndrome. Injury. 2017;48 Suppl 1:S22-S25.
- 9. McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk?. J Bone Joint Surg Br. 2000;82:200-203.
- 10. Bulut M, Fedakar R, Akkose S, et al. Medical experience of a university hospital in Turkey after the 1999 Marmara earthquake. Emerg Med J. 2005;22:494-498.
- 11. Kang P, Zhang L, Liang W, et al. Medical evacuation management and clinical characteristics of 3,255 inpatients after the 2010 Yushu earthquake in China. J Trauma Acute Care Surg. 2012;72:1626-1633.
- 12. Sever MS, Erek E, Vanholder R, et al. The Marmara earthquake: epidemiological analysis of the victims with nephrological problems. Kidney Int. 2001;60:1114-1123.
- 13. Richards NT, Tattersall J, McCann M, et al. Dialysis for acute renal failure due to crush injuries after the Armenian earthquake BMJ. 1989;298:443-445.
- 14. Tattersall JE, Richards NT, McCann M, et al. Acute haemodialysis during the Armenian earthquake disaster. Injury. 1990;21:25-33.
- 15. Armenian HK, Melkonian A, Noji EK, et al. Deaths and injuries due to the earthquake in Armenia: a cohort approach. Int J Epidemiol. 1997;26:806-813.
- 16. Oda J, Tanaka H, Yoshioka T, et al. Analysis of 372 patients with Crush syndrome caused by the Hanshin-Awaji earthquake. J Trauma. 1997;42:470- 476.
- 17. Tanida N. What happened to elderly people in the great Hanshin earthquake. BMJ. 1996;313:1133-1135.
- 18. Frink M, Hildebrand F, Krettek C, et al. Compartment syndrome of the lower leg and foot. Clin Orthop Relat Res. 2010;468:940-950.
- 19. McQueen MM, Duckworth AD, Aitken SA, et al. The estimated sensitivity and specificity of compartment pressure monitoring for acute compartment syndrome. J Bone Joint Surg Am. 2013;95:673-677.
- 20. Safari S, Najafi I, Hosseini M, et al. Outcomes of fasciotomy in patients with crush-induced acute kidney injury after Bam earthquake. Iran J Kidney Dis. 2011;5:25-28.
- 21. Huang KC, Lee TS, Lin YM, et al. Clinical features and outcome of crush syndrome caused by the Chi-Chi earthquake. J Formos Med Assoc. 2002;101:249-256.
- 22. Rush DS, Frame SB, Bell RM, et al. Does open fasciotomy contribute to morbidity and mortality after acute lower extremity ischemia and revascularization?. J Vasc Surg. 1989;10:343-350.
- 23. Görmeli G, Görmeli CA, Güner S, et al. [Article in Turkish] [A clinical analysis of patients undergoing fasciotomy who experienced the 2011 Van earthquake]. Eklem Hastalik Cerrahisi. 2012;23:156-160.
- 24. Duman H, Kulahci Y, Sengezer M. Fasciotomy in crush injury resulting from prolonged pressure in an earthquake in Turkey. Emerg Med J. 2003;20:251- 252.
- 25. Li W, Qian J, Liu X, et al. Management of severe crush injury in a front-line tent ICU after 2008 Wenchuan earthquake in China: an experience with 32cases. Crit Care. 2009;13:R178.
- 26. Guner S, Guner SI, Isik Y, et al. Review of Van earthquakes form an orthopaedic perspective: a multicentre retrospective study. Int Orthop. 2013;37:119-124.
- 27. Togawa S, Yamami N, Nakayama H, et al. The validity of the mangled extremity severity score in the assessment of upper limb injuries. J Bone Joint Surg Br. 2005;87:1516-1519.
- 28. Greenberg A. Hyperkalemia: treatment options. Semin Nephrol. 1998;18:46-57.
- 29. Parham WA, Mehdirad AA, Biermann KM, et al. Hyperkalemia revisited. Tex Heart Inst J. 2006;33:40-47.
- 30. Atef MR, Nadjatfi I, Boroumand B, et al. Acute renal failure in earthquake victims in Iran: epidemiology and management. Q J Med. 1994;87:35-40.
- 31. Erek E, Sever MS, Serdengeçti K, et al. An overview of morbidity and mortality in patients with acute renal failure due to crush syndrome: the Marmara earthquake experience. Nephrol Dial Transplant. 2002;17:33-40.
- 32. Kantarci G, Vanholder R, Tuglular S, et al. Acute renal failure due to crush syndrome during Marmara earthquake. Am J Kidney Dis. 2002;40:682-689.
- 33. Zhang H, Zeng JW, Wang GL, et al. Infectious complications in patients withcrush syndrome following the Wenchuan earthquake. Chin J Traumatol. 2013;16:10-15.
- 34. Childs BR, Verhotz DR, Moore TA, et al. Presentation coagulopathy and persistent acidosis predict complications in orthopaedic trauma patients. J Orthop Trauma. 2017;31:617-623.
- 35. Kazancioglu R, Pinarbasi B, Esen BA, et al. The need for blood products in patients with crush syndrome. Am J Disaster Med. 2010;5:295-301.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | İç Hastalıkları |
| Bölüm | Makaleler |
| Yazarlar | |
| Proje Numarası | - |
| Yayımlanma Tarihi | 29 Aralık 2024 |
| Gönderilme Tarihi | 19 Temmuz 2024 |
| Kabul Tarihi | 16 Eylül 2024 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 77 Sayı: 4 |
