Diyarbakır'da Bir Bomba Patlaması: Klinik Bulgular ve Acil Servis Yönetimi

Amaç: Bu çalışmada bir bombalı saldırı sonrasında acil servis yönetimi, hastaların klinik bulguları ve mortalite analizi sunulmuştur Yöntemler: Diyarbakır Dicle Üniversitesi Hastanesi Acil servisi'ne 5 Haziran 2015 tarihindeki patlama sonrası gelen hastalar retrospektif incelendi. Yaş, cinsiyet, triaj, sistem yaralanmaları, hipotansiyon, kan transfüzyonu, entübasyon, yoğun bakıma yatış, cerrahi tedavi, ampütasyon, travma skorları[Glasgow Coma Skalası (GCS) Skoru, Revize Trauma Skoru (RTS), Yaralanma Şiddet Skoru (Injury Severity Skoru -ISS), Travma Skoru-Yaralanma Şiddet Skoru (TRISS), Şok İndeksi ] incelendi. Acil servis yönetimi ve mortalite üzerine etkili faktörler analiz edildi. Bulgular: Yaşayanların yaş ortalaması 29,64±12,88 yıl ve ölenlerin yaş ortalaması 36±19,98 yıl idi. GCS, ISS, shock index mortaliteyi etkileyen faktörlerdi (p

A Bomb Explosion In Diyarbakir: Clinical Findings And Management of Emergency Department

Objectives: In this study, we present management of emergency department, patients' clinical findings and mortality analysis after a bomb explosion. Methods: Patients brought to Diyarbakır Dicle University Hospital emergency department after the explosion at 5 June 2015 were retrospectively examined. Patients' age, gender, triage, system injuries, hypotension, blood transfusion, admission to the ICU, Intensive care unit surgical treatment, amputation and trauma scores (Glasgow Coma Score (GCS), Revised Trauma Score (RTS), Injury Severity Score (ISS), Trauma Score-Injury Severity Score (TRISS), Shock index) were studied. Factors affecting emergency department management and mortality were analyzed. Results: The mean age was found as 29.64±12.88 years in survivors and 36±19.98 years in deaths. GCS, ISS and shock index were found as the factors affecting mortality (p<=0.05). Wounded taken to the resuscitation room, hypotension, blood transfusion, intubation, treatment in ICU and amputation were correlated with mortality (p<0.05). Conclusion: A fast and effective triage system must be applied in EDs following a bomb explosion. The explosion of a bomb on the open areas are the most common injury to the lower extremity injury. Mortality is most often associated with lower limb amputations.

Kaynakça

1. Mayo A, Kluger Y. Terrorist bombing. World J Emerg Surg. 2006;1:33-9.

2. Kluger Y, Kashuk J, Mayo A. Terror bombing-mechanisms, consequencesand implications. Scand J Surg. 2004;93:11-4.

3. Wightman JM, Gladish SL. Explosions and blast injuries. Ann Emerg Med. 2001;37:664-78.

4. Halpern P, Tsai MC, Arnold J, et al. Mass-casualty, terrorist bombings: Implications for emergency department and hospital emergency response (Part II). Prehosp Disast Med. 2003;18:235-41.

5. Zane RD, Prestipino AL. Implementing the Hospital Emergency Incident Command System: an integrated delivery system's experience. Prehosp Disaster Med. 2004;19:311-7.

6. Gans L, Kennedy T. Management of unique clinical entities in disaster medicine. EmergMed Clin North Am 1996;14:301-326.

7. Gutierrez de Ceballos JP, Fuentes FT, Díaz DP, et al. 11 March 2004: The terrorist bomb explosions in Madrid, Spain - an analysis of the logistics, injuries sustained and clinical management of casualties treated at the closest hospital. Critical Care 2005;9:104-11

8. Arnold JF, Halpern P, Tsai MC, Smithline H. Mass Casualty Terrorist Bombings: A Comparison of Outcomes by Bombing Type. Ann Emerg Med. 2004;43:263-73.

9. Kosashvili Y, Loebenberg MI, Lin G, et al. Medical consequences of suicide bombing mass casualty incidents: The impact of explosion setting on injury patterns. Injury, Int. J. Care Injured.2009; 698-702.

10. A.J. Hart AJ, Mannionb S, Earnshawc, Ward A. The London nail bombings: the St. Thomas' Hospital experience. Injury, Int. J. Care Injured 2003;34: 830-3.

11. Thompson D, Brown S, Mallonee S, Sunshine D. Fatal and non fatal injuries among U.S. Air force personnel resulting from terrorist bombing of the Khobar Towers. J Trauma. 2004;57:208-15.

12. Surani AA, Ali S, Surani A, et al. Pattern of external injuries sustained during bomb blast attacks in Karachi, Pakistan from 2000 to 2007. JPMA 2015;65:715-20.

13. Hull JB. Traumatic amputation by explosive blast: pattern of injuries in survivors. Br J Surg 1992;79:1303-06.

14. Patel HDL, Dryden S, Gupta A, Ang SC. Pattern and mechanism of traumatic limb amputations after explosive blast: Experience from the 07/07/05 London terrorist bombings. J Trauma Acute Care Surg. 2012;73:276-81.

15. Yavuz MS, Asirdizer M, Cetin G, et al. Deaths due to terrorist bombings in Istanbul (Turkey). J Clin Forensic Med 2004 Dec;11:308e15.

16. Mirza FH, Parhyar HA, Tirmizi SZA. Rising threat of terrorist bomb blasts in Karachi e A 5-year study. Journal of Forensic and Legal Medicine 2013;20:747-51.

17. Jaffe DH, Peleg K. Terror explosive injuries: a comparison of children, adolescents, and adults. Ann Surg. 2010;251:138-43.

18. Torkki M, Koljonen V, Sillanpää K, et al. Triage in a Bomb Disaster with 166 Casualties. Eur J Trauma 2006;32:374-80.

Kaynak Göster