Hardal Gazına Maruz Kalmış Kimyasal Yaralıların Tıbbi Yönetiminin Retrospektif Değerlendirilmesi ve Öneriler

Sülfür mustard (hardal gazı) yakıcı harp maddeleri grubunda yer alan kimyasal bir silahtır. Bu kimyasal silah; güçlü bir yakıcı ajan olmasının yanı sıra sitostatik, mutajenik ve sitotoksik etkilere sahiptir. Bu çalışmanın amacı; kimyasal bir saldırı sonucu hardal gazına maruz kalan dört yaralının belirti ve bulgularını, detaylı klinik seyirlerini, uygulanan tedavi yaklaşımlarını incelemek ve hardal gazı maruziyetinde uygulanan tıbbi yönetime ilişkin tecrübeleri paylaşmaktır.09 Mart 2016 tarihinde Irak’ın Kerkük şehri yakınlarında bulunan Tuzhurmatu kasabasına kimyasal bir saldırı düzenlenmiştir. Bu saldırı sonucu ortama yayılan hardal gazına maruz kalan dört yaralı; olaydan 15 gün sonra Ankara’daki bir devlet hastanesinde tedavi altına alınmıştır. Hastaların yapılan detaylı fizik muayenelerinde çift taraflı konjunktivit, gözlerde yanma, fotofobi, genizde yanma ve ağrı, yutma güçlüğü, burun akıntısı ve balgamlı öksürük tespit edilmiştir. Hastaların yapılan cilt muayenelerinde özellikle üst ve alt ekstremiteler başta olmak üzere tüm vücut yüzeylerinde birinci/ikinci derece yanık sekelleri ile hipo ve hiperpigmente alanlar izlenmiştir. Maruziyetten sonraki 15. günde dört hastadan elde edilen detaylı fizik muayene bulguları ve tipik maruziyet hikayeleri kapsamında, söz konusu hastaların Irak’ta düzenlenen kimyasal terörist saldırıda hardal gazına maruz kaldıkları değerlendirilmiştir. Bu hastaların tıbbi yönetiminde semptomatik bir tedavi yaklaşımı uygulanmıştır. Kimyasal yaralıların tıbbi yönetiminde bilgi, kritik altyapı, planlama ve personel anlamında hazırlıklı olmak her sağlık tesisi için mutlak bir zorunluluktur.

Anahtar Kelimeler:

Azotlu mustard, hardal gazı, kimyasal terörizm, kimyasal yaralı, dekontaminasyon

Retrospective Evaluation of Medical Management of Chemical Casualties Who were Exposed to Sulfur Mustard and Recommendations.

Sulfur mustard (mustard gas) is a vesicant chemical warfare agent. Besides it’s vesicant properties, mustard gas has also cytostatic, mutagenic, and cytotoxic effects. The aim of this study was to investigate signs and symptoms, detailed clinical picture, treatment modalities in four casualty who were exposed to mustard gas and to share experience on medical management of victims who were exposed to mustard gas. A chemical terrorist attack which was organized by non-state actors hit Tazahurmatu, a district of Kerkuk, Iraq on March 09, 2016. Four patient who were exposed to mustard gas during the terrorist attack were hospitalized in Turkey at the 15th day after the exposure. Bilateral conjunctivitis, soreness, photophobia, sore throat, dysphagia, rhinorrhea, and productive coughing were noted during the detailed physical examination of four patient. Additionally, both first and second-degree burn scars and hypo/hyperpigmented areas were observed in the whole-body surfaces of four patients, especially in the upper and lower extremities. In consideration of detailed medical examinations of four patient at 15th day after the exposure and typical medical histories of the exposure, it was concluded that four patients were exposed to mustard gas during the chemical terrorist attack in Iraq. Symptomatic treatment approach was performed for the medical management of these patients. Prepardness of health facilities in mean knowledge, critical infrastructure, planning, and personnel is essential for the medical management of chemical casualties.

Keywords:

sulfur mustard, mustard gas, chemical terrorism, chemical casualty, decontamination,

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Kaynaklar
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