Deprem Sonrasý Crush Yaralanmalý Hastalarýn Ortopedi Kliniklerinde Ýzlenmesi

Kartal Eðitim ve Araþtýrma Hastanesi 1. Ortopedi kliniðinde yatýrýlarak tedavi gören; 17 Aðustos depremindeki 98 hastanýn ve 12 Kasým Düzce depremindeki 22 hastanýn genel verileri ile bu hastalardan Crush yaralanmalý hastalarýn klinikte izlenmesine ait bulgular deðerlendirilmiþtir. Crush yaralanmalý hastalan, fasiotomi yapýlanlar ve fasiotomi yapýlmadan izlenenler olarak iki grupta deðerlendirdik. Bu hastalarda; l-Genel medikal durum, 2-Böbrck fonksiyonlarý ve sývý-elektrolit düzeylerinin izlenmesi 3-Fasiotomili olgularýn yara bakýmý 4-Ekstrcmitcnin durumunun izlenmesi öne çýkmaktadýr. Göçük altýndan çýkarýlan ekstremi tenin, tahrip olan kasýnýn, yýkým ürünleri myoglobin'in böbreklerde hasar meydana getirmeden yeterli ve alkali diürezin saðlanmasý ile Crush Sendromunu önlemek mümkündür. Erken ve yeterli sývý replasmaný yapýlmasý, verilen sývý miktarý ile çýkarýlan sývýnýn izlenmesi gereklidir, Crush Sendromu geliþen olgularýn Nefrologlarla beraber izlenmesinde ve diðer medikal-sosyal problemlerinin çözümü, gerekli iþlemlerin takibi hayati öneme sahiptir. Fasiotomi yapýlan olgularýn günlük yara bakýmý, aldýðý- çýkardýðý sývý miktarýnýn izlenmesi, yine bu hastalarýn böbrek fonksiyonlarýnýn izlenmesi ve dializ gerektiren olgularýn tedavilerinin aksatýlmadan yapýlmasý önemlidir. Bu hastalarda ayrýta, hiperbarik oksijen tedavisi, psikiyatrik problemlerin çözümü, sosyal iliþkilerin saðlanmasý ile tedavi için gerekli malzemenin tesbiti ve saðlanmasý gibi problemlerle karþýlaþýlmýþtýr. Kitlesel yaralanmalarda felaketin çapý ile deðiþmek üzere bu problemlerin çözümünde önceden verilen kalýplarýn ne kadar geçerli olduðu tartýþmalýdýr. Ancak bu tür deneyimlerin aktarýlmasýnda yarar olduðu düþüncesiyle bu çalýþmayý yaptýk.

Follow Up Of Patients With Crush Injuries Due To Earthquake Ýn Orthopaedics And Traumatology Clinics

Results of the clinical following of 120 patients, who had crush injuries Ýncured during earthquakes that took place on 17th August 1999 (98 patients) and 12th November 1999 (22 patients), had been evaluated. Patients with crush injuries wcre dividcd into two groups: those who had fasciotomy and those without a fasciotomy. in these patients one must follow (1) general health status and vital functions, (2) renal function and fluid-electrolyte balance, (3) fasciotomy site, (4) vascular and neurologic status of the extremity. it is possible to avoid crush syndrome, if we can help the patients in the excretion of mynglobin that is released from the muscles of the injured extremity. This necessitates early and adequate fluid replacement, with a special emphasis on strict follow up of the fluid regimen. Ýn the treatment of patients who had developed crush syndrome, ncphrologists must be ineluded in the follow up team. Wound çare of patients who had fasciotomi, follow up of renal function and fluid-electrolyte balance and an uninterrupted regimen for patients who need dialysis are the eritical issues in the primary çare uf these patients. On the other hand, hyperbaric oxygen treatment, psychiatrie diseases, restoratiou of social relations and supplying the necessary materials for the treatment of patients )In extretne conditions such as earthquakes are the other difficult problems waiting for a solution. it is not clear whether predetermined treatment protocols can be applied in disaesters successfully. At least they can serve as a guide. We found it useful to share our experience with the others.