Terör Saldırısı Nedeniyle Ateşli Silah Yaralanmaları

Year 2019, Volume: 2 Issue: 1, 18 - 23, 31.03.2019

Nil Saylam , Bünyamin Uyanık Mesut Buz Tunç Büyükyılmaz Yasin Demir Deniz Algedik Gürsoy

Abstract

Amaç: Çalışmamızda, terör saldırısı sonrası acil servise başvuran ateşli silahla yaralanma olgularının literatür eşliğinde retrospektif olarak değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntem: Çalışmada 01.01.2016-31.12.2016 tarihleri arasında Şırnak Devlet Hastanesi Acil Servise başvuran 114 terör vakası retrospektif olarak incelendi. Hastaların cinsiyeti, yaşı, vital bulguları, travma skorları, yaralanma yerleri, yaralanma sonucu oluşan patolojiler, tedavi yöntemleri ve mortalite oranları incelendi.

Bulgular: Çalışmaya %84,2’si erkek olmak üzere 114 hasta dahil edildi. Hastaların yaş ortalaması 26,88 ± 11,08 idi. En sık yaralanma yeri alt ekstremite (%53,5) olarak tespit edildi. Mortalite oranı %15,78 (n=18) bulunurken, arrest olarak getirilen ve KPR uygulanan hastalarda (n=13) bu oran %100 idi. Ölen hasta grubunda en ölümcül yaralanma yerlerinin sol toraks (%44,5) ve batın sol alt kadran olduğu gözlendi (%16,7). Hastaların %26,31’ine cerrahi tedavi, %6,14’üne tüp torakostomi, %17,5’ine mekanik ventilasyon ve %21,05’ine kan transfüzyonu uygulandığı tespit edildi. Birden fazla bölgede yaralanma olması, total sağkalım üzerinde 60,045 kat risk oluşturduğu tespit edildi.

Sonuç: Terör mağdurlarının çoğunluğunu erkeklerin oluşturduğu, sol toraks ve sol batın bölgelerindeki yaralanmalarda mortalite oranının daha yüksek olduğu ve hastaneye kardiyopulmoner arrest olarak getirilenlerde mortalite oranının %100 olduğu tespit edildi.

Keywords

terör, travma, acil servis, ateşli silah

Gunshot Injuries Due to Terror

Abstract

Aims: In our study, it is aimed to evaluate retrospectively with literature the cases of gunshot injury cases who applied to the emergency department due to the terror attack.

Materials and Methods: In this study, 114 terror cases admitted to the emergency department of Şırnak State Hospital between 01.01.2016 and 31.12.2016 were evaluated retrospectively. The gender, age, vital signs, trauma scores, injury sites, pathologies of the injuries, treatment methods and mortality rates were examined.

Results: In the study 114 patients who 84.2% were male were included. The mean age of patients was 26.88 ± 11.08.The most common injury was the lower extremity (53.5%). The mortality rate was found to be 15.78% (n = 18), while this rate was 100% in patients who were brought into arrest and applied CPR (n = 13). The most fatal injuries were left thorax (44.5%) and left lower quadrant (16.7%) in the group of patients who died. It was detected 26.31% surgical treatment, 6.14% tube thoracostomy, 17.5% mechanical ventilation and 21.05% blood transfusion were applied to the patients. In more than one area injury was detected 60.045 times the risk of total survival.

Conclusion: The majority of the victims of terrorism were men, the mortality rate was higher in the left thorax and left abdomen and the mortality rate was 100% as brought to the hospital as cardiopulmonary arrest.

Keywords

Terror, trauma, emergency department, gunshot

References

• Referans1. Hoyt DB, Potenza BM, Cryer HG, et al. Trauma. In: Greenfield LJ, Mullholland MW, Oldham KT, Zelenock GB, Lilimoe KD eds. Surgery:Scientific Principles and Practise. 2nd edn. Philadelphia: Lippincott-Raven, 1997:267–421Referans2. Trunkey DD. Trauma. Accidental and intentional injuries account for more years of life lost in the U.S. than cancer and heart disease. Among the prescribed remedies are improved preventive efforts, speedier surgery and further research. Sci Am 1983;249:28-35.Referans3. Feliciano DV. Patterns of injury. In: Feliciano DV, Moore E, Mattox KL, eds. Trauma. Connecticut: Stamford, 1996:85-l05.Referans4. Emircan S, Ozgüç H, Akköse Aydın S, Ozdemir F, Köksal O, Bulut M. Factors affecting mortality in patients with thorax trauma. Ulus Travma Acil Cerrahi Derg. 2011 Jul;17(4):329-33.Referans5. Graham JM, Mattox KL, Beall AC Jr. Penetrating trauma of the lung. J Trauma 1979;19:665-9.Referans6. Erdik O, Karasu S, Haberal İ, Büyükdoğan V, Ersöz N, Sanal HT. Our surgical experience with thoracic gunshot injuries: evaluation of 258 patients. Turkish Journal of Thoracic and Cardiovascular Surgery, 15(1), 059-063.Referans7. Boon JM, Asobayire WM. Gun shot injuries-an analysis of an epidemic in a South African secondary level public sector hospital, Geneeskunde. The Medicine Journel. 2001: 43: 16-19.Referans8. Köksal O, Ozdemir F, Bulut M, Aydin S, Almacioğlu ML, Ozgüç H. Comparison of trauma scoring systems for predicting mortality in firearm injuries. Ulus Travma Acil Cerrahi Derg 2009;15:559–64.Referans9. Peleg K, Aharonson-Daniel L, Stein M, Michaelson M, Kluger Y, Simon D, et al. Gunshot and explosion injuries: characteristics, outcomes, and implications for care of terror-related injuries in Israel. Ann Surg 2004;239:311–8.Referans10. Eriş S, Orak M, Al B, Güloğlu C, Aldemir M. Factors Affectıng Mortalıty In Patıents Wıth Gunshot Injurıes. Marmara Medical Journal 2009;22;181–91.Referans11. Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Uribe P, Mallett O, Zubko T, Oetjen-Gerdes L, Rasmussen TE, Butler FK, Kotwal RS, Holcomb JB, Wade C, Champion H, Lawnick M, Moores L, Blackbourne LH. Death on the battlefield (2001-2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012 Dec;73(6 Suppl 5):S431-7.Referans12. Holcomb JB, Wade CE, Michalek JE, Chisholm GB, Zarzabal LA, Schreiber MA, Gonzalez EA, Pomper GJ, Perkins JG, Spinella PC, Williams KL, Park MS. Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. Ann Surg. 2008 Sep;248(3):447-58.Referans13. Eryılmaz M, Tezel O, Taş H, Arzıman I, Oğünç GI, Kaldırım U, Durusu M, KozakO. The relationship between Injury Severity Scores and transfusion requirements of 108 consecutive cases injured with high kinetic energy weapons: a tertiary center end-mode mortality analysis]. Ulus Travma Acil Cerrahi Derg. 2014 Jan;20(1):39-44.Referans14. Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Bierens JJ, Brugger H, Deakin CD, Dunning J, Georgiou M, Handley AJ, Lockey DJ, Paal P, Sandroni C, Thies KC, Zideman DA, Nolan JP. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia,hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation. 2010 Oct;81(10):1400-33.