Acil Servise Yılan Isırması Nedeniyle Başvuran Hastaların Demografik ve Klinik Özellikleri

Abstract

Amaç: Yılan zehirlenmeleri ciddi mortalite ve morbiditeye neden olabilir. Bu çalışmada Acil Tıp Kliniğine yılan ısırması tanısı ile başvuran hastaların hastaneye ulaşma süreleri, ısırılan bölgeleri, klinik evreleri, antivenom ihtiyacı ve dozları, hastanede kalış süreleri arasındaki ilişki ve kan biyokimyasındaki değişikliklerinin değerlendirilmesi amaçlandı.

Gereç ve Yöntem: Çalışmamıza Mart 2011- Haziran 2013 tarihleri arasında Adana Numune Eğitim Araştırma Hastanesi Acil Tıp kliniğine yılan ısırması şikayeti ile başvuran 34 hasta dahil edildi. Bu çalışmada Acil Tıp Kliniği’ne yılan ısırması tanısı ile başvuran hastaların hastaneye ulaşma süreleri, ısırılan bölgeleri, klinik evreleri, antivenom ihtiyacı ve dozları, hastanede kalış süreleri arasındaki ilişki ve kan biyokimyasındaki değişiklikler değerlendirildi.

Bulgular: Çalışmamızda Evre 0'da 9 (%26,5) hasta, Evre 1'de 5 (%14,7) hasta, Evre 2'de 17 (%50,0) hasta ve Evre 3'de 3 (%8,8) hasta olduğu saptandı. Klinik takiplerinde 24 saatten daha fazla süre hastanede kalan hastaların antivenom alma oranı ve antivenom miktarı 24 saatten daha az hastanede kalanlardan anlamlı olarak daha yüksekti. Çalışmamıza alınan hastalar evrelerine göre Evre 0-1 ve Evre 2-3 olarak iki gruba ayrılarak bu iki grubun aldıkları antivenom dozları karşılaştırıldı. Evre 2-3 olan gruptaki hastaların aldıkları ortalama antivenom dozu 4.15±2,06 iken, evre 0-1 grup hastalarda 1,83±1,17 olarak bulundu.

Sonuç: Yılan zehirlenmelerinde evrelemeye göre yüksek doz antivenom tedavisi önerilse de öncelikli olarak anlık yüksek doz yerine düşük doz antivenom tedavi ile başlanabilir ve klinik takibe göre ek doz antivenom tedavi uygulanabilir.

Keywords

• Yılan ısırması,antivenom,acil.

Demographic and Clinical Characteristics of Patients Presenting to the Emergency Department with Snakebite

Abstract

Objective: Snake poisonings can cause severe morbidity and mortality. In this study, it was aimed to evaluate arrival times of the patients admitted to the Emergency Medicine Department with a diagnosis of snakebite, bitten areas, clinical manifestations, the need for antivenom doses, the relationship between the length of hospital stay and changes in blood biochemistry.

Materials and Methods: The total number of 34 patients admitted to the Emergency Department of Adana Numune Education and Research Hospital between March 2011 and June 2013 were included in this study. In this study, arrival times of the patients admitted to the Emergency Medicine Department with a diagnosis of snakebite, bitten areas, clinical manifestations, the need for antivenom and their doses, the relationship between the length of hospital stay and changes in blood biochemistry were evaluated.

Results: In our study, 9 (26.5%) patients were grade 0, 5 (14.7%) patients, were grade 1, 17 (50.0%) patients were grade 2, 3 (8.8% ) patients were grade 3. In the clinical follow-up of the patients, the rate of antivenom uptake and the amount of antivenom in patients stay in the hospital for more than 24 hours were significantly higher than the ones that stay in the hospital less than 24 hours. In our study, patients were divided into two groups according to the stages with stage 0-1 and stage 2-3, and doses of antivenoms that they take were compared. The mean dose of antivenom in the group of patients with stage 2-3 was 4.15 ± 2.06, and this value was 1.83 ± 1.17 in patients with stage 0-1.

Conclusions: Despite high-dose antivenom therapy is recommended snake poisonings according to the staging, low-dose antivenom therapy should be considered instead of high-dose antivenom therapy and an additional dose of antivenom could be used according to the clinical follow-up.

Keywords

• antivenom,emergency,snakebite

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