Yüzde 87 Yanıklı Hastaya Yaklaşım: Olgu Sunumu

Year 2014, Volume: 22 Issue: 1, 22 - 29, 01.04.2014

Fırat Özer Gökçen Garipoğlu Demirhan Dal Fatih Zor Sevgi Kara Emine Günal Selçuk Işık

Abstract

Majör yanıklı hastaların tedavilerinde, mortalite ve morbidite oranı yüksek olduğundan multidisipliner bir yaklaşım gerektirmektedir. Bu çalışmada, 2010 yılında GATF Yanık Merkezi’nde, %87 yanık yüzdesi ile takip edilmiş bir olguya tedavi yaklaşımımız sunulmuştur. Yanık sonrası birinci günde yanık merkezimize kabul edilen hastaya %87 alev ve inhalasyonu yanığı tanısı kondu. İlk değerlendirmeyi takiben sıvı resüsitasyonuna başlandı. Günlük yara bakımı yapılan hastada otogreftleme ve otohomogreftleme ameliyatları yapılarak yanık alanları kapatıldı. Ampirik antimikrobiyal tedavi başlanan hastada, kan kültürlerinde Acinetobacter baumannii ve Candida parapsilosis tespit edilmesi üzerine selektif antibakteriyel ve antimikotik tedaviler uygulandı. Hasta yanık sonrası 3. günden itibaren mekanik ventilatörde takip edildi ve yanık sonrası 87. günde mekanik ventilatörden ayrıldı. Hastaya erken dönemde kontraktür ve deformiteleri önlemeye yönelik, geç dönemde ise ambulasyon ve fonksiyonel hareketlerin tekrar kazanılmasına yönelik rehabilitasyon uygulandı. Hasta yanık sonrası 157. günde şifa ile taburcu edildi. Hasta yanık sonrası ilk yılda 2 ayda bir, sonraki iki yılda 6 ayda bir kontrollere çağrıldı. Sosyal yaşamına yardımsız devam eden hastada herhangi bir komplikasyon gelişmedi. Majör yanıklar, mortalite ve morbidite oranı yüksek olan travmalardır. Tedavilerinde uygun sıvı resüsitasyonu, yanık alanlarının bakımı, cerrahi tedavi ile yanık alanlarının kapatılması gibi ana tedavilerinin yanında; sepsis ve enfeksiyon ile mücadele, inhalasyon yaralanmasının tedavisi, beslenme desteği ve rehabilitasyon gibi ek tedavilere de gereksinim vardır. Bu nedenle majör yanıklı hastaların tedavilerinde, multidisipliner yaklaşım hasta sağ kalım oranını arttıran önemli bir tedavi prensibidir.

Keywords

Majör yanık, multidisipliner yaklaşım, morbidite

Management of the Patient with 87% TBSA Burn: Case Report

Abstract

Treatment of the major burn patient requires multi- disciplinary approach because of the high mortality and morbidity rates. In this study the management of the patient with 87% TBSA burn is presented. The patient diagnosed as 87% flame and inhalation burn was hospitalized at the first post burn day. Fluid resuscitation was begun after first evaluation. The burn area which was preformed dressing daily could be closed with autograting and auto-homografting. The patient, who was performed with empirical antibacterial treatment, was treated with antibacterial and antimicotic after Acinetobacter baumannii and Candida parapsilosis were determined with blood culture. He was begun to be received mechanic ventilation since at the post burn 3th day and he was extubated at the post burn 87th day. Rehabilitation which was performed to prevent contracture and deformities in the early stage and it was sustained for ambulation and regain the functional motions. He was discharged at the post burn 157th day. We control the patient two months interval at the first year and six months intervals at the latter two years. No complication was seen and he maintained his social life without any help. Major burn as a trauma, has high mortality and morbidity rates. It requires additional treatments like prevention sepsis and infection, treatment of inhalation injury, nutrition and rehabilitation as well as fundamental treatment like fluid resuscitation, wound dressing and surgical treatment. For this reason multi- disciplinary approach is crucial principal of the treatment for increasing survival rate.

Keywords

major burn, multidisciplinary approach, mortality

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