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

Yıl 2020, Cilt: 42 Sayı: 1, 93 - 102, 01.01.2020

Sermet Sezigen Levent Kenar

https://doi.org/10.20515/otd.521664

Cited By: 2

Öz

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 15^th
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 15^th
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.

Anahtar Kelimeler

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

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

Öz

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

Kaynakça

• Kaynaklar
• 1. Ortatatlı M, Sezigen S, Ayan HA, Balandız H, Kenar L. Terörizm kapsamında kimyasal, biyolojik, nükleer ve radyasyona bağlı yaralanmaların değerlendirilmesi. Turkiye Klinikleri J Foren Med-Special Topics. 2015;1(2):44-52.
• 2. Kehe K, Szinicz L. Medical aspects of sulphur mustard poisoning. Toxicology. 2005;214:198-209.
• 3. Romano JA, Lukey BJ, Salem H. Chemical warfare agents: chemistry, pharmacology, toxicology, and therapeutics, 2th ed, Taylor&Francis;2007.
• 4. Balali-Mood M, Hefazi M. The pharmacology, toxicology, and medical treatment of sulphur mustard poisoning. Fundamental & Clinical Pharmacology. 2005;19:297-315.
• 5. Kehe K, Thiermann H, Balszuweit F, eyer F, Steinritz D, Zilker T. Acute effects of sulfur mustard injury-Munich experiences. Toxicology. 2009; 263: 3-8.
• 6. Sezigen S, Karayılanoğu T. Kimyasal savaş ajanlarının solunum sistemine etkileri ve tedavi yaklaşımları. Türk Hij Den Biyol Derg. 2006;63(1-3):129-34.
• 7. Thiermann H, Worek F, Kehe K. Limitations and challenges in treatment of acute chemical warfare agent poisoning. Chemico-biological interactions. 2013;206:435-443.
• 8. Mood MB, Abdollahi M. Basic and clinical toxicology of mustard compounds. Springer;2015.
• 9. Steinritz D, Striepling E, Rudolf KD, Schröder-Kraft C, Püschel K, Hullard-Pulstinger A, et al. Medical documentation, bioanalytical evidence of an accidental human exposure to sulfur mustard and general therapy recommendations. Toxicol Lett. 2016;244:112-20.
• 10. Mood BM, Mathews R, Pita R, Rice P, Romano J., Theirman H, Willems J. Practical guide for medical management of chemical warfare casualties. Organisation for the Prohibition of Chemical Weapons, International Cooperation and Assistance Division, Assistance and Protection Branch; 2016.
• 11. Schmidt A, Steinritz D, Rudolfd KD, Thiermann H, Strieplingd E. Accidental sulfur mustard exposure: a case report. Toxicology Letters. 2018;293:62–66.
• 12. Kilic E, Ortatatli M, Sezigen S, Eyison RK, Kenar L. Acute intensive care unit management of mustard gas victims: the Turkish experience. Cutaneous and ocular toxicology. 2018;37(4):332-337.
• 13. Sezigen S, Ivelik K, Ortatatli M, Alamacioglu M, Demirkasimoglu M, Eyison RK, et al. Victims of chemical terrorism, a family of four who were exposed to sulfur mustard. Toxicol Lett. 2018;303:9-15.
• 14. AA [Internet]. Iraqi Turkmen mustard gas victims in Turkish hospital [cited 2019 Feb 01]. Available from : https://www.aa.com.tr/en/middle-east/iraqi-turkmen-mustard-gas-victims-in-turkish-hospital/627685
• 15. Goverman J, Montecino R, Ibrahim A, Sarhane KA, Tompkins RG, Fagan SP. Sulfur mustard gas exposure: case report and review of the literature. Ann Burns Fire Disasters. 2014;27(3):146-50.