Karbonmonoksit zehirlenmesi nedeniyle 2014-2018 yılları arasında Selçuk Üniversitesi Tıp Fakültesi acil servisine başvuran olguların adli tıp açısından değerlendirilmesi
Yükleniyor...
Dosyalar
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Karbonmonoksit (CO), hidrokarbon içeren maddelerin tam olarak yanmamasıyla ortaya çıkan renksiz, kokusuz ve tatsız bir gazdır. CO gazı birçok mekanizma ile hayatı tehdit edecek boyutta zehirlenmelere neden olabilir. CO zehirlenmesi, acil servise başvuran zehirlenme olguları arasında en sık görülenlerden biridir. Türkiye'de CO zehirlenmesine bağlı 2008-2018 yılları arasındaki on yıllık dönemde, 2667 ölüm olgusu bildirilmiştir. Tüm diğer zehirlenme olguları gibi CO zehirlenmeleri de adli olarak değerlendirilmesi gereken olgular niteliğindedir. Adli olgularla karşılaşıldığı durumlarda, durumun adli makamlara ihbar edilmesi ve rapor düzenlenmesi, hekimlerin temel görev ve sorumluluklarından birisidir. Adli olgularla karşılaşıldığında düzenlenen ilk raporlardaki eksiklikler ve hatalar geri dönüşümsüz sonuçlar doğurabilmektedir. Bu çalışmada CO zehirlenmesi nedeniyle acil servise başvuran olguların adli tıbbi açıdan değerlendirilmesi amaçlanmıştır. Çalışmamızda CO zehirlenmesi nedeniyle acil servise başvuran 350 olgu değerlendirmeye alınmıştır. Olguların 171'i (%48,9) erkek, 179'u (%51,1) kadındır. Başvuranların 266'sı (%76) erişkin yaş grubu iken, 84'ü (%24) çocuk yaş grubunda idi. En sık başvuru yapılan ay 83 (%23,7) olgu ile ocak ayı iken en sık başvuru yapılan mevsim 192 (%54,9) olgu ile kış mevsimi idi. Zehirlenmelerin en sık 140 (%40) olgu ile soba ve 90 (%25,7) olgu ile yangın kaynaklı olduğu bulunmuştur. Acil serviste düzenlenen adli raporlar değerlendirildiğinde, 255'ine (%72,9) kati rapor, 41'ine (%11,7) geçici rapor düzenlendiği görülmüştür. Olguların 54'üne (%15,4) adli rapor düzenlenmediği tespit edilmiştir. Düzenlenen adli raporlar "Türk Ceza Kanunu'nda Tanımlanan Yaralama Suçlarının Adli Tıp Açısından Değerlendirilmesi Rehberi" eşliğinde tekrar değerlendirildiğinde 123'üne (%35,1) yanlış karar verildiği, 172'sine (%49,1) doğru karar verildiği tespit edilmiştir. Yanlış olarak düzenlendiği tespit edilen raporların 83'ünde (%67,4) BTM ve yaşamsal tehlike kararlarının her ikisinin de yanlış olarak değerlendirildiği, raporların 145'inde (%84,3) COHb seviyesinin belirtilmediği saptanmıştır. Çalışmada, acil servis hekimlerinin adli olgulara yaklaşım ve adli rapor düzenleme hususlarında bilgi düzeyinin artırılması ve ilgili kılavuzun basılı materyal halinde her acil serviste bulunmasının adli raporların daha objektif düzenlenmesine katkı sağlayacağı kanaatine varılmıştır.
Carbon monoxide (CO) is a colorless, odorless and tasteless gas produced by the incomplete combustion of hydrocarbon-containing substances. CO can cause life-threatening poisoning with many mechanisms. CO poisoning is one of the most common among poisoning cases admitted to the emergency room. 2667 death cases in the ten-year period between 2008 to 2018 years of CO intoxication have been reported in Turkey. Like all other poisoning cases, CO poisonings are cases that should be evaluated as forensic. When forensic cases are encountered, reporting the situation to judicial authorities and preparing reports is one of the primary duties and responsibilities of physicians. Deficiencies and errors in the first reports issued when forensic cases are encountered can lead to irreversible results. In this study, it was aimed to evaluate forensic medical cases of patients who admitted to the emergency department due to CO poisoning. In this study, 350 cases who admitted to the emergency department due to CO poisoning were evaluated. 171 (48.9%) of the cases were male and 179 (51.1%) were female. 266 (76%) of the cases were in adult age group and 84 (24%) were in child age group. The month with the most admissions was January with 83 (23.7%) cases, and the season with the most admissions was winter with 192 (54.9%). The month with the most admissions was January with 83 (23.7%) cases, and the season with the most admissions was winter with 192 (54.9%) cases. It was found that poisonings were most frequently caused by stoves with 140 (40%) cases and fire with 90 (25.7%) cases. Intoxications were found to be most frequently caused by 140 (40%) stoves and 90 (25.7%) fires. It was seen that the forensic reports prepared in the emergency service were 255 (72.9%) as final reports and 41 (11.7%) were provisional reports. It was determined that 54 (15.4%) cases did not have forensic reports. In the assessment made with the "Guide to the Evaluation of Injury Crimes Defined in Turkish Criminal Law in terms of Forensic Medicine" of the forensic reports prepared, it was determined that decisions in 123 (35.1%) reports were incorrect, and in 172 (49.1%) reports decisions were correct. It was found that in 83 (67.4%) of the reports that were found to be prepared incorrectly, both basic medical intervention and life threatening decisions were evaluated incorrectly. In 145 (84.3%) reports, it was found that the level of COHb was not specified. In the study, it was concluded that increasing the level of knowledge about the perspective to forensic cases and forensic report preparation of the emergency physicians and the presence of printed material of related guide in each emergency room will contribute to more objective arrangement of forensic reports.
Carbon monoxide (CO) is a colorless, odorless and tasteless gas produced by the incomplete combustion of hydrocarbon-containing substances. CO can cause life-threatening poisoning with many mechanisms. CO poisoning is one of the most common among poisoning cases admitted to the emergency room. 2667 death cases in the ten-year period between 2008 to 2018 years of CO intoxication have been reported in Turkey. Like all other poisoning cases, CO poisonings are cases that should be evaluated as forensic. When forensic cases are encountered, reporting the situation to judicial authorities and preparing reports is one of the primary duties and responsibilities of physicians. Deficiencies and errors in the first reports issued when forensic cases are encountered can lead to irreversible results. In this study, it was aimed to evaluate forensic medical cases of patients who admitted to the emergency department due to CO poisoning. In this study, 350 cases who admitted to the emergency department due to CO poisoning were evaluated. 171 (48.9%) of the cases were male and 179 (51.1%) were female. 266 (76%) of the cases were in adult age group and 84 (24%) were in child age group. The month with the most admissions was January with 83 (23.7%) cases, and the season with the most admissions was winter with 192 (54.9%). The month with the most admissions was January with 83 (23.7%) cases, and the season with the most admissions was winter with 192 (54.9%) cases. It was found that poisonings were most frequently caused by stoves with 140 (40%) cases and fire with 90 (25.7%) cases. Intoxications were found to be most frequently caused by 140 (40%) stoves and 90 (25.7%) fires. It was seen that the forensic reports prepared in the emergency service were 255 (72.9%) as final reports and 41 (11.7%) were provisional reports. It was determined that 54 (15.4%) cases did not have forensic reports. In the assessment made with the "Guide to the Evaluation of Injury Crimes Defined in Turkish Criminal Law in terms of Forensic Medicine" of the forensic reports prepared, it was determined that decisions in 123 (35.1%) reports were incorrect, and in 172 (49.1%) reports decisions were correct. It was found that in 83 (67.4%) of the reports that were found to be prepared incorrectly, both basic medical intervention and life threatening decisions were evaluated incorrectly. In 145 (84.3%) reports, it was found that the level of COHb was not specified. In the study, it was concluded that increasing the level of knowledge about the perspective to forensic cases and forensic report preparation of the emergency physicians and the presence of printed material of related guide in each emergency room will contribute to more objective arrangement of forensic reports.
Açıklama
Anahtar Kelimeler
Karbonmonoksit, Adli Tıp, Adli Rapor, Acil Servis, Zehirlenme, Carbon Monoxide, Forensic Medicine, Forensic Report, Emergency Service, Poisoning
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Doğan, A. (2020). Karbonmonoksit zehirlenmesi nedeniyle 2014-2018 yılları arasında Selçuk Üniversitesi Tıp Fakültesi acil servisine başvuran olguların adli tıp açısından değerlendirilmesi. (Uzmanlık Tezi). Selçuk Üniversitesi, Tıp Fakültesi, Konya.
