Akut ekstremite travmalı olgularda analjezi uygulaması ve eğitimin etkisi
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Tarih
2012
Yazarlar
Akarca, Funda Tarbek
Karcıoğlu, Özgür
Korkmaz, Tanzer
Erbil, Bülent
Demir, Ömer Faruk
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve amaç: Çeşitli çalışmalarda acil hekimlerinin genellikle hastaların ağrısına olması gerekenden daha az önem verip daha az müdahale ettikleri belirtilmiştir. Bu çalışmada amaç acil servise akut ağrı ile başvuran yetişkin ekstremite travmalı hastalarda acil tıp asistanlarının analjezi uygulama davranışlarının eğitimle kısa dönemde nasıl ve ne boyutta etkilendiğini araştırmaktır. Yöntem: : İki ay içinde acil servise akut ağrı ile başvuran 18 yaş üstü, ekstremite travmalı tüm olgular çalışmaya alındı. Başvuru sırasında triajda olgunun ağrı düzeyi sorulup Numeric Rating Scale (NRS) ile işaretlendi. Hastaların gelişinden itibaren 30. ve 60. dakikalarda NRSler'i belirlendi. Son olarak hastanın çıkış NRS’si, son tanısı kaydedildi. Bir ay süresince veriler toplandıktan sonra toplam 4 saat olmak üzere ilişkili konularda eğitim verildi. Eğitim sonrası 30 gün süresince aynı veriler tekrar toplandı. Dönemler arası karşılaştırmalar yapıldı. Bulgular: Eğitim öncesi dönemde alınan 143 hastanın %56.6’sını (n=81), eğitim sonrası dönemde ise 130 hastanın %44.6’sını (n=58) kadınlar oluşturdu. Kadınların başvuru NRS ortalamaları erkeklere göre anlamlı olarak yüksek bulundu (sırasıyla 7.4±2.3 ve 6.7±2.5) (p=0.020). Eğitim sonrası dönemde çalışmaya alınan hastalara (n=91; %70.0) eğitim öncesine (n=61; %42.7) göre anlamlı olarak daha fazla analjezi uygulandığı (p<0.001) ve uygulama sürelerinin de eğitim sonrası dönemde (ortalama 19.3±8.3 dk) eğitim öncesine göre (ortalama 41.3±27.6 dk) anlamlı olarak azaldığı saptandı (p<0.001). Hastalara ikinci dönemde 30 dk içinde analjezi uygulamasında artma görüldü ve yine ikinci dönemde tüm hastalara analjezi uygulamaları bir saat içinde yapılmıştı. Sonuç: Dört saatlik eğitim programı sonucunda acil tıp asistanlarının ağrı yönetimindeki davranışlarında belirgin fark oluşmuştur. Eğitim sonrasında analjezi uygulama oranları artarken uygulama süreleri kısalmıştır.
Introduction: Studies indicate that emergency physicians (EP) underevaluated and undertreated pain their patients experienced. The objective of this study is to investigate how EPs treat pain in adult patients with limb teauma and if their behavior could be affected by training in the short term. Methods: All consecutive adult patients admitted to the University-based emergency department (ED) within two months were enrolled to the study. The patients were asked to rate their level of pain on NRS in triage. NRS scores was noted again in 30th, 60th minutes and on discharge. Their prescriptions were also tracked regarding presence of analgesics. After completion of the pre-education phase, four hours of training covering the area were undertaken by experienced staff faculty. After the same sort of data were abstracted in another 30 days, comparisons between the periods were carried out. Results: A hundred and forty-three patients (81 female) were enrolled in the pre-education phase while 130 (58 female) were eligible in the post-education phase. Mean NRS scores of females noted on admission were significantly higher than of males (7.4±2.3 vs. 6.7±2.5, respectively) (p=0.020). Patients included in the first phase received analgesia less frequently (42.7% vs. 70.0%, respectively) (p<0.001). Mean period passed between admission and the initial analgesic administration was shorter in the second phase (41.3 vs. 19.3 minutes, respectively) (p<0.001). The ratio of patients receiving analgesia within thirty minutes was greater after training. Concurrently, all patients in the second phase received analgesia within 60 minutes. The residents prescribed analgesics more frequently after training. Conclusion: A four-hour training programme resulted in apparent changes in the residents' management of pain in patients with extremity trauma. In addition to a more timely administration, the rates of analgesic treatment increased.
Introduction: Studies indicate that emergency physicians (EP) underevaluated and undertreated pain their patients experienced. The objective of this study is to investigate how EPs treat pain in adult patients with limb teauma and if their behavior could be affected by training in the short term. Methods: All consecutive adult patients admitted to the University-based emergency department (ED) within two months were enrolled to the study. The patients were asked to rate their level of pain on NRS in triage. NRS scores was noted again in 30th, 60th minutes and on discharge. Their prescriptions were also tracked regarding presence of analgesics. After completion of the pre-education phase, four hours of training covering the area were undertaken by experienced staff faculty. After the same sort of data were abstracted in another 30 days, comparisons between the periods were carried out. Results: A hundred and forty-three patients (81 female) were enrolled in the pre-education phase while 130 (58 female) were eligible in the post-education phase. Mean NRS scores of females noted on admission were significantly higher than of males (7.4±2.3 vs. 6.7±2.5, respectively) (p=0.020). Patients included in the first phase received analgesia less frequently (42.7% vs. 70.0%, respectively) (p<0.001). Mean period passed between admission and the initial analgesic administration was shorter in the second phase (41.3 vs. 19.3 minutes, respectively) (p<0.001). The ratio of patients receiving analgesia within thirty minutes was greater after training. Concurrently, all patients in the second phase received analgesia within 60 minutes. The residents prescribed analgesics more frequently after training. Conclusion: A four-hour training programme resulted in apparent changes in the residents' management of pain in patients with extremity trauma. In addition to a more timely administration, the rates of analgesic treatment increased.
Açıklama
Anahtar Kelimeler
Acil Tıp Eğitimi, Ağrı Yönetimi, Travma, Emergency Medicine Education, Pain Management, Trauma
Kaynak
Türkiye Acil Tıp Dergisi
Turkish Journal of Emergency Medicine
Turkish Journal of Emergency Medicine
WoS Q Değeri
Scopus Q Değeri
Q3
Cilt
12
Sayı
2
