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Acil koşullarda ağrı yönetimi ve analjezi uygulamaları

Management of pain and practice of analgesia in the emergency setting

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DOI: 
doi:10.2399/tahd.10.053

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Author NameFaculty of Author
Abstract (2. Language): 
Pain constitutes the vast majority of all referrals in the emergency setting per se. The present review is designed to discuss and enlighten the practice of analgesia, based on literature findings and our experiences. Pain is often viewed as an ill-defined, elusive and subjective condition to describe and interpret. It is also a behavioral pattern strongly affected by expectations and experiences. Pain is defined as a sensory and emotional experience deriving from any part of the body, in response to tissue injury or a related process. Nonetheless, the pathophysiology of acute pain is more clear-cut, easy to diagnose, and efficiently treated. However, many studies demonstrate that healthcare workers do not respond sensitively enough facing acute (emergency) or chronic pain. It is reported in many instances that waiting times for analgesia are unnecessarily longer than reasonable and most patients are treated with inade¬quate dosages (oligoanalgesia). The presence and severity of pain should be distinctly questioned by physicians and nurses, instead of trying to make estimations about it. There is no better instrument than the patients' self report to gauge the pain. The priority is to relieve the pain in the emergency management of pain in the emer¬gency setting. The management of pain should be instituted in the very beginning of the patients' admission and should include expe¬dient and proper treatment with right choice of analgesics.
Abstract (Original Language): 
Ağrı tüm sağlık sisteminde en sık acil başvuru nedenidir. Makalemizde literatür bilgilerinden ve deneyimlerimizden hareketle acil koşullarda önerilen analjezi uygulama pratiği tartışılmaktadır. Ağrı sübjektif, güç ve sıklıkla tanımlanması ve yorumlanması zor bir durumdur. Beklentiler ve deneyimlerden etkilenen bir davranış bi¬çimidir. Ağrı vücudun herhangi bir yerinden kaynaklanan, doku hasarına veya potansiyel doku hasarı ile birlikte olan ya da böyle bir hasar sürecinde tanımlanan duyusal ve emosyonel deneyim olarak tanımlanmıştır. Akut ağrı patofizyolojisi oldukça iyi anlaşılmıştır, tanısı zor değildir ve tedavi etkindir. Buna karşın birçok araştırmada hekim ve hemşirelerin hem acil durumlarda veya akut ağrıda, hem de kronik ağrı karşısında yeterince duyarlı davranmadıkları bildirilmiştir. Acil servislerde sıklıkla analjezi için bekletilme sürelerinin gereksiz uzadığı ve yetersiz dozda analjezik uygulandı¬ğı gösterilmiştir (oligoanaljezi). Acil hekim ve hemşireleri ağrının olup olmadığını tahmin etmeye çalışmak yerine mutlaka hastaya sormalıdırlar. Hastanın kendi ifadesi ağrı için en güvenilir göster¬gedir. Acil serviste ağrı yönetiminde ilk öncelik ağrıyı geçirmek ol¬malıdır. Ağrı yönetimi hastanın girişinde başlamalı ve uygun za¬manda doğru analjezik ilacın uygulanmasını içermelidir.

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