Acil Serviste Eksite Hasta Yönetimi
Özet
Acil serviste eksite (ajite) hastaların yönetimi hem tıbbi hem de çalışan güvenliği açısından ciddi zorluklar barındırır ve hızlı değerlendirme, güvenlik önlemleri, uygun farmakolojik tedavi ve sürekli izlemeyi gerektiren çok yönlü bir yaklaşım gerektirir. Ajitasyon, genellikle madde bağımlılığı, psikiyatrik hastalıklar ve enfeksiyonlar gibi nedenlere bağlı olarak sıkça karşılaşılırken, eksite deliryum sendromu özellikle stimülan madde kullanan genç, obez erkeklerde yaygındır. Bu sendrom, dopaminerjik ve adrenerjik sistemlerdeki bozukluklarla ilişkilidir. Klinik belirtiler arasında ağrı eşiğinin düşmesi, ajitasyon, fiziksel güç artışı vb. bulgular yer alır. Ajitasyon derecesi Richmond Ajitasyon Sedasyon Skalası ya da davranışsal aktivite ölçekleriyle değerlendirilir; hafif ajitasyon sözlü yönlendirme, orta düzey ajitasyon oral ilaçlarla, şiddetli ajitasyon ise farmakolojik ve fiziksel kısıtlamalarla yönetilir. Tedavide haloperidol, benzodiazepinler ve ketamin gibi ilaçlar tercih edilirken, fiziksel kısıtlamalar sadece eğitilmiş ekiplerce protokole uygun şekilde yapılmalıdır. Hastalar stabilize edildikten sonra vital bulguları düzenli olarak izlenmelidir. Güvenliğin sağlanması, altta yatan nedenlerin hızla belirlenmesi ve iyi planlanmış protokollerle uygulanan müdahaleler hem hasta hem de sağlık çalışanları için yönetim başarısını artırır.
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