热力大面积重度烧伤病人的护理

热力是一种常见的和多发的严重创伤,尤其是大面积重度烧伤后患者全身皮肤破坏,屏障功能受损,机体抵抗力下降,易引起全身感染,烧伤的面积越大,深度越深,对局部和全身影响也就越严重[1].病人机体天然防御屏障严重受损,机体抵抗力严重下降,并发症多,要经历休克、感染、修复期过程,对病人的身心来说都是很大的考验,再加上烧伤治疗费用昂贵,病人心里承受着很大的压力.以上的种种因素给治疗与护理都带来了不利的影响.     

特大井喷意外灾难事故的组织管理与现场急救

目的探讨大型井喷意外灾难事故的组织管理与现场急救方法的有效性。方法对特大井喷意外灾难事故启动应急预案,科学分组、各负其责,创设临时医疗急救站,就地施救,验伤分诊登记,临时医疗急救站按病种分组施救,120急救转送。结果共对1 067例患者进行急救,711 例轻度中毒和51 例其它(外伤、感冒)患者病情明显好转;238例中度和15例重度中毒患者病情稳定后安全转送到指定医院住院治疗;死亡52 例。结论组织管理的准确有效与现场急救的程序化、规范化,可避免急救现场混乱,使伤者得到及时有效的诊治,同时可减少灾难事故中患者的伤残率和病死率。     

特大井喷意外灾难事故的组织管理与现场急救

目的探讨大型井喷意外灾难事故的组织管理与现场急救方法的有效性。方法对特大井喷意外灾难事故启动应急预案．科学分组、各负其责．创设临时医疗急救站．就地施救．验伤分诊登记．临时医疗急救站按病种分组施救．120急救转送。结果共对l067例患者进行急救，711例轻度中毒和5l例其它(外伤、感冒)患者病情明显好转；238例中度和15例重度中毒患者病情稳定后安全转送到指定医院住院治疗；死亡52例。结论组织管理的准确有效与现场急救的程序化、规范化．可避免急救现场混乱．使伤者得到及时有效的诊治．同时可减少灾难事故中患者的伤残率和病死率。     

重度烧伤患者心理干预的效果观察

目的:探讨心理干预对重度烧伤患者焦虑和抑郁状态的影响效果.方法:对142名量度以上烧伤病人按住院顺序隔一例选取一例.共选取71例为实验组,另71例为对照组.对实验组进行心理干预,比较实验组与对照组焦虑与抑郁的发生人数差异;同时采用焦虑自评量表(SAS)和抑郁自评量表(SDS)分别评定两组患者治疗前后焦虑与抑郁的心理状态.结果:入院时两组患者焦虑与抑郁的发生人数比较,差异无统计学意义(x2*=0.195,p＞0.05,x2△=1.06,p＞0.05).对实验组进行干预后,两组患者焦虑与抑郁发生人数差异有统计学意义(x2*=47.93,p＜0.01,x2△=5.57,p＜0.05);实验组干预前后焦虑与抑郁得分比较有统计学意义(t*=14.86,p＜0.01;t△=19.37,p＜0.01);对照组治疗后期焦虑与抑郁得分有所下降,但无统计学意义(p＞0.05).结论:对重度烧伤患者进行心理干预,使焦虑与抑郁的发生人数明显降低,同时能有效缓解患者焦虑与抑郁的心理状态.     

特重度烧伤患者并发凝血功能障碍的探讨

目的探讨严重烧伤患者伤后凝血功能障碍的发病规律,防止措施及预后。方法对我院2007年1月至12月收治的39例特重烧伤患者依据凝血功能衰竭的诊断标准,结合患者血液血小板计数(BPC)、血浆凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶时间(TT)的检测结果及变化规律,计算凝血功能衰竭的发生率,分析本组患者治疗情况及预后。结果39例特重度烧伤患者中有7例患者血小板在伤后2~7 d降低至50×109/L以下,PT、APTT、TT延长3 s以上。凝血功能衰竭发生率17.9%,其中1例患者血小板计数最低降至9×109/L,1例3P实验(+),2例D-二聚体试验(+)。最终治愈3例,死亡4例。结论严重烧伤早期及并发全身感染时,烧伤患者的BPC下降至低水平,PT、APTT、TT延长。血小板下降的程度及烧伤面积及感染程度正相关。力争平稳过度休克期,防治烧伤全身感染,应用升血小板药物、输注血小板是救治凝血功能障碍的重要措施。     

重度烧伤合并多器官功能障碍综合征患者的护理

对26例重度烧伤合并多器官功能障碍综合征(MODS)患者,采取尽早纠正休克,预防和控制感染,维持通气效能,早期肠道喂养及重要器官功能的维护等治疗及综合性护理措施,结果治愈或好转15例,死亡11例。提出科学地实施护理干预,能有效预防MODS的进展,降低病死率。     

规范化肠内营养护理对重度烧伤患者的影响

目的 分析规范化肠内营养护理对重度烧伤患者的影响。方法 选取2021年6月-2022年9月邯郸钢 铁集团有限责任公司职工医院收治的60例重度烧伤伴并发症患者为研究对象,依据随机数字表法分为观察 组与对照组,各30例。对照组给予常规营养护理干预,观察组实施规范化肠内营养护理干预,比较两组临床 指标、生活质量、营养状况及并发症发生情况。结果 观察组创口愈合时间、正氮平衡恢复时间均短于对照 组,差异有统计学意义（P＜0.05）;两组干预后躯体功能、社会关系、心理功能、一般健康状况评分均高于 干预前,且观察组高于对照组,差异有统计学意义（P＜0.05）;两组干预后转铁蛋白、血浆白蛋白、血浆前 白蛋白水平均高于干预前,且观察组高于对照组,差异有统计学意义（P＜0.05）;观察组并发症总发生率低 于对照组,差异有统计学意义（P＜0.05）。结论 对重度烧伤患者实施规范化肠内营养护理可增强患者营养 水平,增加抵抗力,促进创面愈合,同时提高其烧伤后健康生活质量,降低并发症发生风险。     

重度烧伤合并多器官功能障碍综合征患者的护理

对26例重度烧伤合并多器官功能障碍综合征（MODS）患者,采取尽早纠正休克,预防和控制感染,维持通气效能,早期肠道喂养及重要器官功能的维护等治疗及综合性护理措施,结果治愈或好转15例,死亡11例。提出科学地实施护理干预,能有效预防MODS的进展,降低病死率。     

创伤现场急救的护理体会

<正>意外发生创伤,损伤人员多,损伤的种类和性质复杂,常危及患者生命。因此急诊科出诊突发性强,时间短促,快速准确抢救,可有效提高抢救成功率。2011-01—2012-12,我院急诊科对创伤患者实施综合护理措施,提高了抢救成功率,现总结如     

成批中重度烧伤患者的护理体会

2004年6～12月，我科共收治成批烧伤患者5批31例，每批3～7例，烧伤面积大，病情危重，抢救任务艰巨，由于组织指挥得力，抢救工作及时准确，护理措施得当，均治愈，现总结报告如下。     

A simplified fluid resuscitation formula for burns in mass casualty scenarios: Analysis of the consensus recommendation from the WHO Emergency Medical Teams Technical Working Group on Burns

BackgroundBurn fluid resuscitation guidelines have not specifically addressed mass casualty with resource limited situations, except for oral rehydration for burns below 40% total body surface area (TBSA). The World Health Organization Technical Working Group on Burns (TWGB) recommends an initial fluid rate of 100 mL/kg/24 h, either orally or intravenously, beyond 20% TBSA burned. We aimed to compare this formula with current guidelines.MethodsThe TWGB formula was numerically compared with 2–4 mL/kg/%TBSA for adults and the Galveston formula for children.ResultsIn adults, the TWGB formula estimated fluid volumes within the range of current guidelines for burns between 25 and 50% TBSA, and a maximal 20 mL/kg/24 h difference in the 20–25% and the 50–60% TBSA ranges. In children, estimated resuscitation volumes between 20 and 60% TBSA approximated estimations by the Galveston formula, but only partially compensated for maintenance fluids. Beyond 60% TBSA, the TWGB formula underestimated fluid to be given in all age groups.ConclusionThe TWGB formula for mass burn casualties may enable appropriate fluid resuscitation for most salvageable burned patients in disasters. This simple formula is easy to implement. It should simplify patient management including transfers, reduce the risk of early complications, and thereby optimize disaster response, provided that tailored resuscitation is given whenever specialized care becomes available.     

Optimizing mass casualty burns intensive care organization and treatment using evidence-based outcome predictors

Background

Majority of current research focuses on pre-hospital care in mass casualty incidents (MCI) whereas this study is the first to examine multifactorial aspects of intensive care unit (ICU) resource management during a surge in massive burn injury (MBI) patients whilst identifying key outcome predictors that resulted in successful disaster managements.

Mass chemical burn casualty: emergency management of 118 patients with alkali burn during a Matsa typhoon attack in Shanghai, China in 2005

BACKGROUND: This article reports a chemical burn incident that occurred on August 7th, 2005, when a Matsa typhoon hit Shanghai, China. This is the largest chemical burn incident reported in the literature for 20 years in China, involving 118 alkali burn patients who were rescued by the Burn Department of Shanghai Changhai Hospital independently. METHODS: The scene of the incident was investigated, and the clinical, emergency and hospitalized data of the patients were summarized. RESULTS: The main injurious chemical was a water solution of sodium hydroxide and ammonium chloride. The 118 victims were mostly young men with 5%TBSA deep thickness burn of both lower extremities, including 31 patients who had additional light coughing. Of 58 patients who were finally hospitalized, 42 patients received surgical treatment. Most of these patients recovered within 1 month. There were no deaths. DISCUSSION: Retrospective analysis of the therapeutic data of the incident demonstrates that pre-designed disaster planning for emergency management of mass burn patients, an effective command group, accurate assessment of pathological conditions, and correct allocation of different casualties are key elements in successful management in a mass casualty even involving burn patients. In addition, it is essential for specialized personnel to take part in emergency treatment of chemical burns.     

Recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020

Health and logistical needs in emergencies have been well recognised. The last 7 years has witnessed improved professionalisation and standardisation of care for disaster affected communities – led in part by the World Health Organisation Emergency Medical Team (EMT) initiative.Mass casualty incidents (MCIs) resulting in burn injuries present unique challenges. Burn management benefits from specialist skills, expert knowledge, and timely availability of specialist resources. With burn MCIs occurring globally, and wide variance in existing burn care capacity, the need to strengthen burn care capability is evident. Although some high-income countries have well-established disaster management plans, including burn specific plans, many do not – the majority of countries where burn mass casualty events occur are without such established plans. Developing globally relevant recommendations is a first step in addressing this deficit and increasing preparedness to deal with such disasters.Global burn experts were invited to a succession of Technical Working Group on burns (TWGB) meetings to:1) review literature on burn care in MCIs; and2) define and agree on recommendations for burn care in MCIs.The resulting 22 recommendations provide a framework to guide national and international specialist burn teams and health facilities to support delivery of safe care and improved outcomes to burn patients in MCIs.     

Beyond surge: Coping with mass burn casualty in the closest hospital to the Formosa Fun Coast Dust Explosion

PurposeTo provide an insight into the challenges faced by the closest hospital to the Formosa Fun Coast Dust Explosion (FFCDE) disaster scene, and to examine how the hospital staff adapted to cope with the mass burn casualty (MBC) in their overcrowded emergency department (ED) after the disaster.Material and methodsThe critical incident technique was used for the investigation. Data was gathered through in-depth individual interviews with 15 key participants in this event. The interview data was combined with the medical records of the FFCDE patients and admission logs to build a detailed timeline of ED workload. Process tracing analysis was used to evaluate how the ED and other units adapted to deal with actual and potential bottlenecks created by the patient surge.ResultsFifty-eight burn patients were treated and registered in approximately six hours while the ED managed 43 non-FFCDE patients. Forty-four patients with average total body surface area burn 51.3% were admitted. Twenty burn patients were intubated. The overwhelming demand created shortages primarily of clinicians, ED space, stretchers, ICU beds, and critical medical materials for burn care. Adaptive activities for the initial resuscitation are identified and synthesized into three typical adaptation patterns. These adaptations were never previously adopted in ED normal practices for daily surge nor in periodical exercises. The analysis revealed adaptation stemmed from the dynamic re-planning and coordination across roles and units and the anticipation of bottlenecks ahead.ConclusionIn the hospital closest to the FFCDE disaster scene, it caused an overwhelming demand in an already crowded, beyond-nominal-capacity ED. This study describes how the hospital mobilized and reconfigured response capacity to cope with overload, uncertainty, and time pressure. These findings support improving disaster planning and preparedness for all healthcare entities through organizational support for adaptation and routine practice coping with unexpected scenarios.     

Complex chemical burns following a mass casualty chemical plant incident: how optimal planning and organisation can make a difference

Introduction

Four employees at a chemical plant sustained extensive chemical burns following the explosion of a pipeline containing 100% sulphuric acid. We describe the management of these patients from the initial ED triage through to discharge from hospital in life and limb threatening chemical burns.

Methods

Four patients who sustained chemical burns to the torso and extremities are reviewed. Data was retrieved from patient case notes and operating theatre logbooks.

Results

Four patients sustained chemical burns during the blast and were immediately transferred to a local ED where a prompt referral was made to the burns service. All patients were male aged 25–59 years (mean 46.5). Burn size was 2–50% BSA (mean 22.5). Following RFDS transfer to the state burns service two patients required immediate excisional surgery. In these patients the chemical burn involved full thickness skin loss with extensive underlying muscle and neurovascular damage. One patient required immediate above knee amputation of one leg and fascial burn excision of the other. The other patient required fascial burn excision of both legs followed by Integra placement 24 h later. Both patients had prolonged hospital stays due to the complex nature of their injuries requiring multiple trips to theatre and lengthy rehabilitation. The two patients with smaller burns had straightforward surgery and an unremarkable recovery.

Conclusion

Early communication following this mass casualty incident allowed for organisation of tertiary services and early radical surgery which was life saving. Management lessons were learnt following this mass casualty chemical burn incident.     

European Burns Association guidelines for the management of burn mass casualty incidents within a European response plan

BackgroundA European response plan to burn mass casualty incidents has been jointly developed by the European Commission and the European Burn Association. Upon request for assistance by an affected country, the plan outlines a mechanism for coordinated international assistance, aiming to alleviate the burden of care in the affected country and to offer adequate specialized care to all patients who can benefit from it. To that aim, Burn Assessment Teams are deployed to assess and triage patients. Their transportation priority recommendations are used to distribute outnumbering burn casualties to foreign burn centers. Following an appropriate medical evacuation, these casualties receive specialized care in those facilities.MethodsThe European Burns Association’s disaster committee developed medical-organizational guidelines to support this European plan. The experts identified fields of interest, defined questions to be addressed, performed relevant literature searches, and added their expertise in burn disaster preparedness and response. Due to the lack of high-level evidence in the available literature, recommendations and specially designed implementation tools were provided from expert opinion. The European Burns Association officially endorsed the draft recommendations in 2019, and the final full text was approved by the EBA executive committee in 2022.RecommendationsThe resulting 46 recommendations address four fields. Field 1 underlines the need for national preparedness plans and the necessary core items within such plans, including coordination and integration with an international response. Field 2 describes Burn Assessment Teams' roles, composition, training requirements, and reporting goals. Field 3 addresses the goals of specialized in-hospital triage, appropriate severity criteria, and their effects on priorities and triage. Finally, field 4 covers medical evacuations, including their timing and organization, the composition of evacuation teams and their assets, preparation, and the principles of en route care.     

严重骨盆骨折的救治及手术治疗

目的报道严重骨盆骨折的治疗经验,以期进一步提高其早期诊断和救治水平。方法回顾性分析总结了1994年4月～2002年3月106例严重骨盆骨折的临床资料。结果骨盆骨折主要的致伤原因为交通事故伤(69例,占65.1%)及坠落伤(31例,占29.3%)。106例中,87例生存,19例死亡,死亡率为17.9%,其中10例死于出血性休克,4例死于严重脑外伤,3例死于多器官功能衰竭,2例死于急性呼吸窘迫综合征。其中骨盆骨折手术治疗32例,优良率达91.7%。结论严重骨盆骨折救治中院前急救十分重要,要及时处理严重合并伤,积极行骨盆骨折内固定手术。     

The Ilizarov method for the treatment of complex tibial fractures and non-unions in a mass casualty setting: the 2005 earthquake in Pakistan

We report our experience in treating victims of the recent earthquake disaster in Pakistan. Our experience was based on two humanitarian missions to Islamabad: one in October 2005, 10 days after the earthquake, and the second in January 2006. The mission consisted of a team of orthopaedic surgeons and a second team of plastic surgeons. The orthopaedic team bought all the equipment for application of Ilizarov external fixators. We treated patients who had already received basic treatment in the region of the disaster and subsequently had been evacuated to Islamabad. During the first visit, we treated 12 injured limbs in 11 patients. Four of these patients were children. All cases consisted of complex multifragmentary fractures associated with severe crush injuries. All fractures involved the tibia, which were treated with Ilizarov external fixators. Nine fractures were type 3b open injuries. Eight were infected requiring debridement of infected bone and acute shortening. During a second visit, we reviewed all patients treated during our first mission. In addition, we treated 13 new patients with complex non-unions. Eight of these patients were deemed to be infected. All patients had previous treatment with monolateral fixators as well as soft tissue coverage procedures, except one patient who had had an IEF applied by another team. All these patients had revision surgery with circular frames. All patients from both groups were allowed to fully weight-bear post-operatively, after a short period of elevation to allow the flaps to take. Overall, all fractures united except one case who eventually had an amputation. Four patients had a corticotomy and lengthening, and three of them had a successful restoration of limb length. The fourth patient was the one with the eventual amputation.