危重病人护理以严重烧伤病人为例

O. Kovalenko
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Analysis of literature sources on this issue. \nResults and discussion. Care for patients with burns is divided into general and special. The use of specialized beds “Clinitron” and air-insolating complexes is of paramount importance. Since the heat loss from the burn wound is 580 kcal/h, the temperature in the burn rooms should be maintained at 26-30 °C. Wound surfaces are easily infected with nosocomial microorganisms, so it is necessary to carefully maintain hand hygiene of healthcare workers (HCW). The latter are the cause of the hospital infections in 50-80 % of cases, so when caring for different patients and before the transition from a bacteria-contaminated area of the body to a clean one, the gloves should be changed. All works near the patient must be carried out in the nitrile gloves without powder, as the latter increases the risk of infection and allergies. It is advisable to use high-strength gloves with an elongated cuff. After removing the gloves, hand hygiene must be carried out. To disinfect the hands of HCW in order to prevent the spread of transient microflora, you can use Gorosten (“Yuria-Pharm”) – a solution based on decamethoxine. Gorosten has antibacterial, antifungal, antiviral, anti-inflammatory and desensitizing properties. Hand hygiene should be performed before the contact with the patient, before clean/aseptic procedures, after contact / risk of contact with the patient’s biological fluids, after contact with the patient and his surroundings, after contact with him-/herself and personal protective equipment. In case of big burn area, bandages are changed under general anesthesia, in some cases after a bath with 0.05-0.1 % potassium permanganate solution. Improper care of patients with burns and other patients with severe conditions can cause the following complications: contractures, bedsores, infectious processes in the lungs, injuries and more. 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引用次数: 0

摘要

背景。在欧洲和美国,每年有超过20万名烧伤患者需要住院治疗。在乌克兰,每年有3.5万人遭受热伤。乌克兰有1 060张烧伤专科病床(875张为成人,175张为儿童)。将人送往烧伤中心的适应症包括:成人烧伤面积为体表的10%;面部、手、脚、会阴、生殖器、大关节烧伤;深度烧伤> 3%;电或化学灼伤;吸入燃烧;四肢或胸部的圆形烧伤;孕妇、儿童、老人、严重合并症患者的烧伤;烧伤合并多处创伤。目标。目的描述烧伤危重病人的处理。材料和方法。对这一问题的文献来源进行分析。结果和讨论。烧伤病人的护理分为一般和特殊。使用专门的床“Clinitron”和空气辐照复合物是至关重要的。烧伤创面散热量为580千卡/小时,烧伤室温度应保持在26-30℃。创面易被医院微生物感染,医护人员应注意手卫生。后者是50- 80%的医院感染病例的原因,所以当照顾不同的病人时,在从身体被细菌污染的区域过渡到干净的区域之前,应该更换手套。所有靠近病人的工作必须戴无粉丁腈手套进行,因为无粉丁腈手套会增加感染和过敏的风险。建议使用长袖口的高强度手套。脱下手套后,必须进行手部卫生。为了对HCW的手进行消毒,以防止瞬时微生物群的传播,你可以使用Gorosten(“Yuria-Pharm”)——一种基于十甲氧辛的溶液。枸杞具有抗菌、抗真菌、抗病毒、抗炎和脱敏的特性。在与患者接触之前、清洁/无菌程序之前、与患者的生物液体接触/有接触风险之后、与患者及其周围环境接触之后、与患者本人和个人防护装备接触之后,均应进行手卫生。如果烧伤面积大,在全身麻醉下更换绷带,在某些情况下,用0.05- 0.1%高锰酸钾溶液浸泡。对烧伤患者和其他病情严重的患者护理不当可导致以下并发症:挛缩、褥疮、肺部感染过程、损伤等。预防和治疗褥疮,建议使用现代敷料:水胶体、半透膜、海绵、硅胶。结论:1。将人送往烧伤中心的适应症包括:成人烧伤面积为体表的10%;面部、手、脚、会阴、生殖器、大关节烧伤;深度烧伤> 3%;电或化学灼伤;吸入燃烧;四肢或胸部的圆形烧伤;孕妇、儿童、老人、严重合并症患者的烧伤;烧伤合并多处创伤。2. 创面容易被医院微生物感染,因此有必要认真保持手部卫生。3.所有靠近病人的工作都应戴无粉丁腈手套。4. 脱下手套后,应进行手部卫生。5. 为防止瞬间微生物菌群的传播,可使用葛洛斯腾消毒双手。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Care for critically ill patients on the example of patients with severe burns
Background. More than 200,000 patients with burns in Europe and the United States need inpatient treatment every year. In Ukraine, 35,000 people suffer thermal injuries each year. Medical care for burns in Ukraine is provided on 1,060 specialized beds (875 – for adults, 175 – for children). Indications for transporting people to the burn center include burn area >10 % of the body surface in adults; burns of the face, hands, feet, perineum, genitals, large joints; deep burns >3 %; electrical or chemical burns; inhalation burns; circular burns of the extremities or chest; burns in pregnant women, children, the elderly, patients with severe comorbid conditions; burns in combination with polytraumas. Objective. To describe the management of critically ill patients with burns. Materials and methods. Analysis of literature sources on this issue. Results and discussion. Care for patients with burns is divided into general and special. The use of specialized beds “Clinitron” and air-insolating complexes is of paramount importance. Since the heat loss from the burn wound is 580 kcal/h, the temperature in the burn rooms should be maintained at 26-30 °C. Wound surfaces are easily infected with nosocomial microorganisms, so it is necessary to carefully maintain hand hygiene of healthcare workers (HCW). The latter are the cause of the hospital infections in 50-80 % of cases, so when caring for different patients and before the transition from a bacteria-contaminated area of the body to a clean one, the gloves should be changed. All works near the patient must be carried out in the nitrile gloves without powder, as the latter increases the risk of infection and allergies. It is advisable to use high-strength gloves with an elongated cuff. After removing the gloves, hand hygiene must be carried out. To disinfect the hands of HCW in order to prevent the spread of transient microflora, you can use Gorosten (“Yuria-Pharm”) – a solution based on decamethoxine. Gorosten has antibacterial, antifungal, antiviral, anti-inflammatory and desensitizing properties. Hand hygiene should be performed before the contact with the patient, before clean/aseptic procedures, after contact / risk of contact with the patient’s biological fluids, after contact with the patient and his surroundings, after contact with him-/herself and personal protective equipment. In case of big burn area, bandages are changed under general anesthesia, in some cases after a bath with 0.05-0.1 % potassium permanganate solution. Improper care of patients with burns and other patients with severe conditions can cause the following complications: contractures, bedsores, infectious processes in the lungs, injuries and more. For the prevention and treatment of bedsores, it is advisable to use modern dressings: hydrocolloid, semi-permeable film, sponge, and silicone. Conclusions. 1. Indications for the transporting people to the burn center include the area of the burn >10 % of the body surface in adults; burns of the face, hands, feet, perineum, genitals, large joints; deep burns >3 %; electrical or chemical burns; inhalation burns; circular burns of the extremities or chest; burns in pregnant women, children, the elderly, patients with severe comorbid conditions; burns in combination with polytraumas. 2. Wound surfaces are easily infected with nosocomial microorganisms, so it is necessary to carefully maintain hand hygiene of HCW. 3. All works near the patient should be carried out in nitrile gloves without powder. 4. After removing the gloves, hand hygiene should be carried out. 5. Gorosten can be used for disinfection of HCW hands in order to prevent the spread of transient microflora.
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