Karnes Jonathan B
Maine-Dartmouth Family Medicine Residency, 15 East Chestnut St, Augusta, ME 04330.
FP Essent. 2020 Feb;489:27-31.
Burns, whether caused by thermal, chemical, or electrical exposure, are common and often preventable. Burn injuries are most common in children. All patients with burns should undergo primary and secondary assessment, including assessment of airway, breathing, and circulation. Evaluation of the location, size, and depth of burns can help to determine the optimal setting for management. Patients with full-thickness burns, circumferential burns, or burns on the face, hands, feet, genitals, or perineum should be referred to a burn subspecialist. Minor acute pain can be managed with irrigation of the burn area with cool water, acetaminophen, or a nonsteroidal anti-inflammatory drug. Acetaminophen is the first-line treatment for pain associated with minor burns. Opioids are a mainstay of pain management for patients with severe burns. Prophylactic antibiotics are not indicated for most patients. Silver sulfadiazine is used widely as a topical therapy, and is a standard treatment for partial-thickness burns. Many other topical therapies are available but comparative data are limited. Goals of therapy are to manage pain, facilitate healing, minimize scarring, and achieve return to function.
烧伤，无论是由热、化学物质或电接触引起，都很常见且往往是可预防的。烧伤在儿童中最为常见。所有烧伤患者都应接受初级和二级评估，包括气道、呼吸和循环评估。评估烧伤的部位、大小和深度有助于确定最佳的治疗环境。全层烧伤、环形烧伤或面部、手部、足部、生殖器或会阴烧伤的患者应转诊至烧伤专科医生处。轻度急性疼痛可用冷水冲洗烧伤部位、对乙酰氨基酚或非甾体抗炎药进行处理。对乙酰氨基酚是轻度烧伤相关疼痛的一线治疗药物。阿片类药物是重度烧伤患者疼痛管理的主要手段。大多数患者无需预防性使用抗生素。磺胺嘧啶银被广泛用作局部治疗药物，是浅度烧伤的标准治疗方法。还有许多其他局部治疗方法，但比较数据有限。治疗目标是控制疼痛、促进愈合、减少瘢痕形成并恢复功能。
