Eisenhower Army Medical Center, Fort Gordon, GA, USA.
Am Fam Physician. 2020 Apr 15;101(8):463-470.
Most patients with burn injuries are treated as outpatients. Two key determinants of the need for referral to a burn center are burn depth and percentage of total body surface area involved. All burn injuries are considered trauma, prompting immediate evaluation for concomitant injuries. Initial treatment is directed at stopping the burn process. Superficial (first-degree) burns involve only the epidermal layer and require simple first-aid techniques with over-the-counter pain relievers. Partial-thickness (second-degree) burns are subdivided into two categories: superficial and deep. Superficial partial-thickness burns extend into the dermis, may take up to three weeks to heal, and require advanced dressings to protect the wound and promote a moist environment. Deep partial-thickness burns require immediate referral to a burn surgeon for possible early tangential excision. Full-thickness (third-degree) burns involve the entire dermal layer, and patients with these burns should automatically be referred to a burn center. Prophylactic antibiotics are not indicated for outpatient management and may increase bacterial resistance. People with diabetes mellitus are at increased risk of complications and infection, and early referral to a burn center should be considered. Pruritus, hypertrophic scarring, and permanent hyperpigmentation are long-term complications of partial-thickness burns. Burn injuries are more likely to occur in children and older people. Patient education during primary care visits may be an effective prevention strategy.
大多数烧伤患者都在门诊接受治疗。需要转诊到烧伤中心的两个关键决定因素是烧伤深度和总身体表面积的百分比。所有烧伤都被视为创伤，需要立即评估是否伴有其他损伤。初始治疗旨在阻止烧伤过程。轻度（一度）烧伤仅涉及表皮层，只需使用非处方止痛药进行简单的急救即可。部分厚度（二度）烧伤分为两类：浅度和深度。浅部部分厚度烧伤延伸到真皮，可能需要长达三周的时间才能愈合，需要先进的敷料来保护伤口并促进湿润的环境。深部部分厚度烧伤需要立即转诊给烧伤外科医生，以进行可能的早期切线切除。全层（三度）烧伤涉及整个真皮层，此类烧伤患者应自动转诊至烧伤中心。预防性抗生素不适用于门诊管理，并且可能会增加细菌耐药性。患有糖尿病的人更容易发生并发症和感染，应考虑早期转诊到烧伤中心。瘙痒、肥厚性瘢痕和永久性色素沉着过度是部分厚度烧伤的长期并发症。烧伤更容易发生在儿童和老年人中。在初级保健就诊期间对患者进行教育可能是一种有效的预防策略。
