Faldmo L, Kravitz M
AACN Clin Issues Crit Care Nurs. 1993 May;4(2):351-66.
Initial management of minor and moderate, uncomplicated burn injury focuses on wound management and patient comfort. Initial management of patients with major burn injury requires airway support, fluid resuscitation for burn shock, treatment for associated trauma and preexisting medical conditions, management of adynamic ileus, and initial wound treatment. Fluid resuscitation, based on assessment of the extent and depth of burn injury, requires administration of intravenous fluids using resuscitation formula guidelines for the initial 24 hours after injury. Inhalation injury complicates flame burns and increases morbidity and mortality. Electrical injury places patients at risk for cardiac arrest, metabolic acidosis, and myoglobinuria. Circumferential full-thickness burns to extremities compromise circulation and require escharotomy or fasciotomy. Circumferential torso burns compromise air exchange and cardiac return. Loss of skin function places patients at risk for hypothermia, fluid and electrolyte imbalances, and systemic sepsis. The first 24 hours after burn injury require aggressive medical management to assure survival and minimize complications.
轻度和中度非复杂性烧伤的初始处理重点在于伤口处理和患者舒适度。重度烧伤患者的初始处理需要气道支持、烧伤休克的液体复苏、相关创伤和原有疾病的治疗、动力性肠梗阻的处理以及伤口的初始治疗。基于对烧伤程度和深度的评估进行液体复苏，需要在伤后最初24小时按照复苏公式指南给予静脉输液。吸入性损伤会使火焰烧伤复杂化，并增加发病率和死亡率。电击伤使患者面临心脏骤停、代谢性酸中毒和肌红蛋白尿的风险。四肢环形全层烧伤会影响血液循环，需要进行焦痂切开术或筋膜切开术。躯干环形烧伤会影响气体交换和心脏回心血量。皮肤功能丧失使患者面临体温过低、液体和电解质失衡以及全身性败血症的风险。烧伤后最初24小时需要积极的医疗处理以确保存活并将并发症降至最低。
