وصف
يمكن علاج معظم الحروق الطفيفة بفعالية في العيادات الخارجية والتعافي منها دون الحاجة إلى تدخل طبي. يُعدّ التصنيف الدقيق للحروق أمرًا بالغ الأهمية لضمان الرعاية المناسبة. الحروق الحرارية هي إصابات جلدية ناجمة عن حرارة شديدة، عادةً نتيجة ملامسة أجسام ساخنة أو سوائل أو بخار أو لهب. معظم الحروق ليست خطيرة، ويمكن للمرضى تلقي الرعاية في المستشفيات القريبة أو كمرضى خارجيين. تعالج مراكز الحروق المتخصصة حوالي 6.5% من جميع حالات الحروق. تُؤخذ في الاعتبار مساحة سطح الجسم المحروقة، ودرجة الحروق، والخصائص الفريدة لكل مريض - مثل العمر، والإصابات السابقة، أو أي مشاكل طبية أخرى - عند اتخاذ قرار نقل المريض وعلاجه في مركز الحروق.
ملخص
- The speaker discusses common pitfalls in emergency department care for burn patients, highlighting the need for accurate burn size assessment, early intubation considerations, and appropriate fluid resuscitation volumes. They emphasize the importance of managing core temperature to prevent hypothermia, adequate analgesia, proper dressing techniques, and considering associated trauma in burn patients.
- The presentation covers different types of burns, including thermal, chemical, electrical, cold, and radiation burns. A case study involving a child with burns is presented, emphasizing the need to differentiate between accidental and non-accidental trauma, potentially indicating child abuse. First aid measures, particularly washing burns with cool running water for 20 minutes, are recommended, cautioning against the use of ice and domestic remedies like toothpaste.
- Hospital management of burns includes primary evaluation focusing on ABC (airway, breathing, circulation), detailed incident history, co-morbidities, medication review, and identifying associated injuries. Airway management, breathing support with supplemental oxygen, and circulation management with fluid resuscitation are prioritized. Diagnostic investigations like CBC, kidney and liver function tests, and coagulation profiles are essential.
- Fluid resuscitation should be based on the percentage of body surface area burned, using ringer lactate as the preferred solution. Over and under-hydration must be avoided to prevent complications like compartment syndrome or acute kidney injury. Fluid formulas like Parkland are starting points, requiring adjustment based on urine output monitoring.
- The speaker stresses the significance of pain management, suggesting a combination of acetaminophen, NSAIDs, and opioids, including fentanyl or ketamine. Proper wound care is emphasized, maintaining a moist environment with non-adherent dressings, and using antibiotic-based dressings. Blisters should generally not be debrided, and dressing changes should be frequent enough to manage exudate without interfering with healing.
- Electrical burns present unique challenges due to potential internal injuries and muscle necrosis. Fluid resuscitation for electrical burns requires a higher volume, and urine alkalization might be necessary to prevent acute kidney injury caused by myoglobinuria. Hospital admission or referral to a burn center is required for significant burns based on percentage of body surface area affected and location of burn.
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