W opatrywaniu oparzeń kluczowe jest szybkie działanie. Wiele osób popełnia jednak błędy, które doprowadzają do krwawienia, powodują dodatkowe uszkodzenia tkanek, hamują proces gojenia rany, zwiększają ryzyko wystąpienia infekcji i powstawania blizn. Czego nie powinno się robić podczas opatrywania ran oparzeniowych?
Oparzenia to jedne z najczęstszych urazów, do których dochodzi w gospodarstwach domowych i miejscach pracy. Szczególnie narażone są na nie dzieci i osoby starsze. Niezależnie od rodzaju oparzenia podczas udzielania pierwszej pomocy należy wystrzegać się kilku powszechnych błędów, które mogą pogorszyć stan poszkodowanego. Jakie są najważniejsze zasady postępowania z oparzeniami?
- Nie wolno obkładać rany lodem ani polewać bardzo zimną wodą
Oparzeń nie wolno chłodzić bardzo zimną wodą ani przykładać na ranę kostek lodu. Gwałtowna zmiana temperatury wiąże się z ryzykiem wystąpienia szoku termicznego skóry, który może doprowadzić do zaburzeń krążenia. Wychłodzone naczynia krwionośne ulegają obkurczeniu, przez co tkanki nie mogą skutecznie oddać ciepła i ulegają dalszemu uszkadzaniu. Niedokrwienie brzegów rany spowalnia także proces gojenia i zwiększa ryzyko powstawania blizn pooparzeniowych.
- Nie można zrywać odzieży przyklejonej do skóry
Jeżeli ubranie lub inny materiał przylepi się do rany powstałej w wyniku oparzenia, nie powinno się go odrywać. Usunąć można jedynie odzież, która nie przywarła do oparzonego miejsca. Próby usunięcia ubrania wtopionego w oparzoną tkankę zwiększają ryzyko powstania otwartej rany, która będzie podatna na zakażenie. Oderwanie zwęglonego lub stopionego materiału wywołuje dodatkowy ból i krwawienie, które mogą doprowadzić do omdlenia i wstrząsu.
- Nie powinno się przekłuwać pęcherzy wypełnionych płynem surowiczym
Przekłuwanie pęcherzy surowiczych wydłuża czas gojenia rany. Zwiększa również ryzyko zakażeń, szczególnie jeśli do tego celu użyto niesterylnych narzędzi. Jeżeli rana jest rozległa, przekłucie pęcherzy surowiczych doprowadza do przerwania ciągłości skóry i zwiększenia utraty płynów fizjologicznych. Zmniejszenie objętości krwi krążącej w organizmie może skutkować wstrząsem hipowolemicznym.
- Ran nie można przemywać takimi środkami odkażającymi jak jodyna, woda utleniona czy alkohol
Podczas opatrywania ran oparzeniowych nie powinno się używać takich środków odkażających jak woda utleniona czy jodyna. Woda utleniona podrażnia zranione tkanki i jednocześnie powoduje uszkodzenia tkanek zdrowych. Jodyna i alkohol także nie są zalecane do odkażania ran, ponieważ mają działanie podrażniające i wysuszające. Co więcej jodyna i inne substancje barwiące zmieniają kolor skóry. Na późniejszym etapie leczenia utrudnia to rozróżnienie niedokrwionej lub martwiczej tkanki od zdrowej, której kolor zmienił się pod wpływem barwnika.
- W przypadku świeżego oparzenia nie używa się kremów kosmetycznych ani tłuszczy zwierzęcych
Świeżego oparzenia nie powinno się smarować środkami, których nie przepisał lekarz. Częstym błędem przy opatrywaniu dopiero co powstałych oparzeń jest stosowanie maści i kremów kosmetycznych. Maści, zwłaszcza te na bazie wazeliny, przyłożone na oparzenie, w którym doszło do przerwania ciągłości skóry, hamują dostęp tlenu do uszkodzonych tkanek – spowalnia to proces gojenia. Z kolei substancje zapachowe w kremach kosmetycznych podrażniają ranę i w efekcie także wydłużają czas jej regeneracji. Środki natłuszczające i nawilżające można stosować tylko przy oparzeniach powierzchownych i ranach częściowo zagojonych, ponieważ zwiększają elastyczność skóry. Przed ich użyciem powinno się jednak skonsultować z lekarzem. Następnym ryzykownym domowym sposobem opatrywania oparzeń jest stosowanie tłuszczy zwierzęcych, np. smalcu, oraz białek jajek. Nałożenie tych produktów na świeżą ranę oparzeniową grozi wywołaniem zakażenia bakteryjnego rany.
- Na oparzenie nie powinno się przykładać niejałowych materiałów
Na oparzenie nie wolno kłaść niejałowych opatrunków, waty, chusteczek higienicznych ani ligniny, ponieważ materiały te przywierają do rany. Podczas ich usuwania pacjent jest narażony na dodatkowy ból. Oprócz tego lignina i wata rozwarstwiają się, przez co w łożysku rany mogą zostać pojedyncze włókna – trudno je usunąć, a ich obecność zaburza proces gojenia. Jednocześnie odrywanie materiałów, które przykleiły się do oparzenia, powoduje zwiększenie głębokości rany oraz krwawienie.
- W przypadku oparzeń przełyku nie należy prowokować wymiotów ani stosować środków zobojętniających
Do oparzeń górnego odcinka przewodu pokarmowego najczęściej dochodzi wskutek połknięcia chemicznych substancji żrących. Poszkodowany oprócz pieczenia i bólu w jamie ustnej oraz gardle, może doświadczać m.in. ślinotoku i bólu nadbrzusza. Nie powinno się jednak prowokować wymiotów, gdyż mogą one doprowadzić do wtórnych uszkodzeń błony śluzowej przełyku, a nawet skutkować perforacją przełyku. Nie zaleca się również podawania środków zobojętniających, ponieważ podczas neutralizacji spożytej substancji wskutek reakcji egzotermicznej może dojść do pogłębienia skutków oparzenia.
- Oparzeń spowodowanych niegaszonym wapnem nie można od razu polewać wodą
W przypadku oparzeń większością środków chemicznych zaleca się przemycie rany wodą w celu wypłukania z niej substancji uszkadzającej. Wyjątkiem od tej reguły są jednak rany powstałe przez kontakt z niegaszonym wapnem. W wyniku zetknięcia się wody z lasującym wapnem następuje reakcja egzotermiczna, która powoduje pogłębienie uszkodzeń tkanek. Wody można użyć dopiero po mechanicznym usunięciu wapna z rany oparzeniowej.
Źródła:
K. Grabowski, K. Markocka-Mączka, „Oparzenia przełyku – leczenie zachowawcze i operacyjne” w: „Chirurgia po Dyplomie” 2014, 1
mp.pl, pooparzeniu.pl, ratownikmed.pl, podyplomie.pl, wum.edu.pl
Więcej tematów związanych z leczeniem oparzeń będzie poruszanych na konferencji Oparzenia 2021, która odbędzie się w dniach 18-20 listopada w Zakopanem.
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