Rany oparzeniowe a pierwsze działania medyczne na SOR
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Rany oparzeniowe a pierwsze działania medyczne na SOR

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Wśród czynności medycznych wykonywanych u pacjentów z ranami oparzeniowymi wymienić należy zablokowanie lub neutralizacje szkodliwego działania czynnika parzącego, okrycie poszkodowanego w celu mechanicznej osłony oparzonego obszaru i ochrony przez utratą ciepła, wdrożenie zabiegów ratujących życie jak również dożylne podanie płynów i środków przeciwbólowych.

Procedura w stosunku do pacjentów z ranami oparzeniowymi, którzy trafili na SOR przewiduje początkowo kontrolę i ewentualne wdrożenie postępowania w stanach zagrażających życiu, szczegółowe badanie pacjenta, które obejmuje badania laboratoryjne, obrazowe, jak również konsultacje ze specjalistami.

Zgodnie z zaleceniami, rana oparzeniowa bezpośrednio po zdarzeniu powinna zostać schłodzona wodą lub chłodnym płynem o temperaturze 8-23°C przez 15-20 minut, a u dzieci do 5 min. W przypadku ciężkich oparzeń należy traktować ranę wodą do chwili ustąpienia bólu.

Na czym polega zabieg escherotomii?

U pacjentów z głębokimi oparzeniami okrężnymi (kończyn i klatki piersiowej) niezbędne będzie wykonanie escharotomii, czyli uwalniającego nacięcia tkanek martwiczych. Należy pamiętać, aby wykonać ten zabieg niezwłocznie, ponieważ opóźnienie go, bądź zaniechanie może prowadzić do niedokrwienia dystalnych części kończyn, zaburzeń oddychania, a nawet zespołu ciasnoty wewnątrzbrzusznej.

Kolejnym krokiem będzie określenie skali oparzenia, czyli rozległości i głębokości rany oraz jej opracowanie. Będzie ono polegało na delikatnym umyciu oparzonej powierzchni, usunięciu zabrudzeń czy luźnych fragmentów skóry oraz pęcherzy.

Ważne, aby poparzone kończyny wyprostować, unieść i ułożyć w odwiedzeniu

Na poparzone obszary nakładany jest miejscowo działający środek przeciwbakteryjny oraz opatrunek zakrywający ranę lub opatrunek biologiczny.

U tej grupy pacjentów może dojść do wstrząsu oparzeniowego. Wówczas najważniejsze będzie odpowiednie przetaczanie płynów. Aby wyliczyć objętość płynów należy zastosować się do odpowiednich reguł przetoczeniowych. Można to zrobić na podstawie godzinowego pomiaru wydalania moczu.

Poparzonym pacjentom podaje się 0,5 ml toksoidu tężcowego. Natomiast osoby niezaszczepione lub zaszczepione ponad 10 lat wcześniej, otrzymują 250 jednostek immunoglobuliny tężcowej.

Biorąc pod uwagę ciężkość oparzenia, pacjenta kieruje się do leczenia ambulatoryjnego, na oddział chirurgiczny lub do ośrodka specjalistycznego.

Źródło: Głuszek S., Chirurgia podstawy, Wydanie II uaktualnione i rozszerzone Warszawa 2019, s. 29-30

Przeczytaj także: „Pielęgniarka w leczeniu ran musi mieć głos w dyskusji i być partnerem w działaniu” – rozmowa z mgr Zuzanną Konrady

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