成批烧伤病人的救治体会

目的 探讨保证成批烧伤病人救治顺利进行的方法和措施。方法 从成批烧伤的现场、休克期处理,以及抢救工作的组织领导、伤员的转送时机、事故的预防几个方面,总结了１９７０年至今２２批４０３例成批烧伤的救治经验和体会。结果 ２２批４０３例病人中治愈３８２例,治愈率９４．７９％。结论 只要组织、措施和治疗方法得当,成批病人的救治,可以取得满意的效果。     

成批烧伤病人的救治体会

目的探讨保证成批烧伤病人救治顺利进行的方法和措施。方法从成批烧伤的现场、休克期处理,以及抢救工作的组织领导、伤员的转送时机、事故的预防几个方面,总结了1970年至今22批403例成批烧伤的救治经验和体会。结果 22批403例病人中治愈382例,治愈率94.79%。结论只要组织、措施和治疗方法得当,成批烧伤病人的救治,可以取得满意的效果。     

成批特重烧伤救治体会

<正> 成批烧伤病人死亡率高于平时,而成批大面积烧伤更增加了救治难度。我院于1996年7月-1998年7月2年间收治了15批烧伤病人,其中有4批32例病人均为特重烧伤,经积极抢救治疗,全部救治成功,成活率100％。     

我院不同时期成批烧伤救治的比较

成批烧伤都发生于突发事件或事故，因病人量大，给救治工作带来一定难度。伴随临床经验的积累和设备条件的改善，成批救治的过程和效果逐年有所进步，通过我院不同时期治疗成批烧伤的比较，可以看出９０年代确比８０年代有了明显提高。１　临床资料１－１　病例收录标准本组成批烧伤病例系指一次事故中烧伤３人以上并同时于伤后４８ｈ之内入院者。１９８２年４月～１９８９年１２月为Ａ组共４４例；１９９０年１月～１９９７年１２月为Ｂ组共５４例。１－２　两组病例烧伤原因及伤情Ａ组：１０批共４４例，其中男３２例，女１２例，年龄２～…     

成批烧伤病员的救治体会

目的:总结成批烧伤病员的救治经验。方法::对5批共计46例烧伤病员的现场救护和休克期的补液复苏个体化治疗[1],综合治疗和创面早期处理及疗效进行分析总结。结果:成批烧伤病员救治成功率高,并发症少。结论:健全的抢救预案,有效的院前急救,正确的个体化补液复苏治疗,有计划早期创面切削痂植皮,是救治成批烧伤病员的关键。     

成批特重烧伤救治失败分析

特重烧伤病人治愈困难，而成批特重烧伤死亡率更高，各地报告近年成批特重烧伤的治愈率有明显提高［１］，但我科近３年收治的６批２５例特重烧伤病人的治愈率比早年有明显下降［２］。１临床资料１９９５年至１９９８年４月，我科收治６批２５例特重烧伤病人，皆为男性，...     

成批烧伤的救治

目的总结成批烧伤救治的经验。方法对１９９３年１１月～１９９７年５月救治的１０批烧伤事故共计４２例进行回顾性总结。结果４２例中Ⅲ度烧伤面积５０％以上者１５例;７０％以上者７例;９０％以上者３例。最大Ⅲ度面积９３％。烧伤总面积９０％以上同时Ⅲ度７０％以上者５例。除１例总面积７０％,Ⅲ度３０％于伤后３天死于ＡＲＤＳ,另１例总面积７０％,Ⅲ度７０％于伤后７天死于急性肾功能衰竭外,余４０例全部治愈。结论救治成批烧伤病人的技术力量必须前伸;航空救护有利于特重伤员的转运;休克期复苏尿量指标维持在５０～８０ｍｌ／ｈ可为后续治疗垫定一良好基础;大面积切痂植皮时间提前至伤后２～３天;建立“烧伤皮库”可为成批烧伤救治提供十分必要的异体皮保障。     

成批烧伤的救治

目的总结成批烧伤救治的经验。方法对1993年11月～1997年5月救治的10批烧伤事故共计42例进行回顾性总结。结果 42例中Ⅲ度烧伤面积50%以上者15例;70%以上者7例;90%以上者3例。最大Ⅲ度面积93%。烧伤总面积90%以上同时Ⅲ度70%以上者5例。除1例总面积70%,Ⅲ度30%于伤后3天死于 ARDS,另1例总面积70%,Ⅲ度70%于伤后7天死于急性肾功能衰竭外,余40例全部治愈。结论救治成批烧伤病人的技术力量必须前伸;航空救护有利于特重伤员的转运;休克期复苏尿量指标维持在50～80ml/h 可为后续治疗垫定一良好基础;大面积切痂植皮时间提前至伤后2～3天;建立“烧伤皮库”可为成批烧伤救治提供十分必要的异体皮保障。     

成批特重烧伤救治失败分析

特重烧伤病人治愈困难,而成批特重烧伤死亡率更高,各地报告近年成批特重烧伤的治愈率有明显提高,但我科近3年收治的6批25例特重烧伤病人的治愈率比早年有明显下降。1 临床资料1995年至1998年4月,我科收治6批25例特重烧伤病人,皆为男性,年龄18～40岁,烧伤总面积全部≥68％TB-SA,Ⅲ度面积≥40％,25例病人一般情况见表1。表1 6批25例特重烧伤病人的一般情况     

成批烧伤在基层医院的组织救治

成批烧伤因事故的突发性,受伤人数多、伤情重,救治工作任务繁重,药品器械供应后勤保障等矛盾突出。１９９６年８月－１９９９年 １１月,我院收治了 ６批 ３９例大面积烧伤皆获得成功。 １．一般资料：本组６批,共３９例,男２１例,女１８例,年龄２２－６８岁。烧伤原因;４批为爆炸性燃烧,１批为工厂化学性热液外溢,互批为家庭液化气起火。其中７０％－９０％ＴＢＳＡ Ⅱ－Ⅲ度烧伤 １５例,３０％－７０％ＴＢＳＡⅡ－Ⅲ度烧伤１８例,５％－３０％ＴＢＳＡ Ⅱ－Ⅲ度烧伤 ６例。３９例患者入院时均有低血容量性休克体征,因吸入性…     

Flüssigkeitstherapie und hämodynamisches Monitoring im Verbrennungsschock

Successful surgical and intensive care treatment of severely burned patients requires adequate prehospital management and fluid resuscitation adjusted to individual needs of the patient. Burn shock fluid resuscitation is now predominantly performed utilizing crystalloid solutions. Whenever possible, colloid solutions should not be given in the first 24 h after burn injury. The rate of administration of resuscitation fluids should maintain urine outputs between 0.5 ml/kg per h and 1 ml/kg per h and mean arterial pressures of >70 mmHg. Extended hemodynamic monitoring can provide valuable additional information, if burn resuscitation is not proceeding as planned or volume therapy guided by these typical vital signs is not attaining the desired effect. We recommend this in patients with TBSA burns of >30%. Inhalation injuries, pre-existing cardiopulmonary diseases, or TBSA burns of >50% definitely require extended hemodynamic monitoring during burn shock resuscitation. The Swan-Ganz catheter or less invasive transcardiopulmonary indicator dilution methods can be utilized to assess hemodynamic data.     

成批烧伤的救治

目的 总结成批烧伤救治的经验。方法 对１９９３年１１月￣１９９７年５月救治的１０批烧伤事故共计４２例进行回顾性总结。结果 ４２例中Ⅲ度烧伤面积５０％以上者１５例;７０％以上者７例;９０％以上者３例。最大Ⅲ度面积９３％。烧伤总面积９０％以上同时Ⅲ度７０％以上者５例。除１例总面积７０％,Ⅲ度３０％于伤后３天死于ＡＲＤＳ,另１例总面积７０％,Ⅲ于伤后７天死于急性肾功能衰竭外,余４０例人全部治愈。结论 救     

应用“四早”方案提高成批烧伤的救治水平

目的探讨“四早”救治方案在成批严重烧伤病人救治过程中的可行性。方法对１２年内１８批１５５名烧伤病人实施“四早”救治方案,即：对延迟复苏者休克期采用早期快速液体复苏;对中、重度吸入性损伤坚持早期气管切开,辅以气道湿化、灌洗,保持气道通畅;对深度大面积烧伤从休克期开始有计划地施行切（削）痂植皮;坚持早期胃肠道营养。结果成批严重烧伤病人应用“四早”救治方案后,显著地提高了救治的成功率并减少了并发症。结论对成批严重烧伤实施“四早”救治方案是有效可行的。     

应用“四早”方案提高成批烧伤的救治水平

目的 探讨“四早”救治方案在成批严重烧伤病人救治过程中的可行性。方法 对１２年内１８批１５５名烧伤病人实施“四早”救治方案,即：对延迟复苏者休克期采用早期快速液体复苏;对中、重度吸入性损伤坚持早期气管切开,铺以气道湿化、灌洗,保持气道通畅;对深度大面积烧伤从休克期开始有计划地施行切（削）痂植皮;坚持早期胃肠道营养。结果成批严重烧伤实施“四早”救治方案后,显著地提高了救治的成功率并减少了并发症。结论     

Abdominal war wounds--experiences from Red Cross field hospitals

The traditional approach to abdominal war wounds consists of triage, eche-loned care, and mandatory laparotomy for penetrating abdominal injuries, and it remains valid in modern conventional wars with well-organized evacuation and surgical services. Expectant management of abdominal casualties can be considered under difficult circumstances with a high influx of patients exhausting the available resources. This can occur in regional conflicts associated with mass movements of people and with collapsed infrastructure. While always combined with adequate fluid resuscitation, antibiotic treatment, and other supportive care, the expectant approach in patients with penetrating abdominal injuries could be indicated for asymptomatic patients with multiple fragment wounds or for patients presenting several days post-injury in good condition. The focus of surgical resources and competence should be on the majority of patients with intestinal perforation only, who need surgery to save life--but not necessarily on an urgent basis--and who have a good chance of survival. The limited availability of blood products to correct blood loss and coagulation factor deficiencies, and the lack of sophisticated monitoring of hemodynamic variables that call into question the value of a damage-control approach for the most severely injured. Even if the bleeding could be temporarily controlled, the subsequent need for adequate resuscitation before returning the patient to the operating room could be difficult to achieve and would result in incompletely resuscitated patients being reoperated while acidotic, coagulopathic, and even hypothermic. Perhaps, in mass casualty situations these patients should be recognized during triage or at least early during operation, and aggressive surgery should be replaced with adequate expectant management with sedation and analgesics.     

A review of emergency department fluid resuscitation of burn patients transferred to a regional,verified burn center

The purpose of this study was to examine the adequacy of burn patient fluid resuscitation in relationship to the American Burn Association formula before arrival at a regional burn center. Further substratification of the data was undertaken to compare total burn surface area and fluid volume resuscitation as evaluated from the primary hospital's emergency department staff vs. the burn intensive care unit staff. The charts of all patients admitted to the burn center during 1 year were reviewed retrospectively. Data were compiled to calculate the time of injury, time of arrival in the referring emergency room, time in transit to the burn unit, and time of arrival in the burn unit. The total number of patients evaluated in the study was 41. Patients who were not referred from outside hospitals or who had incomplete charts were excluded. The average time from initial burn to transfer to the burn intensive care unit was 6.26 hours (range, 0.5-96 hours). The average total body surface area (TBSA) evaluated by the referring emergency department staff was 23.9% (range, 5-70%) compared with the burn intensive care unit staff evaluation average of 17.8% (range, 2-55%). Using the referring emergency department staff TBSA percentage, evaluation of the data revealed that only 23% of patients fell within the accepted range using the American Burn Association formula. Furthermore, 30% of patients were overresuscitated whereas 47% were underresuscitated. Of the overresuscitated patients, 1 patient was critically overresuscitated. In the group of underresuscitated patients, five were critically underresuscitated. Thirty-three percent of the patients' TBSA had a more than 50% discrepancy between the burn unit and the emergency department calculations. The authors conclude that better educating providers referring patients to regional burn centers can make a marked improvement in the overall care of burn patients. More important, early communication with the referring burn staff has been encouraged. Early communication permits review of estimated TBSA burn evaluations and permits cooperative calculations and optimal delivery of early fluid resuscitation. Burn center practitioners can improve care of patients before arrival by appropriately guiding the referring physician.     

A simplified fluid resuscitation formula for burns in mass casualty scenarios: Analysis of the consensus recommendation from the WHO Emergency Medical Teams Technical Working Group on Burns

BackgroundBurn fluid resuscitation guidelines have not specifically addressed mass casualty with resource limited situations, except for oral rehydration for burns below 40% total body surface area (TBSA). The World Health Organization Technical Working Group on Burns (TWGB) recommends an initial fluid rate of 100 mL/kg/24 h, either orally or intravenously, beyond 20% TBSA burned. We aimed to compare this formula with current guidelines.MethodsThe TWGB formula was numerically compared with 2–4 mL/kg/%TBSA for adults and the Galveston formula for children.ResultsIn adults, the TWGB formula estimated fluid volumes within the range of current guidelines for burns between 25 and 50% TBSA, and a maximal 20 mL/kg/24 h difference in the 20–25% and the 50–60% TBSA ranges. In children, estimated resuscitation volumes between 20 and 60% TBSA approximated estimations by the Galveston formula, but only partially compensated for maintenance fluids. Beyond 60% TBSA, the TWGB formula underestimated fluid to be given in all age groups.ConclusionThe TWGB formula for mass burn casualties may enable appropriate fluid resuscitation for most salvageable burned patients in disasters. This simple formula is easy to implement. It should simplify patient management including transfers, reduce the risk of early complications, and thereby optimize disaster response, provided that tailored resuscitation is given whenever specialized care becomes available.     

Preparing for a burn disaster in Brazil: Geospatial modelling to inform a coordinated response

IntroductionTo optimize the early care of burned patients, protocols were developed that guide pre-hospital care and the need to transfer to a specialized burn treatment unit. Burn disasters are an important public health concern in developed and developing nations. Among the early steps in disaster preparedness is the understanding of geographic locations and capacity of burn care facilities. We aimed to map and classify medical facilities that provide burn care in Brazil and to undertake a location-allocation analysis to identify which could be targeted to increase capacity.MethodsA review of burn hospitalizations was conducted using Brazilian Ministry of Health data. Capacity was defined by number of burn patients admitted each year and bed type. Spatial population data per one-square kilometer were obtained from World Pop as a raster dataset. A road network dataset using Open Street Map data was created to conduct the drive time analysis. Location/allocation analysis was conducted to identify the proportion of Brazil’s population living within 2- and 6-hours’ drive time of a burn care capable hospital, stratified by the level of hospital capacity. Hospitals were ranked according to number of additional people served.ResultsWe found 26.471 burn admissions. Of these, 3.508(13,2 %) were ICU admissions. A total of 735(2,7 %) hospital deaths occurred under the selected burn codes. In all, 1.273 facilities admitted burn patients, and 263(20,7 %) reported ICU admissions of burn patients. Seventeen hospitals were classified as maximum capacity facilities. Additional 23 hospitals were identified as potential targets for capacity building. Most maximum capacity hospitals are clustered in the Southeast of Brazil. Currently, 40.8 % of the Brazilian population live within 2 h of a maximum capacity facility. A large part of the population lives farther than 6 h away from a maximum capacity hospital. Most of the potential targets for capacity building are located near the coast of Brazil.DiscussionWe mapped and classified facilities that provide public burn care in Brazil. We identified public facilities that could be targeted to increase capacity to improve access for patients in the event of a burn disaster. Mapping, planning, and coordinating response is key for optimal outcomes in Mass Casualties Incidents. Cataloging and understanding local resources is a crucial first step in disaster management. Inequality in profiles can determine specific regional needs. Specialized burn centers are rare in regions other than the southeast. Health equity should be considered when planning disaster preparedness initiatives. Location-allocation modelling may assist in universal and equitable burn care service offerings.ConclusionThis study proposes an initial step in the classification and mapping of available burn treatment centers and population coverage in Brazil.