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-rw-r--r--2024/01/25/急诊与灾难医学-烧伤/index.html348
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diff --git a/2024/01/23/G-Machine/index.html b/2024/01/23/G-Machine/index.html
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@@ -189,6 +189,11 @@
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@@ -0,0 +1,348 @@
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+ 急诊与灾难医学--烧伤
+
+
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+ <span class="post-date">
+ Jan 25, 2024
+ </span>
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+ <div class="post-img">
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+ <div class="post-content">
+ <p>烧伤，烫伤是一个很常见的急诊意外损伤，这里科普一下相关的知识。</p>
+<h2 id="临床特点"><a href="#临床特点" class="headerlink" title="临床特点"></a>临床特点</h2><p>烧伤组织出现变性坏死，体液渗出引起组织水肿，变性，小面积的浅度烧伤，体液渗出有限，经过代偿之后不会影响身体的有效循环血量，大面积或者深度的烧伤，会因为大量渗出，休克，感染等病理变化导致并发脓毒症和多器官功能衰竭。</p>
+<h3 id="烧伤面积判断"><a href="#烧伤面积判断" class="headerlink" title="烧伤面积判断"></a>烧伤面积判断</h3><p>首先我们要估算烧伤的面积，也就是判断皮肤烧伤区占人体表面积的百分比，最常用的是九分法和手掌法，前者用于大面积烧伤，后者用于小面积烧伤。</p>
+<ul>
+<li>手掌法：病人的五个手指并拢后，手掌的面积估算为 1% 体表面积。</li>
+<li>九分法：</li>
+</ul>
+<table>
+<thead>
+<tr>
+<th>部位</th>
+<th>成人各部位面积（%）</th>
+<th>小儿各部位面积（%）</th>
+</tr>
+</thead>
+<tbody><tr>
+<td>头额</td>
+<td><code>9x1=9 (发部3,面部3,颈部3)</code></td>
+<td><code>9 + (12-年龄) </code></td>
+</tr>
+<tr>
+<td>双上肢</td>
+<td><code>9x2=18 (双手5, 双前臂6, 双上臂7)</code></td>
+<td><code>9x2</code></td>
+</tr>
+<tr>
+<td>躯干</td>
+<td><code>9x3=27 (腰腹13, 背侧13，会阴1)</code></td>
+<td><code>9x3</code></td>
+</tr>
+<tr>
+<td>双下肢</td>
+<td><code>9x5+1=45 (双臀5, 双大腿21, 双小腿13, 双足7)</code></td>
+<td><code>46-(12-年龄)</code></td>
+</tr>
+</tbody></table>
+<h3 id="烧伤深度判断"><a href="#烧伤深度判断" class="headerlink" title="烧伤深度判断"></a>烧伤深度判断</h3><p>三度四分法：</p>
+<ul>
+<li>I 度：仅伤及表皮浅层</li>
+<li>浅 II 度：伤及表皮的生发层与真皮乳头层</li>
+<li>深 II 度：伤及皮肤真皮乳头层及部分真皮网状层</li>
+<li>III 度：全皮层烧伤甚至达到皮下，肌肉或骨骼</li>
+</ul>
+<table>
+<thead>
+<tr>
+<th>分度</th>
+<th>皮损性状</th>
+<th>皮损状态</th>
+<th>感觉</th>
+<th>预后</th>
+</tr>
+</thead>
+<tbody><tr>
+<td>I</td>
+<td>粉红或红色</td>
+<td>干燥</td>
+<td>疼痛</td>
+<td>数天</td>
+</tr>
+<tr>
+<td>浅 II</td>
+<td>粉红或大水疱</td>
+<td>潮湿</td>
+<td>疼痛</td>
+<td>2 ～ 3周</td>
+</tr>
+<tr>
+<td>深 II</td>
+<td>粉红或出血性水疱</td>
+<td>潮湿</td>
+<td>疼痛</td>
+<td>数周，可能发展为 III 度，需植皮</td>
+</tr>
+<tr>
+<td>III</td>
+<td>白色或褐色</td>
+<td>干燥似皮革</td>
+<td>无感觉</td>
+<td>需切痂皮，植皮，皮瓣移植或截肢</td>
+</tr>
+</tbody></table>
+<p>根据以上的参考，可以把伤情分为四类：</p>
+<ol>
+<li>轻度烧伤：总面积 9% 以下的 II 度烧伤</li>
+<li>中度烧伤：II 度烧伤总面积达 10%～29% ，或 III 度烧伤面积在 9% 以下。</li>
+<li>重度烧伤：烧伤面积达到 30%～49%，III 度烧伤面积达到 10%～19%，或烧伤面积虽然不足 30% ，但全身情况较重或已经有休克，复合伤，呼吸道吸入性损伤或化学中毒等并发症</li>
+<li>特重度烧伤：烧伤面积 50% 以上，III 度烧伤面积在 20% ，有严重并发症</li>
+</ol>
+<hr>
+<p><strong>根据烧伤病史和临床表现，要注意包括对烧伤严重程度的判断，烧伤原因的鉴别，需要派出电和化学烧伤</strong></p>
+<hr>
+<h2 id="急诊处理"><a href="#急诊处理" class="headerlink" title="急诊处理"></a>急诊处理</h2><h3 id="现场急救"><a href="#现场急救" class="headerlink" title="现场急救"></a>现场急救</h3><ol>
+<li>迅速脱离热源，褪去衣物，不可粗暴剥脱。在现场可用干净敷料或布织物保护伤处，立即送医</li>
+<li>初步判断伤情，如有大出血，窒息，开放性气胸，严重中毒，立即组织抢救<blockquote>
+<p>烧伤常伴呼吸道受烟雾，热力灼伤<br>切记注意有无呼吸道吸入性损伤，保持呼吸通畅，<strong>必要时切开气管</strong><br>出现心脏骤停，确认环境安全后，迅速心肺复苏</p>
+</blockquote>
+</li>
+<li>轻度烧伤，特别是四肢烧伤，立即用冷水连续冲洗或浸泡</li>
+<li>大面积烧伤，立即建立静脉通道，予以补液，抗休克治疗</li>
+<li>转运伤员就近原则，严重烧伤早期，<strong>切忌长途转运</strong></li>
+</ol>
+<h3 id="急诊治疗"><a href="#急诊治疗" class="headerlink" title="急诊治疗"></a>急诊治疗</h3><h4 id="轻度烧伤"><a href="#轻度烧伤" class="headerlink" title="轻度烧伤"></a>轻度烧伤</h4><blockquote>
+<p>处理创面，<strong>小心</strong> 剔净创面周围毛发，清洁健康皮肤，去除异物。</p>
+</blockquote>
+<ul>
+<li>I 度创面无需处理，外敷清凉药物即可</li>
+<li>浅 II 度，如果水疱完整，不要动它，如果水疱很大，用消毒空针去抽水疱液，然后消毒包扎，如果水疱已经撕破，用无菌纱布，油性敷料包扎。创面无感染无需经常换药，面颈部和会阴部烧伤可以予以暴露，关节部位 II～III 度必须用夹板固定关节，按需用止痛镇静药物，酌情使用破伤风抗毒素。</li>
+</ul>
+<h1 id="中度及以上烧伤立刻运送至有烧伤专科的医院"><a href="#中度及以上烧伤立刻运送至有烧伤专科的医院" class="headerlink" title="中度及以上烧伤立刻运送至有烧伤专科的医院"></a>中度及以上烧伤立刻运送至有烧伤专科的医院</h1><p>处理要点：</p>
+<ol>
+<li>吸氧，呼吸支持，建立输液通道，留置尿管，观察每小时尿量，比重，pH，有无血红蛋白尿，肌红蛋白尿。</li>
+<li>估算烧伤面积，深度</li>
+<li>液体复苏，抗休克，应用林格氏液，生理盐水，葡萄糖液，胶体溶液</li>
+<li>创面处理（烧伤清除术，创面覆盖物应用，环状焦痂切开减压术，植皮术）</li>
+<li>镇静，止痛</li>
+<li>如果创面污染重，注射破伤风抗毒血清</li>
+<li>抗感染，积极防治烧伤脓毒症</li>
+<li>肠内肠外营养支持，尽量肠内营养</li>
+<li>减少瘢痕，挛缩，进行功能康复</li>
+</ol>
+<h2 id="参考"><a href="#参考" class="headerlink" title="参考"></a>参考</h2><ul>
+<li>《外科护理学【第六版】》</li>
+<li>《烧伤外科学分册》</li>
+<li>《急诊与灾难医学【第三版】》</li>
+</ul>
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@@ -138,6 +138,24 @@
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@@ -138,6 +138,24 @@
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@@ -293,24 +311,6 @@
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@@ -138,6 +138,24 @@
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+
+ 过度疲劳的六种表现
+
+ </a>
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<a href="/2023/10/05/v8%E4%B8%AD%E7%9A%84Number-toString/">
v8中的Number.toString()
@@ -293,24 +311,6 @@
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-
-
-
- <div class="post-list-item">
- <div class="post-title">
- <a href="/2023/07/30/%E4%BA%8C%E9%9B%B6%E4%BA%8C%E4%B8%89%E5%B9%B4%E4%B8%83%E6%9C%88%E4%B8%89%E5%8D%81%E6%97%A5/">
-
- 二零二三年七月三十日
-
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- </div>
-
- <span class="post-date">Jul 30, 2023</span>
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<div id="paginator">
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diff --git a/archives/page/4/index.html b/archives/page/4/index.html
index d5d68397..6c34ebda 100644
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+++ b/archives/page/4/index.html
@@ -138,6 +138,24 @@
<div class="post-list-item">
<div class="post-title">
+ <a href="/2023/07/30/%E4%BA%8C%E9%9B%B6%E4%BA%8C%E4%B8%89%E5%B9%B4%E4%B8%83%E6%9C%88%E4%B8%89%E5%8D%81%E6%97%A5/">
+
+ 二零二三年七月三十日
+
+ </a>
+ </div>
+
+ <span class="post-date">Jul 30, 2023</span>
+ </div>
+
+
+
+
+
+
+
+ <div class="post-list-item">
+ <div class="post-title">
<a href="/2023/07/21/WiscKey-Separating-Keys-from-Values-in-SSD-conscious-Storage/">
WiscKey: Separating Keys from Values in SSD-conscious Storage
@@ -293,24 +311,6 @@
</div>
-
-
-
-
-
- <div class="post-list-item">
- <div class="post-title">
- <a href="/2023/03/14/%E8%9E%BA%E5%86%85%E9%85%AF%E7%89%87/">
-
- 螺内酯片
-
- </a>
- </div>
-
- <span class="post-date">Mar 14, 2023</span>
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-
<div id="paginator">
<div class=paginator>
diff --git a/archives/page/5/index.html b/archives/page/5/index.html
index f3c593fc..6b37c714 100644
--- a/archives/page/5/index.html
+++ b/archives/page/5/index.html
@@ -138,6 +138,24 @@
<div class="post-list-item">
<div class="post-title">
+ <a href="/2023/03/14/%E8%9E%BA%E5%86%85%E9%85%AF%E7%89%87/">
+
+ 螺内酯片
+
+ </a>
+ </div>
+
+ <span class="post-date">Mar 14, 2023</span>
+ </div>
+
+
+
+
+
+
+
+ <div class="post-list-item">
+ <div class="post-title">
<a href="/2023/03/14/%E5%91%8B%E5%A1%9E%E7%B1%B3/">
呋塞米
@@ -293,24 +311,6 @@
</div>
-
-
-
-
-
- <div class="post-list-item">
- <div class="post-title">
- <a href="/2023/02/22/%E4%BA%8C%E9%9B%B6%E4%BA%8C%E4%B8%89%E5%B9%B4%E4%BA%8C%E6%9C%88%E4%BA%8C%E5%8D%81%E4%BA%8C%E6%97%A5/">
-
- 二零二三年二月二十二日
-
- </a>
- </div>
-
- <span class="post-date">Feb 22, 2023</span>
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-
<div id="paginator">
<div class=paginator>
diff --git a/archives/page/6/index.html b/archives/page/6/index.html
index c56931fc..a6788643 100644
--- a/archives/page/6/index.html
+++ b/archives/page/6/index.html
@@ -138,6 +138,24 @@
<div class="post-list-item">
<div class="post-title">
+ <a href="/2023/02/22/%E4%BA%8C%E9%9B%B6%E4%BA%8C%E4%B8%89%E5%B9%B4%E4%BA%8C%E6%9C%88%E4%BA%8C%E5%8D%81%E4%BA%8C%E6%97%A5/">
+
+ 二零二三年二月二十二日
+
+ </a>
+ </div>
+
+ <span class="post-date">Feb 22, 2023</span>
+ </div>
+
+
+
+
+
+
+
+ <div class="post-list-item">
+ <div class="post-title">
<a href="/2023/02/02/%E4%BA%8C%E9%9B%B6%E4%BA%8C%E4%B8%89%E5%B9%B4%E4%BA%8C%E6%9C%88%E4%BA%8C%E6%97%A5/">
二零二三年二月二日
@@ -295,24 +313,6 @@
</div>
-
-
-
-
-
- <div class="post-list-item">
- <div class="post-title">
- <a href="/2022/01/01/%E4%BA%8C%E9%9B%B6%E4%BA%8C%E4%BA%8C%E5%B9%B4%E4%B8%80%E6%9C%88%E4%B8%80%E6%97%A5/">
-
- 二零二二年一月一日
-
- </a>
- </div>
-
- <span class="post-date">Jan 1, 2022</span>
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<div id="paginator">
<div class=paginator>
diff --git a/archives/page/7/index.html b/archives/page/7/index.html
index ac44184f..f1f1d681 100644
--- a/archives/page/7/index.html
+++ b/archives/page/7/index.html
@@ -133,6 +133,26 @@
+ <div class="year-title">2022</div>
+
+
+ <div class="post-list-item">
+ <div class="post-title">
+ <a href="/2022/01/01/%E4%BA%8C%E9%9B%B6%E4%BA%8C%E4%BA%8C%E5%B9%B4%E4%B8%80%E6%9C%88%E4%B8%80%E6%97%A5/">
+
+ 二零二二年一月一日
+
+ </a>
+ </div>
+
+ <span class="post-date">Jan 1, 2022</span>
+ </div>
+
+
+
+
+
+
<div class="year-title">2021</div>
diff --git a/tags/Medicine/index.html b/tags/Medicine/index.html
index dd9e208c..5f26faa2 100644
--- a/tags/Medicine/index.html
+++ b/tags/Medicine/index.html
@@ -145,6 +145,24 @@
<div class="post-list-item">
<div class="post-title">
+ <a href="/2024/01/25/%E6%80%A5%E8%AF%8A%E4%B8%8E%E7%81%BE%E9%9A%BE%E5%8C%BB%E5%AD%A6-%E7%83%A7%E4%BC%A4/">
+
+ 急诊与灾难医学--烧伤
+
+ </a>
+ </div>
+
+ <span class="post-date">Jan 25, 2024</span>
+ </div>
+
+
+
+
+
+
+
+ <div class="post-list-item">
+ <div class="post-title">
<a href="/2024/01/23/%E6%85%A2%E6%80%A7%E8%82%BA%E6%BA%90%E6%80%A7%E5%BF%83%E8%84%8F%E7%97%85/">
慢性肺源性心脏病
@@ -302,24 +320,6 @@
</div>
-
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-
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-
- 灯笼草
-
- </a>
- </div>
-
- <span class="post-date">Jun 22, 2023</span>
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+++ b/tags/Medicine/page/2/index.html
@@ -145,6 +145,24 @@
<div class="post-list-item">
<div class="post-title">
+ <a href="/2023/06/22/%E7%81%AF%E7%AC%BC%E8%8D%89/">
+
+ 灯笼草
+
+ </a>
+ </div>
+
+ <span class="post-date">Jun 22, 2023</span>
+ </div>
+
+
+
+
+
+
+
+ <div class="post-list-item">
+ <div class="post-title">
<a href="/2023/06/17/%E5%8F%91%E7%83%AD%E5%8F%8A%E8%B6%85%E9%AB%98%E7%83%AD%E5%8D%B1%E8%B1%A1/">
发热及超高热危象
generated by cgit v1.2.3 (git 2.39.1) at 2026-10-04 17:27:39 +0000