Quality care of the injured with extensive heat burn in prehospital environment

Uvod: Koža je največji človeški površinski organ, ki je pri opeklinah najbolj prizadet in so njegove zaščitne funkcije zaradi tega okvarjene. Opekline predstavljajo raznoliko skupino poškodb glede na vzrok in čas ter jakost delovanja povzročitelja. Preživetje huje opečenih, končni izid zdravljenja in teža trajnih posledic so v veliki meri odvisni od pravočasnega ter pravilnega nudenja prve in nujne pomoči. Pristop poškodovancu v predbolnišničnem okolju je specifičen, ker je potrebno upoštevati celo vrsto dejavnikov, ki jih srečamo v tem okolju. Čas oskrbe je pri poškodovancu zelo pomemben in nepotrebno zavlačevanje z oskrbo na terenu lahko povzroči celo smrt. Namen: Namen diplomskega dela je na podlagi literature predstaviti poškodbo s termalno opeklino in opisati potek oskrbe poškodovanca v predbolnišničnem okolju ter predstaviti ključne zaplete. Cilji diplomskega dela so s pomočjo pregleda literature: predstaviti opeklino in opredeliti vrste opeklinskih poškodb glede na povzročitelja, opisati oskrbo opeklinske poškodbe v predbolnišničnem okolju v skladu s sistematičnim pregledom ITLS, predstaviti najpogostejše zaplete pri oskrbi opeklinske poškodbe. Metode dela: Uporabljen je bil sistematičen pregled domače in tuje literature med 2006 in 2016. Iskanje je potekalo v podatkovnih bazah CINAHL, Medline, Wiley Online Library ter v vzajemni bibliografski kataloški bazi podatkov COBIB.SI. Rezultati: Opekline so eden od ključnih vzrokov za smrt in invalidnost. Obsežne opekline so strahotna izkušnja, ki pusti pacientom dolgotrajne fizične in psihološke posledice. Opekline so izjemno kompleksne poškodbe in lahko sprožajo različne zaplete, ki zahtevajo dolgotrajno in razmeroma drago oskrbo od meseca do nekaj let. Pri poškodovancu z opeklinsko rano na terenu je potrebno prepoznati vse nevarnosti, ki spremljajo opeklinsko rano in v nekaj urah lahko poslabšajo stanje poškodovanca ali celo ogrozijo njegovo življenje. Poznavanje ključnih znanstvenih ugotovitev o oskrbi poškodovanca s termalno opeklino v predbolnišničnem okolju in preprečevanje zapletov je pomembno za delo medicinske sestre pri kakovostni oskrbi teh pacientov. Razprava in sklep: Kakovostna in strokovno utemeljena oskrba na terenu je nujno potrebna, saj se s pravilnim nudenjem prve pomoči takoj po poškodbi lahko v določeni meri vplivamo na obseg poškodbe. Kakovostna oskrba zmanjšuje možnosti pojava zapletov, kot so hipovolemični šok, okužba in hipotermija.Introduction: Skin is the largest suface organ of the human body, which is most affected by burns and its protective function is defected. Burns represent a diverse group of injuries in terms of the cause, time and the intensity of the operation agent. Survival of severely burned, the final outcome of the treatment and the weight of the permanent consequences largely depend on the timely and proper first and emergency aid. The approach to the injured in the prehospital environment is specific because it takes into account a whole range of factors encountered in the environment. The time of supply is very important for injured and unnecessary delays in treatment on the ground even can cause death. Purpose: The aim of the thesis is to present thermal burn injury based on literature and describe the course of treatment of the injured in the prehospital environment, and present key complications. The objectives of the thesis with the help of a literature review: to present a burn and specify the types of burn injuries regardless of the perpetrator, describe the treatment of burn injuries in the prehospital environment in accordance with a systematic review of ITLS, present the most common complications in the care of burn injuries. Methods: Descriptive method is based on a systematic review of domestic and foreign scientific and professional literature in the period 2006-2016 using the databases Medline and CINAHL and the COBIB.SI. Results: Burn injury is one of the major causes of death and disability. Serious burn injuries are devastating events that leave patients with long-term physical and psychological challenges. Burn injuries may be extremely complex in their presentation, and any resulting complications may extend the need for expensive long-term management from months to years. Whit a patient with burn injuries at the scene, nurses should identify all risks that could worsen the conditions of the injured and even threaten his/her life. Knowledge of key scientific findings on the care of patients with thermal burn injury in the prehospital environment and prevention of complications that may arise, is important for the work of nurses with those patients. Discussion and conclusion: Quality and scientifically based care at the scene is necessary since proper first aid can have some influence on the extent of the injury. Quality care can reduce the chances of complications, such as hypovolemic shock, infection, and hypothermia