Sažetak | Opeklina je jedna od najčešćih traumatskih ozljeda na svijetu kod koje dolazi do ozljede kože,
potkožja, sluznica i dubokih struktura, koje su nastale štetnim djelovanjem patogene količine
topline, kemikalija, elektriciteta ili zračenja na površini tijela. Opasnost od ozljede prisutna je na
svakom koraku, u kuhinji, kupaonici, garaži, ali i izvan kućnog praga, na radnom mjestu ili na
ulici. Prema dubini oštećenja opekline možemo podijeliti na četiri stupnja. Kod određivanja
postotka opečene površine najčešće se koristi Wallecovo pravilo devetke.
Po prijemu bolesnika u bolnicu potrebno je procijeniti stupanj opekline i liječiti opeklinu po
principu općeg algoritma procjene i zbrinjavanja opečenih osoba – osigurati dišni put,
oksigenaciju, ventilaciju, i hemodinamsku stabilnost, te kirurški zbrinuti opeklinu. Primarna
kirurška obrada opekline sastoji se od procjene veličine i dubine opekline, zaštite protiv tetanusa
(anaTe) i debridmana rane. Lokalno liječenje opekline započinje s previjanjem, pri kojem se
poštuju mjere asepse i antisepse kako bi se smanjio rizik unošenja infekcije, nakon čega se
aplicira krema na bazi srebra, a prema odredbi liječnika mogu se koristiti razne obloge koje u
sebi sadrže aktivno srebro. Kod kirurškog liječenja primjenjuje se Mesh graft, Thiersch graft,
Meek micrografting metoda, Integra ili kultura keratinocita.
Zdravstvena njega opeklinskog bolesnika je opsežna i zahtijeva svakodnevnu suradnju
medicinskih sestara s anesteziolozima, kirurzima i ostalim članovima tima (mikrobiolozi,
radiolozi, fizioterapeuti, nutricionisti, psiholozi), te je stoga u zbrinjavanju bolesnika sa
opeklinom potreban učinkovit multidisciplinaran pristup. |
Sažetak (engleski) | A burn is one of the most traumatic injuries in the world which leads to injury of skin,
subcutaneous tissue, mucous membranes and deep structures created by the harmful effects of
pathogenic quantities of heat, chemicals, electricity or radiation to the surface of the body. The
risk of injury is present at every step, in the kitchen, in the bathroom, in the garage, but also
outside the doorstep, at the workplace or in the street. Depending on the depth of burning
damage, we can divide it into four levels. When determining the percentage of total body area
affected, the Wallecs' rule of the nines is most often used.
Upon hospital admittance, it is necessary to evaluate the degree of burns and treat burns
according to the general algorithm for estimating and taking care of burned persons - providing
airways, oxygenation, ventilation, and hemodynamic stability and surgically assisted burns.
Primary surgical burning treatment consists of estimation of the size and depth of the burn, the
protection against tetanus (anaTe) and the debridement of the wound. Local treatment of burns
begins with bandaging, at which rules of asepsis and antisepsis are taken in order to reduce the
risk of infection, followed by applying silver bazed cream, and according to doctors' advice
various burn dressings which contain active silver can be used. For surgical treatment Mesh
graft, Thiersch graft, Meek micrografting method, Integra or keratinocytes culture are applied.
The health care of a burned patient is extensive and requires daily co-operation of nurses with
anesthesiologists, surgeons and other team members (microbiologists, radiologists,
physiotherapists, nutritionists, psychologists), therefore, an effective multidisciplinary approach
in taking care of burning patients is needed. |