2026-01-27 19:34
相關筆記
剛看另一篇研究. 燙傷三小時內沖冷水20分鐘能降低需植皮和手術的機率. 所以又回頭查了一下 uptodate 是否有新的改變.
據我以前在急診的經驗. 有些燙傷患者到達醫院的時間已經是好幾小時之後. 這樣還需要先沖冷水嗎? 到底燙傷幾小時之內降溫才有好處. uptodate 2025年版的乾脆不寫. 只寫 Immediate cooling after injury, 以及降溫治療可持續30分鐘.
下面是 uptodate 內容. 僅節錄 cooling and pain management 兩段.
Treatment of minor thermal burns(from uptodate) Literature review current through: Dec 2025. This topic last updated: Jun 25, 2024.
舊的uptodate 版本, 我本來以為是沖水3小時. 但看新的研究的描述. 回頭再看一次原文. 應該是指燙傷三小時內降溫會有好處. 不是連續降溫三小時. 但這段話在版本更新後已經被拿掉了.
Multiple studies have investigated optimal burn cooling, with durations from 15 minutes to three hours
冷卻 －
去除衣物、首飾（例如戒指）和不黏附的碎屑後，可用室溫或涼自來水冷卻燒傷創面，以緩解疼痛並減少組織損傷。對於燒傷面積小於體表面積5%的創面，受傷後立即冷卻最多30分鐘可能有助於減輕燒傷深度，但必須權衡傷口浸漬風險。或者，可以用濕紗布或毛巾覆蓋創面，這樣既能減輕疼痛又不會浸濕創面，可以保持最多30分鐘，直到敷料包紮完畢。
應避免直接使用冰塊或冰水，因為這會加劇疼痛和組織損傷。使用浸泡過水或生理食鹽水的紗布（冷卻至約12°C/55°F）進行降溫是一種有效的方法[ 5 ]。在門診，可以將一份冷藏生理食鹽水與一份室溫生理食鹽水混合。應密切監測患者，尤其是幼兒，以防體溫過低[ 6 ]。
疼痛管理 －
應避免直接使用冰塊或冰水，因為這會加劇疼痛和組織損傷。使用浸泡過水或生理食鹽水的紗布（冷卻至約12°C/55°F）進行降溫是一種有效的方法[ 5 ]。在門診，可以將一份冷藏生理食鹽水與一份室溫生理食鹽水混合。應密切監測患者，尤其是幼兒，以防體溫過低[ 6 ]。
疼痛管理 －
對於小面積燒傷，對乙醯氨基酚和非類固醇類抗發炎藥（NSAIDs），單獨使用或與鴉片類藥物聯合使用，通常足以緩解疼痛[ 7 ]。對於兒童嚴重或疼痛性燒傷的止痛治療，將在其他章節詳細討論。
在急診室 (ED) 或門診部對輕微燒傷（即部分厚度 <25 cm 2 ）進行清創時，局部麻醉劑如利多卡因-丙胺卡因乳膏（局部麻醉劑共晶混合物，EMLA）可有效減輕疼痛 [ 8 ]。
初期應全天候給予止痛藥，並在換藥和增加體力活動前給予額外的「急救」藥物[ 7,9 ]。抬高四肢燒傷部位至高於心臟水平，可減輕傷後數天的疼痛和腫脹。用浸泡過涼水的紗布敷於傷口最多30分鐘，是燒傷後早期緩解疼痛的有效方法。
傷口上皮化後，疼痛管理需求通常會顯著下降。然而，如果搶救藥物不足，止痛需求反而可能增加。面積較大或近期燒傷的患者可能會出現劇烈疼痛，需要靜脈注射鴉片類藥物進行初始鎮痛。
在急診室 (ED) 或門診部對輕微燒傷（即部分厚度 <25 cm 2 ）進行清創時，局部麻醉劑如利多卡因-丙胺卡因乳膏（局部麻醉劑共晶混合物，EMLA）可有效減輕疼痛 [ 8 ]。
初期應全天候給予止痛藥，並在換藥和增加體力活動前給予額外的「急救」藥物[ 7,9 ]。抬高四肢燒傷部位至高於心臟水平，可減輕傷後數天的疼痛和腫脹。用浸泡過涼水的紗布敷於傷口最多30分鐘，是燒傷後早期緩解疼痛的有效方法。
傷口上皮化後，疼痛管理需求通常會顯著下降。然而，如果搶救藥物不足，止痛需求反而可能增加。面積較大或近期燒傷的患者可能會出現劇烈疼痛，需要靜脈注射鴉片類藥物進行初始鎮痛。
Cooling —
After any clothing, jewelry (eg, rings), and nonadherent debris is removed, burn wounds can be cooled with room-temperature or cool tap water to provide some pain relief and limit tissue injury. Immediate cooling after injury for up to 30 minutes for burns <5 percent total body surface area (TBSA) may diminish burn depth, however this must be weighed with increased risk of wound maceration. Alternatively, the wound may be covered with wet gauze or towels, which can decrease pain without immersing the wound and may be kept on the wound for as long as 30 minutes, until dressings are applied.
Direct application of ice or iced water should be avoided as this can increase pain and tissue injury. Applying water or saline-soaked gauze, cooled to around 12°C (55°F), is one effective means of cooling [5]. In the outpatient setting, this can be done by mixing one part refrigerated saline with one part room temperature saline. Patients, particularly small children, should be carefully monitored for hypothermia [6].
Pain management — For small burn injuries, acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), alone or in combination with opioids, are often sufficient for analgesia [7]. Analgesia for children with significant or painful burns is discussed in detail separately. (See "Management of burn wound pain and itching".)
When debriding minor burns (ie, partial thickness <25 cm2) in the emergency department (ED) or outpatient setting, topical anesthetic agents such as lidocaine-prilocaine cream (Eutectic Mixture of Local Anaesthetics, EMLA) may be effective in reducing pain [8].
Initially, analgesics should be administered around the clock, giving additional "rescue" medication before dressing changes and increased physical activity [7,9]. Elevation of lower and upper extremity burns above the level of the heart can reduce pain and swelling for several days following the injury. Applying gauze soaked in cool water to a wound for up to 30 minutes is a suitable technique for reducing pain soon after the burn is sustained.
Pain management needs usually decline markedly once wound epithelization has occurred. However, analgesia requirements can actually increase if rescue medications are inadequate. Patients with larger or recently sustained burns can present with significant pain and may require intravenous (IV) opioids for initial analgesia.
Direct application of ice or iced water should be avoided as this can increase pain and tissue injury. Applying water or saline-soaked gauze, cooled to around 12°C (55°F), is one effective means of cooling [5]. In the outpatient setting, this can be done by mixing one part refrigerated saline with one part room temperature saline. Patients, particularly small children, should be carefully monitored for hypothermia [6].
Pain management — For small burn injuries, acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), alone or in combination with opioids, are often sufficient for analgesia [7]. Analgesia for children with significant or painful burns is discussed in detail separately. (See "Management of burn wound pain and itching".)
When debriding minor burns (ie, partial thickness <25 cm2) in the emergency department (ED) or outpatient setting, topical anesthetic agents such as lidocaine-prilocaine cream (Eutectic Mixture of Local Anaesthetics, EMLA) may be effective in reducing pain [8].
Initially, analgesics should be administered around the clock, giving additional "rescue" medication before dressing changes and increased physical activity [7,9]. Elevation of lower and upper extremity burns above the level of the heart can reduce pain and swelling for several days following the injury. Applying gauze soaked in cool water to a wound for up to 30 minutes is a suitable technique for reducing pain soon after the burn is sustained.
Pain management needs usually decline markedly once wound epithelization has occurred. However, analgesia requirements can actually increase if rescue medications are inadequate. Patients with larger or recently sustained burns can present with significant pain and may require intravenous (IV) opioids for initial analgesia.
2023-03-28 燒燙傷使用冷水沖洗, 應該用多低溫的水, 要沖多久?
1. 可將組織降溫到大約 12度. 在燒燙傷最初幾小時內將組織溫到降到 12 度C 可緩解疼痛.
2. 各種醫學研究. 沖水時間 15分鐘至三小時
3. 禁止使用冰塊/冰水.
筆記: 2025-08-20 燒燙傷水泡處置 from uptodate
1. 可將組織降溫到大約 12度. 在燒燙傷最初幾小時內將組織溫到降到 12 度C 可緩解疼痛.
2. 各種醫學研究. 沖水時間 15分鐘至三小時
3. 禁止使用冰塊/冰水.
筆記: 2025-08-20 燒燙傷水泡處置 from uptodate
筆記:燒燙傷.節錄自WMS
下面是 uptodate 的建議 (下面中文是google的翻譯)
立即燒傷護理和冷卻— 應立即除去任何灼熱或燒傷的衣服、珠寶和明顯的碎片，以防止進一步受傷，並能夠準確評估燒傷程度（護理人員應採取預防措施，避免在以下情況下受傷）：移除此類材料。
燒傷部位應立即用冷水或鹽水浸濕的紗布冷卻。對於中小型燒傷，冷卻可以最大程度地減少受傷區域。多項研究調查了最佳燒傷冷卻時間，持續時間從 15 分鐘到 3 小時不等 [ 52-54 ]。我們一般用生理食鹽水浸濕的紗布，在12℃左右的溫度下敷15到30分鐘。在受傷後的最初幾個小時內將組織冷卻至 12°C (54°F) 左右可有效減輕燒傷疼痛；應避免冰敷和冷凍，以防止凍傷、全身溫過低和燒傷損傷擴大。
持續監測核心體溫，同時進行冷卻以幫助防止體溫過低，特別是在處理超過 10% TBSA 的燒傷時；應避免體溫低於 35°C (95°F) [ 55,56 ]。溫熱的靜脈輸液可用於維持核心體溫。
Immediate burn care and cooling —
下面是 uptodate 的建議 (下面中文是google的翻譯)
立即燒傷護理和冷卻— 應立即除去任何灼熱或燒傷的衣服、珠寶和明顯的碎片，以防止進一步受傷，並能夠準確評估燒傷程度（護理人員應採取預防措施，避免在以下情況下受傷）：移除此類材料。
燒傷部位應立即用冷水或鹽水浸濕的紗布冷卻。對於中小型燒傷，冷卻可以最大程度地減少受傷區域。多項研究調查了最佳燒傷冷卻時間，持續時間從 15 分鐘到 3 小時不等 [ 52-54 ]。我們一般用生理食鹽水浸濕的紗布，在12℃左右的溫度下敷15到30分鐘。在受傷後的最初幾個小時內將組織冷卻至 12°C (54°F) 左右可有效減輕燒傷疼痛；應避免冰敷和冷凍，以防止凍傷、全身溫過低和燒傷損傷擴大。
持續監測核心體溫，同時進行冷卻以幫助防止體溫過低，特別是在處理超過 10% TBSA 的燒傷時；應避免體溫低於 35°C (95°F) [ 55,56 ]。溫熱的靜脈輸液可用於維持核心體溫。
備註.
計算傷燙傷面積, 以二度或以上的(更嚴重)才列入計算
二度燒燙傷會起水泡.
二度燒燙傷會起水泡.
Immediate burn care and cooling —
Any hot or burned clothing, jewelry, and obvious debris should immediately be removed to prevent further injury and to enable accurate assessment of the extent of burns (caretakers should take precautions to avoid injuring themselves when removing such material).
Burned areas should be cooled immediately using cool water or saline soaked gauze. For small and moderate sized burns, cooling can minimize the zone of injury. Multiple studies have investigated optimal burn cooling, with durations from 15 minutes to three hours [52-54]. We generally apply saline-soaked gauzes, at a temperature of approximately 12°C, for 15 to 30 minutes. Cooling tissue to around 12°C (54°F) during the first several hours after injury effectively decreases pain from burns; ice and freezing should be avoided to prevent frostbite, systemic hypothermia, and extension of burn injury.
Core body temperature is continuously monitored while cooling is performed to help prevent hypothermia, especially when dealing with burns greater than 10 percent TBSA; body temperature below 35°C (95°F) should be avoided [55,56]. Warmed IV fluids can be used to maintain core body temperature.
Burned areas should be cooled immediately using cool water or saline soaked gauze. For small and moderate sized burns, cooling can minimize the zone of injury. Multiple studies have investigated optimal burn cooling, with durations from 15 minutes to three hours [52-54]. We generally apply saline-soaked gauzes, at a temperature of approximately 12°C, for 15 to 30 minutes. Cooling tissue to around 12°C (54°F) during the first several hours after injury effectively decreases pain from burns; ice and freezing should be avoided to prevent frostbite, systemic hypothermia, and extension of burn injury.
Core body temperature is continuously monitored while cooling is performed to help prevent hypothermia, especially when dealing with burns greater than 10 percent TBSA; body temperature below 35°C (95°F) should be avoided [55,56]. Warmed IV fluids can be used to maintain core body temperature.
