- 期刊
槍傷護理
Nursing Care of Patients With Gunshot Wounds: An Overview
摘要
槍傷案件國內外時有所聞，而台灣各家醫院急診處理槍傷病人經驗缺乏，槍傷護理文獻卻付之闕如。本文依據槍傷病生理、到院前槍傷護理以及到院後槍傷護理等內容分別說明之。到院前救護工作之證據保留議題也應被重視。槍傷病生理包含傷害程度、槍傷熱動能及衝擊波、子彈軌跡和受傷部位，了解槍傷病生理機轉與原理對於臨床照護及學理非常重要。到院前依照到院前創傷救命術XABCDE原則處置病人，到院後則以急診護理可執行之急診創傷訓練以及外傷護理訓練等處置照護槍傷病人。到院後槍傷護理評估應包括檢視全身、意識評估、止血及維持穩定血液循環、維持呼吸道通暢及足夠的氧合、槍傷部位處理和精神狀態評估等，而槍傷護理處置除評估整體臨床護理問題外，分別討論身體各部位如：頭部、頸部、心胸部、腹部、四肢之護理措施，及少數案例子彈殘留體內病人日後需追蹤鉛濃度，相關傳染病或毒藥物篩檢、後續心理問題如創傷後壓力症候群、面對新聞媒體相關事項等各項進行說明。槍傷護理罕見安排於在職教育中，相關創傷護理訓練中篇幅微薄，期盼本文可以做為未來臨床護理師在照護槍傷病人時的參考。
並列摘要
Gunshot wounds (GSWs) are commonly encountered around the world, including in Taiwan. However, few studies in Taiwan have investigated the specific nursing care required for trauma patients with GSWs. This study provides a comprehensive overview of the pathophysiology of GSWs and the necessary nursing care in both prehospital and emergency department settings. The study encompasses initial assessment, advanced treatments, and posttraumatic care. The degree of damage caused by GSWs is influenced by thermal energy and shock waves, the bullet's trajectory, and the body parts affected. In prehospital care, adherence to the XABCDE principles of prehospital trauma life support is essential for patient survival; evidence retention is also essential. Upon hospital arrival, nursing assessment should include full-body, consciousness, mental status, and hemostasis evaluations, stable blood circulation maintenance, clearing of the respiratory tract, adequate oxygenation, treatment of the GSW site, and an overall clinical assessment of the GSW care required. The present study also focuses on nursing care for specific body parts, such as the head, neck, cardiothoracic area, abdomen, and limbs. Furthermore, it discusses the need for monitoring lead concentrations in patients with bullet residue, screening for infectious diseases or toxic substances, addressing psychological problems, such as posttraumatic stress syndrome, and managing interactions with the news media. GSW nursing is rarely included in in-service education, and relevant trauma nursing training is limited. The study findings may be used as a reference for clinical nurses when caring for patients with GSWs.