Management of Body Temperature, Wound Exudate,and Pain in Severe Burn Patients

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  • 広範囲熱傷患者における体温，創部滲出液，疼痛の管理

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 Introduction: Nursing care for patients with severe burns involves three major challenges: management of body temperature, management of wounds, and management of pain. This study investigated the currently recommended care based on guidelines with a literature review.<br>  Body temperature management for patients with extensive burns: Avoiding hypothermia is essential in patients with extensive burns and the following measures are advised: 1）Establish target room temperatures tailored to specific situations（shock phase, perioperative period, management in the intensive care unit, etc.）and monitor body temperature. 2）In the perioperative period, combine active rewarming（e.g., with a warm air blanket）with management of appropriate room temperature and shortening of operative time.<br>  Management of burn wounds: The recommended treatment for third-degree burns is excision of the burn wound and early wound closure such as using skin grafts. Extensive third-degree burns require the management of large amounts of exudate until the wound closes. However, few studies have examined this issue, warranting future study.<br>  Analgesia and sedation for patients with burns: Several guidelines related to analgesia and sedation have been published based on a large body of evidence and are applied in practice. However, studies in this area are insufficient regarding patients with burns. The current recommendations are as follows: 1）Sedation is unnecessary as long as analgesia is instituted. 2）Opioids（fentanyl, etc.）are the first-line drugs for pain management in wound care. The dose of opioids can be reduced by combining them with other analgesics and/or sedatives, including acetaminophen, nonsteroidal anti-inflammatory drugs, propofol, dexmedetomidine (Precedex®), and ketamine. 3）Pain should be regularly evaluated using pain assessment tools such as the Behavioral Pain Scale, Critical-Care Pain Observation Tool, and Numeric Rating Scale. 4）Pregabalin (Lyrica®) can be considered for neuropathic pain.

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