作者Houyhnhnms (buffoonery)
看板NCCU_Climb
標題[分享] 野外急救技巧（人受或被動物咬、螫傷）
時間Sat Feb 5 22:29:39 2011
這篇文章是上學期開完志佳陽蜂螫檢討會後，家辰給我的文章
先前允諾要翻譯，拖到寒假才動工，萬分抱歉
全文節譯自美國心臟協會及美國紅十字協會所刊行之「循環」期刊2010年11月第122期
所刊載之初步急救要領。
未經譯者同意有條件轉載，請勿以各種形式自行轉錄本文。
原文網址請見：
http://circ.ahajournals.org/cgi/content/full/122/18_suppl_3/S934
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[p.938]
Snakebites
Do not apply suction as first aid for snakebites (Class III, LOE C).
Suction does remove some venom, but the amount is very small.134 Suction
has no clinical benefit135 and it may aggravate the injury.136 –138
Applying a pressure immobilization bandage with a pres- sure between 40
and 70 mm Hg in the upper extremity and between 55 and 70 mm Hg in the
lower extremity around the entire length of the bitten extremity is an
effective and safe way to slow the dissemination of venom by slowing
lymph flow (Class IIa, LOE C139,140). For practical purposes pressure
is sufficient if the bandage is comfortably tight and snug but allows
a finger to be slipped under it. Initially it was theorized that slowing
lymphatic flow by external pressure would only benefit victims bitten by
snakes producing neurotoxic venom, but the effectiveness of pressure
immobilization has also been demonstrated for bites by non-neurotoxic
American snakes.140,141 The challenge is to find a way to teach the
application of the correct snugness of the bandage because inadequate
pressure is ineffective and too much pressure may cause local tissue
damage. It has also been demonstrated that, once learned, retention of
the skill of proper pressure and immobilization application is poor.
毒蛇咬傷
不要用吸吮/抽取作為被毒蛇咬傷患者的初步急救方法。吸吮/抽取確實能移除少量
毒液，但效果有限。這種方法在臨床上的效果不彰，且有可能加重患者傷勢。使用
加壓制動包紮[註一](患部上肢端使用40-70水銀柱壓力，下肢端使用55-70水銀柱壓力)
能夠藉由淋巴液流動，有效且安全地減緩蛇毒擴散。在實際操作時，包紮繃帶的壓力
要寬緊適中，大約就是能讓一支手指塞進繃帶下的程度。早期只認為藉由外部施壓
減少淋巴液流動只能處理神經性蛇毒的傷患，但加壓制動包紮也可以泛用到它種非
神經性毒的毒蛇咬傷。此種急救法的要訣在於如何拿捏繃帶的鬆緊程度。太鬆就無
法減緩毒液擴散，太緊則會造成患部組織傷害。另外一個問題就是，大多數的人記
不住適當的壓力值以及加壓制動包紮的施用方式。
[p. 939]
Hypothermia
Hypothermia is caused by exposure to cold. The urgency of treatment
depends on the length of exposure and the victim’s body temperature.
Begin rewarming a victim of hypothermia immediately by moving the victim
to a warm environment, removing wet clothing, and wrapping all exposed
body surfaces with anything at hand, such as blankets, clothing, and
newspapers. If the hypothermia victim is far from definitive health care,
begin active rewarming (Class IIa, LOE B159,160) although the effectiveness
of active rewarming has not been evaluated. Active rewarming should not
delay definitive care. Potential methods of active rewarming in- clude
placing the victim near a heat source and placing containers of warm,
but not hot, water in contact with the skin.
失溫
失溫肇因於接觸太冷的環境。急救的緊急程度取決於傷者暴露在寒冷環境下的時間
長短以及傷者的體溫。可以藉由將傷者移到溫暖的場所來使失溫者回溫，除去濕透
的衣物，並將外露的身體部位用像是毛毯、衣服或報紙等手邊現有的材料包覆。
如果傷者無法得到適度醫療照顧，無論成效如何也應該實行主動的保暖動作。
除了主動保暖外，也別忘記要儘快請求醫療照護。可行的主動保暖方法有：將傷者
移至熱源附近，並在水瓶/杯子裡裝上溫水（不要用滾水）接觸傷者肌膚。
Frostbite
Frostbite usually affects an exposed part of the body such as the
extremities and nose. In case of frostbite, remove wet clothing and
dry and cover the victim to prevent hypothermia. Transport the victim
to an advanced medical facility as rapidly as possible. Do not try to
rewarm the frostbite if there is any chance that it might refreeze161,162
or if you are close to a medical facility (Class III, LOE C).
Minor or superficial frostbite (frostnip) can be treated with simple,
rapid rewarming using skin-to-skin contact such as a warm hand.
Severe or deep frostbite should be rewarmed within 24 hours of injury
and this is best accomplished by immersing the frostbitten part in warm
(37° to 40°C or approximately body temperature) water for 20 to 30
minutes (Class IIb, LOE C161–170). Chemical warmers should not be placed
directly on frostbitten tissue because they can reach temperatures that
can cause burns (Class III, LOE C171). Following rewarming, efforts should
be made to protect frostbitten parts from refreezing and to quickly evacuate
the patient for further care. The effectiveness of ibuprofen or other
nonsteroidal antiin- flammatory drugs (NSAIDs) in frostbite has not been
well established in human studies.170,172–175
凍傷
凍傷通常發生於暴露在外的肢體、部位，像是四肢以及鼻子。如果凍傷了，先移除
傷者浸濕的衣物，並且擦乾、為傷者鋪上保暖物，以免造成失溫。儘快將傷者送至
有良好醫療設備的機構。千萬不要試著替受凍傷的部位加溫，以免該部位有再次凍
傷的可能，除非你可以在短時間內將它送到鄰近的醫院。
輕微或是表面的凍傷(frostnip)可以用像是以貼觸溫暖的肌膚、手來處理。嚴重或
深層的凍傷應該在24小時內給予回溫，而最好的方法便是將患部浸泡在37-40度的
溫水當中，浸泡時間從20-30分鐘不等。化學性的保暖物不要直接與患部組織接觸
，因會那樣可能會造成燒傷。給予保暖之後，請盡力避免患部再度受凍且將患者儘
快送醫急救。（後略）
*註一： pressure immobilization bandage 應該可用彈性繃帶纏繞，纏繞方式請見：
http://australianmuseum.net.au/image/Applying-a-pressure-immobilisation-bandage
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◆ From: 140.119.144.114
推 aaa123aaa:why化學性保暖物會燒傷? 02/05 23:03
推 bachelour:重點在於這文章打了毒蛇急救器一巴掌 02/08 20:37
推 jcwang:也不算一巴掌, 對於出血性毒蛇還是有攻用 02/12 12:18
→ bachelour:之前沒推完，文章內說suction，我翻吸吮/抽取是針對 02/12 15:51
→ bachelour:用嘴吸蛇毒的錯誤方式，至於急救器效用如何就有待商榷 02/12 15:52
→ bachelour:我問了讀護理的表妹，他說也可以先用止血帶綁住傷肢上端 02/12 15:53
→ bachelour:以減緩蛇毒流動，不過不要綁太緊就是 02/12 15:53
→ bachelour:但我覺得，等待救援期間吸兩下應該無妨 02/12 16:01
推 jcwang:除了減緩蛇毒流動, 最重要的應該是移至安全位置 02/14 12:13
→ jcwang:跟穩定患者生命跡象 02/14 12:13
推 bachelour:所以我覺得山裡被蛇咬重點是要怎麼求救，直接叫直升機？ 02/14 14:22
→ bachelour:如果硬要下山，血液流通快就掛更快。 02/14 14:23
推 jcwang:就移至安全環境跟穩定生命跡象阿, 山上求救來不及 02/14 21:01