熱昏了～熱中暑病人之急診護理經驗

An Emergency Nursing Experience of A Patient with Heat Stroke

本文旨在描述照護一位高溫環境工作導致熱中暑病人的急診護理經驗。護理期間為2014年07月02日17:10至20:45，運用生理、心理、社會及靈性四大層面做為評估架構，藉由身體評估、觀察、會談等方式收集資料，確立主要健康問題依序為體溫過高、體液容積缺失與案妻之焦慮問題。個案因熱中暑導致昏迷，急診團隊透過大量補充輸液、積極降溫、穩定生命徵象等方式，改善個案生理問題，經由向案妻詳細解說、澄清迷思與引導共同照護下，緩解案妻焦慮問題，轉加護病房前個案體溫已從43℃降到37.8℃，昏迷指數從8分轉為13分。炎炎夏日氣溫屢創新高，熱中暑急診人次也跟著逐年增加，如何在黃金兩小時內給予正確的緊急處置，將影響熱中暑的存活率與預後，有鑑於此，本成功照護經驗成為筆者撰寫報告之理由。建議急症單位須加強熱中暑等環境傷害的緊急照護能力與急重症家屬的焦慮照護，唯有家屬配合參與及對病人立即、積極、正確的熱中暑照護，才能及時穩定病人生命徵象、預防續發性傷害，避免生命垂危、不可逆性腎傷害等威脅，幫助個案早日健康出院、回歸職場，幫助家庭渡過危機。

This paper describes the emergency nursing experience of caring for a patient with heat stroke resulting from occupational exposure to a hot environment. The nursing period was from 17:10 to 20:45 on July 2, 2014. We used the four aspects of health (physical, psychological, social, and spiritual) as the assessment framework and collected data through physical assessment, observations, and conversations. The health problems included hyperthermia, fluid volume deficit. The patient’s wife was also suffering from anxiety. During the nursing process, we first conducted several strategies to manage the comatose patient’s physical problems, such as providing adequate fluids, proactively reducing his temperature, and stabilizing his vital signs. We also provided a detailed explanation to the patient’s wife to help alleviate her worries and misconceptions and help her understand the shared care plan, thereby relieving her anxiety. Before the patient’s transfer to ICU, his temperature had already reduced from 43°C to 37.8°C and the Glasgow Coma Scale score had improved from 8 to 13. More frequent high summer temperatures have resulted in an increased number of emergency patients with heat stroke. The administration of appropriate emergency management within the first two hours (“the golden hours”) is the key to a better rate of survival and prognosis for patients with heat stroke. In view of this, we would like to share this successful nursing experience with other medical professionals. We suggest that emergency units should reinforce the emergency nursing care provided for patients exposed to environmental hazards, such as those suffering from heat stroke, and that this should also include helping patients’ family members to manage their anxiety. The cooperation and participation of family members and the provision of timely, proactive, and appropriate care can promptly stabilize heat stroke patients’ vital signs, and prevent secondary injury. This means that patients can then avoid life-threatening complications, such as irreversible renal damage, thereby assisting patients to be discharged from hospital and return to work. In addition, patients’ families are helped through the crisis.