閃過人生跑馬燈～照護一位電灼傷併發創傷後壓力症候群病人之加護經驗

Flashing Through Marquee of Life ~ Critical Care Experience in Caring for a Patient with Electrical Burn Complications and Post-Traumatic Stress Disorder

本個案因工作不慎觸擊高壓電，導致心臟驟停及左手電灼傷，因急性心因性休克入住加護病房，治療期間左手電灼傷傷口深度持續擴大合併神經性受損，個案除面臨心臟損傷、肢體傷口惡化，同時飽受觸電造成的精神受創，導致負面情緒，故引發筆者協助此個案的動機。護理期間為2023年8月22日至9月13日，以Gordon十一項功能性健康評估為架構，藉由直接照護、觀察、會談傾聽、身體評估、病歷查閱等收集資料，發現心輸出量減少、組織完整性受損、創傷後症候群等健康問題，運用實證的目標溫度管理照護，給予適切的護理措施，密切監測病危期的生命徵象。此外，面對重大創傷的心理陰影，個案情緒低落，筆者深刻感受陪伴、精神支持與鼓勵對個案的重要，因此提供心理專業及鼓勵重要他人的情緒支持，使個案度過創傷歷程。透過此個案護理過程，評估後發現個案有急性心理創傷，建議未來於加護病房可將中文版簡式創傷後壓力疾患量表列為常規評估，有助於即早發現此類個案的創傷問題給予介入。

This article describes the intensive nursing experience of a worker who suffered a cardiac arrest and deep electrical burns with neurological damage to the left hand following an occupational high-voltage shock, resulting in acute cardiogenic shock and severe psychological trauma. During the care period from August 22 to September 13, 2023, a comprehensive evaluation utilizing Gordon’s eleven functional health patterns—conducted via direct care, observations, interviews, and medical record reviews—identified core health problems of decreased cardiac output, impaired tissue integrity, and post-traumatic stress disorder (PTSD). To address the critical physiological instability, evidence-based Targeted Temperature Management (TTM) was applied alongside rigorous vital sign monitoring, while the progressive limb wounds were managed to support tissue healing. Recognizing the profound psychological shadow and depressive symptoms caused by the major trauma, the author provided continuous companionship and partnered with the patient's significant others to deliver targeted emotional encouragement, helping the patient navigate the trauma recovery process. Ultimately, this clinical experience highlights the acute mental health risks faced by critical trauma survivors, leading to the recommendation that the Chinese version of the Short Post-Traumatic Stress Disorder Rating Scale be implemented as a routine assessment tool in intensive care units to facilitate the early detection of and timely intervention for PTSD.