这篇文章是上学期开完志佳阳蜂螫检讨会後，家辰给我的文章 先前允诺要翻译，拖到寒假才动工，万分抱歉 全文节译自美国心脏协会及美国红十字协会所刊行之「循环」期刊2010年11月第122期 所刊载之初步急救要领。 未经译者同意有条件转载，请勿以各种形式自行转录本文。 原文网址请见： http://circ.ahajournals.org/cgi/content/full/122/18_suppl_3/S934 *************************************************************** [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. 毒蛇咬伤 不要用吸吮/抽取作为被毒蛇咬伤患者的初步急救方法。吸吮/抽取确实能移除少量 毒液，但效果有限。这种方法在临床上的效果不彰，且有可能加重患者伤势。使用 加压制动包紮[注一](患部上肢端使用40-70水银柱压力，下肢端使用55-70水银柱压力) 能够藉由淋巴液流动，有效且安全地减缓蛇毒扩散。在实际操作时，包紮绷带的压力 要宽紧适中，大约就是能让一支手指塞进绷带下的程度。早期只认为藉由外部施压 减少淋巴液流动只能处理神经性蛇毒的伤患，但加压制动包紮也可以泛用到它种非 神经性毒的毒蛇咬伤。此种急救法的要诀在於如何拿捏绷带的松紧程度。太松就无 法减缓毒液扩散，太紧则会造成患部组织伤害。另外一个问题就是，大多数的人记 不住适当的压力值以及加压制动包紮的施用方式。 [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. 失温 失温肇因於接触太冷的环境。急救的紧急程度取决於伤者暴露在寒冷环境下的时间 长短以及伤者的体温。可以藉由将伤者移到温暖的场所来使失温者回温，除去湿透 的衣物，并将外露的身体部位用像是毛毯、衣服或报纸等手边现有的材料包覆。 如果伤者无法得到适度医疗照顾，无论成效如何也应该实行主动的保暖动作。 除了主动保暖外，也别忘记要尽快请求医疗照护。可行的主动保暖方法有：将伤者 移至热源附近，并在水瓶/杯子里装上温水（不要用滚水）接触伤者肌肤。 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 冻伤 冻伤通常发生於暴露在外的肢体、部位，像是四肢以及鼻子。如果冻伤了，先移除 伤者浸湿的衣物，并且擦乾、为伤者铺上保暖物，以免造成失温。尽快将伤者送至 有良好医疗设备的机构。千万不要试着替受冻伤的部位加温，以免该部位有再次冻 伤的可能，除非你可以在短时间内将它送到邻近的医院。 轻微或是表面的冻伤(frostnip)可以用像是以贴触温暖的肌肤、手来处理。严重或 深层的冻伤应该在24小时内给予回温，而最好的方法便是将患部浸泡在37-40度的 温水当中，浸泡时间从20-30分钟不等。化学性的保暖物不要直接与患部组织接触 ，因会那样可能会造成烧伤。给予保暖之後，请尽力避免患部再度受冻且将患者尽 快送医急救。（後略） *注一： pressure immobilization bandage 应该可用弹性绷带缠绕，缠绕方式请见： http://australianmuseum.net.au/image/Applying-a-pressure-immobilisation-bandage --

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