중증외상환자의 주 손상 부위별 특성과 간호활동

김명희; 김명희; 박정하

서지반출

국문초록

오늘날 산업화와 경제성장에 따라 교통사고, 재해, 산업 재해 등의 각종사고가 증가하면서(Kim, J. J. et al., 2011) 매년 12만 5천 명의 중증외상환자가 발생하고, 이 중 1만 1천 명이 사망하고 있지만, 적절하고 신속한 치료가 이루어진다면 살릴 수 있는 중증외상환자도 3천 5백 명에 달한다(Joo, 2010). 외상환자의 예방가능 사망률은 그 나라의 전체적인 외상체계를 평가할 수 있는 지표로(Mackenzie, 1999) 미국과 일본의 중증외상환자 예방가능 사망률은 10-15% (Esposito, Sanddal, Reynolds, & Sanddal, 2003; Kunihiro, 2005)인 데 비해 국내는 33%로(Kim, 2011) 2배가 넘는 실정이다. 외상진료체계를 구축하여 외상환자의 예방가능 사망률을 줄이고 있는 외국사례를 토대로(Stewart, Lane, & Stefanits, 1995) 국내에서는 2009년 중증외상 특성화 후보센터를 지정하였고, 향후 전문외상센터를 운영할 계획이다(Central Emergency Medical Center, 2009). 현재 중증외상환자들은 권역응급의료센터에서 치료를 전담하고 있으나 입원대기 환자들이 정체되고(Chun, 2008) 치료전담 의료 인력이 부족(Lee, 2011)하여 중증외상환자의 진단, 치료 및 처치가 지연되고 있다. 외상환자는 외상초기의 적절한 치료여부에 따라 예후에 많은 영향을 받으므로(Nguyen, Rivers, & Havastad, 2000), 진단 및 치료에 소요되는 시간을 단축시켜 빠른 시간 내에 처치가 이루어지는 것이 매우 중요하다(Kim et al., 2007). 외상환자의 대부분은 다발성 외상환자들로(Kim, T. Y. et al., 2011) 복합적인 문제들을 동반하는 경우가 많기 때문에 생명유지를 위한 기본적인 처치와 동시에 손상부위에 따른 사정, 처치 및 간호활동이 이루어져야 한다. 국군간호사관학교의 외상간호교육과정(Trauma Nursing Core Course, TNCC)에 신체의 해부학적 부위에 따른 간호가 있지만, 이는 사고현장에서부터 병원에 도착하기까지의 상황에 대한 것(Korean Nurses Association, 2013)이고, 응급환자 매뉴얼의 외상환자 간호처치는 이론적이므로 임상실무현장을 반영한 병원 도착 후의 중증외상환자의 간호활동에 대한 연구가 필요하다.

영문초록

Purpose: The purpose of this study was to identify the characteristics and nursing activities of severe trauma patients regarding damaged body parts in Busan Regional Emergency Medical Center. Methods: A survey using a ‘trauma patient information questionnaire and a list of nurse activities’ was conducted with 133 patients over 15 points ISS on EMR from June 1, 2011 to May 31, 2012. The collected data were analyzed by the SPSS/WIN 12.0 program. Results: Almost all of the subjects were men, and the mean age was 48.8. The amount of road traffic accidents was 60.4%, and the mean RTS and ISS were 6.08, and 23.14 points. Nursing activities in common were airway management, assessment of LOC & GCS, and EKG monitoring. Most of head and neck trauma patients were cared for manasing using intracranial pressure: each patience had the following assessed: pupil size and light reflex, they were checked the leak of CSF, kept 30˚ head elevation, and administered medications. Some of chest trauma patients were treated for chest tube and central venous catheter insertion. Partial abdominal trauma patients were administered analgesic and cared for using arterial pressure measurement. Part of the limbs and pelvis trauma patients were given a blood transfusion. Conclusion: Based on the results, the characteristics and nursing activities were specific according to the specific damaged body parts.

키워드

Trauma Nursing activities Emergency 외상 간호활동 응급

참고문헌 (30건)

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