一位 35 歲男性因工業爆炸事故被收治於燒燙傷中心。評估發現他有覆蓋 40% 總體表面積（TBSA）的深度部分皮層與全層燒傷。病人心搏過速（130 次/分）、低血壓（80/50 mmHg），且意識改變。在嚴重燒傷的急救期（Emergent phase），護理師的首要行動為何？
A 35-year-old male is admitted to the burn unit following an industrial explosion. Assessment reveals deep partial-thickness and full-thickness burns covering 40% of total body surface area (TBSA). The client is tachycardic (130 bpm), hypotensive (80/50 mmHg), and has an altered level of consciousness. During the emergent (resuscitative) phase of severe burn injury, what is the nurse's priority action?
- AAdminister intravenous opioid analgesics to control severe pain before any other intervention.在任何其他介入措施之前，給予靜脈鴉片類鎮痛劑以控制劇烈疼痛
- BEstablish two large-bore IV lines and initiate fluid resuscitation with Lactated Ringer's solution.✓ 正解建立兩條粗大靜脈導管，並開始以乳酸林格氏液進行液體復甦
- CInsert a nasogastric tube to decompress the stomach and prevent Curling's stress ulcer.插入鼻胃管以減壓胃部並預防庫林氏（Curling）應激性潰瘍
- DCleanse the burn wounds thoroughly with povidone-iodine solution to prevent infection.徹底用聚維酮碘溶液清潔燒傷傷口以預防感染
嚴重燒傷急救期（Emergent / Resuscitative phase，受傷後 24-48 小時內）的核心病理變化為微血管通透性大幅增加，血漿從血管內漏入組織間隙（第三空間），導致低血容性休克（Burn shock）。題目中病人低血壓、心搏過速、意識改變正是循環衰竭的徵象。依據 Parkland 公式進行積極的靜脈輸液復甦（Lactated Ringer's solution）以維持組織灌流，是此階段最優先的處置。傷口清創（D）需待病人穩定後進行；止痛（A）雖重要，但在血容量未恢復前給予鴉片類藥物可能加重低血壓；NG 管減壓（C）為次要措施。
The priority intervention for a client in burn shock is aggressive fluid resuscitation to restore intravascular volume and maintain tissue perfusion, typically using Lactated Ringer's solution via large-bore IV lines. While pain management and wound care are important, they are secondary to stabilizing the client’s hemodynamic status during the emergent phase.
世界急救外傷第一常識：「大範圍燒燙傷的第一秒＝建立大條打針管線狠狠給他灌下大量的 乳酸林格氏液(Lactated Ringer's) 救低血容休克，這遠比止痛防感染還重要！」。全宇宙通用。