Current Management of Burns

Abstract

Major burns are relatively frequent injuries that carry a high risk for morbidity and mortality. Patients at the extremes of age or with concomitant inhalation injury are at increased risk for complications and death from their thermal injuries. The initial management of thermal injuries continues to prioritize maintenance of the airway, breathing, and circulation with prompt consideration for transfer to a specialized burn care center. Early fluid resuscitation is best accomplished with an isotonic crystalloid solution to maintain tissue perfusion, hemodynamic stability and prevent remote organ failure. The necessary fluid volume is estimated from the patient's weight and percentage of body surface area burned and adjusted as determined by the patient's clinical response. Patients who have sustained an inhalation injury are at increased risk for pneumonia and require additional fluid resuscitation, meticulous pulmonary toilet and, occasionally, mechanical ventilation. Wound care following fluid resuscitation is based on topical antimicrobial therapy followed by early surgical excision and grafting to achieve wound closure and control infection. Adequate enterai nutrition is required to minimize the loss of lean body mass. Progressive improvements in the understanding of burn shock, early wound excision and closure, the control of infection, nutritional requirements and the treatment of inhalation injuries have significantly improved the survival of burn patients in recent years.