From the Guidelines
The approach to a patient with burns should be immediate and thorough, with a focus on assessing the severity of the burn, providing fluid resuscitation, and managing pain.
Initial Assessment
- The severity of the burn is assessed by evaluating the total burned body surface area (TBSA), with the Lund-Browder chart being the most accurate method for TBSA quantification 1.
- The Wallace rule of nines can be used as an alternative, but it may overestimate TBSA, especially in children 1.
- Patients with second- or third-degree burns involving the face, hands, feet, and genitals, and those with TBSA > 10% (5% in children), should be treated in a specialized burn center 1.
Fluid Resuscitation
- Intravenous fluid should be administered early in the management of severe burns, with a suggested dose of 20 mL/kg of crystalloid solution within the first hour 1.
- Balanced crystalloid solutions should be used for fluid resuscitation 1.
- The infusion rate should be adjusted as soon as possible based on clinical and haemodynamic parameters 1.
- Albumin may be considered for fluid resuscitation in severe burns, especially in patients with TBSA > 30%, to reduce mortality and organ failure 1.
Pain Management
- Over-the-counter analgesics such as acetaminophen or NSAIDs are recommended for burn pain management 1.
- Topical treatments such as petrolatum, honey, and aloe may improve healing time in patients with partial-thickness burns 1.
Other Considerations
- Jewelry should be removed before the onset of swelling to prevent constriction and vascular ischemia 1.
- Inhalation injury should be suspected in patients with facial burns, difficulty breathing, singed nasal hairs, or soot around the nose or mouth, and EMS should be activated immediately 1.
From the Research
Approach to Burn Patient Care
The approach to a patient with burns involves a multidisciplinary team approach, with the goal of providing optimal care and improving outcomes. Key aspects of burn patient care include:
- Resuscitation and monitoring, with a focus on the pathophysiology of burns, inhalation injury, and edema formation 2
- Early operative intervention and wound closure, metabolic interventions, early enteral nutrition, and intensive glucose control 2
- Prevention of complications such as hypothermia and compartment syndromes 2
Initial Assessment and Management
The initial assessment and management of the burn patient is critical, and requires a team approach. This includes:
- Assessment of the severity of the burn, including the size and depth of the burn, as well as any associated injuries 3
- Resuscitation, including fluid management and advanced airway management 3
- Pain relief and management of any associated conditions, such as inhalation injury 3
Prehospital Care
Prehospital care is an important aspect of burn patient management, and involves a range of simple but critical steps, including:
- Assessment of the burn and associated injuries 4, 5
- Provision of basic care, such as cooling of the burn and management of pain 4, 5
- Transportation to a specialist burn center, where possible 4, 5
Multidisciplinary Team Approach
The multidisciplinary team approach to burn care is a key aspect of optimal patient management. This involves a team of clinicians and researchers working together to provide comprehensive care, including: