Which of the following statements regarding acute burns is not true?

Incorrect Statement Regarding Acute Burns

The incorrect statement is: "E. Intestinal feeding should be delayed till the 5th day post burn." In fact, early nutritional support within 12 hours after burn injury is recommended, with oral or enteral routes preferred over parenteral nutrition 1.

Evaluation of Each Statement

A. Bronchopneumonia is the leading cause of death

• This statement is true. Infections, particularly bronchopneumonia, remain a major complication of severe burns and a leading cause of death in burn patients 1.
• Burn injuries trigger inflammation, hypermetabolism, and capillary leakage, making patients susceptible to infections 1.

B. Electric burns need more fluid than other type of burn

• This statement is true. Electrical burns cause deeper tissue damage than is apparent on the surface and require more aggressive fluid resuscitation compared to thermal burns of similar visible TBSA 2.
• The internal damage from electrical burns leads to greater fluid shifts and third-spacing, necessitating higher fluid requirements 2.

C. Bacterial endocarditis is increased due to the use of invasive techniques

• This statement is true. The use of invasive monitoring and vascular access in burn patients increases the risk of bloodstream infections, including bacterial endocarditis 1.
• Burn patients often require multiple invasive procedures, which serve as portals of entry for bacteria in the setting of immunosuppression from the burn injury 2.

D. Escharotomy should be performed in deep circumferential burn of extremities within 6-8 hrs post burn

• This statement is true. Escharotomy should be performed if a deep burn induces compartment syndrome in the limbs that compromises circulation, ideally within 6-8 hours post-burn 1, 2.
• The procedure should ideally be performed in a burns center by an experienced provider to minimize complications 1.

E. Intestinal feeding should be delayed till the 5th day post burn

• This statement is false. Current guidelines recommend starting nutritional support within 12 hours after burn injury 1.
• Early initiation of oral or enteral nutrition (within the first 6 to 12 hours) is associated with better outcomes 3, 4.
• Delaying enteral nutrition can lead to increased catabolism, impaired wound healing, and higher infection rates 3.

Importance of Early Enteral Nutrition

• Early enteral feeding helps maintain gut integrity and provides essential nutrition in burn trauma patients 4.
• The median time for initiation of enteral nutrition should be within the SCCM/ASPEN guidelines for initial nutrition in critically ill patients 3.
• While there are rare complications associated with enteral feeding (such as bowel obstruction reported in some cases), the benefits of early feeding outweigh the risks 5.

Burn Management Priorities

• Accurate assessment of burn size using the Lund-Browder chart is essential for appropriate fluid resuscitation 2.
• Fluid resuscitation should be initiated based on providing 2 mL/kg/% TBSA burn to reduce resuscitation fluid volumes 6.
• Pain management using multimodal analgesia is crucial, with medications titrated based on validated comfort and analgesia assessment scales 1.
• Wound care should be performed in a clean environment with appropriate analgesia or sedation 1.
• Systemic antibiotic prophylaxis should be avoided to prevent selecting multidrug-resistant bacteria 1.

Early nutritional support is a cornerstone of burn management, and delaying enteral feeding until the 5th day post-burn contradicts current evidence-based guidelines 1, 3, 4.