Burns Management

Abstract

Initial burns assessment can be performed in the field or at the closest medical facility for initial stabilization. Inhalation injuries may require immediate securing of airway. Burns greater than 20–30% TBSA and/or with inhalation injury require triage preferably to an ABA-verified burn center for ICU-level care, fluid resuscitation, and appropriate wound treatments. Smaller burns usually <20% TBSA may in addition require admission for burn wound and pain management as well as for social services support. Most burns <10–15% TBSA can be managed as an outpatient. Indeterminate and/or partial-thickness burns are treated initially with dressings that maintain a moist bacteriostatic or bactericidal wound environment to facilitate reepithelialization. Fluid resuscitation with the modified Brooke formula (2 ml/kg/%TBSA) can be titrated according to urine output, heart rate, and blood pressure in addition to guidance by invasive and noninvasive cardiac monitoring. Nutritional support in the face of burn-induced catabolism should begin early, and consideration should be given to the use of the anabolic steroid oxandrolone and propranolol. Early excision and grafting is performed preferably within 72 h of admission. Full-thickness burns are dressed with salves which penetrate eschar such as silver sulfadiazine (Silvadene) and mafenide acetate (Sulfamylon) to reduce risk of infection. Alternatively, large areas of partial and indeterminate thickness mixed with areas of full-thickness burns may be dressed with petroleum-based salves while awaiting end points of initial resuscitation prior to excision and grafting.