Burns injury - PACT - ESICM

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Burn mass casualties Mass casualty burn disasters are a highly challenging issue for several reasons: specialised burn beds are limited, the majority of healthcare personnel are not experienced in treating burn victims, and burn treatment is time, manpower and resource consuming. Analysis of several landmark fires in the US between 1900 and 2000 showed that most victims had fatal injuries and died on the scene or within 24 hours. Another large group was those patients with minimal burns that could be treated as outpatients suggesting that fire disasters produce relatively few patients requiring inpatient burn care. Since hospitals have limited surge capacities in the event of burn disasters, a special approach to both pre-hospital and hospital management of these victims is required to avoid overwhelming local resources; no objective criteria exist which define how to triage patients in such a situation. A table classifying patients according to their anticipated survival from burn injury was created some years ago to help and assist with this difficult task. Specialised rescue and care can be adequately met at all levels of need by deploying mobile burn teams to the scene but such teams are not widely available. Burn specialists should nevertheless assist with both primary and secondary triage, contribute to initial patient management and offer advice to non-specialised designated hospitals that provide acute care for burn patients with TBSA 30% TBSA depending of course on numbers. A triage suggestion is provided below based on the Swiss burn plan. Type of hospital Up to 50 victims >50 victims Burn centre Burns >20% TBSA Children: >10% TBSA Inhalation Burns 10-20% TBSA Children : 5-10% TBSA Burns >30% TBSA Children >15% TBSA University teaching or major regional Adults 10–30% TBSA Children 5–15% TBSA Inhalation Smaller community hospital None Adults
Haberal M. Guidelines for dealing with disasters involving large numbers of extensive burns. Burns 2006; 32(8): 933–939. PMID 17081856 Cancio LC, Pruitt BA Jr. Management of mass casualty burn disasters. International Journal of Disaster Medicine 2004; 2: 114–129. http://informahealthcare.com/toc/sdis/2/4 Barillo DJ, Wolf S. Planning for burn disasters: lessons learned from one hundred years of history. J Burn Care Res 2006; 27(5): 622–634. PMID 16998394 Saffle JR, Gibran N, Jordan M. Defining the ratio of outcomes to resources for triage of burn patients in mass casualties. J Burn Care Rehabili 2005; 26(6): 478–482. PMID 16278561 Potin M, Sénéchaud C, Carsin H, Fauville JP, Fortin JL, Kuenzi W, et al. Mass casualty incidents with multiple burn victims: rationale for a Swiss burn plan. Burns 2010; 36(6): 741–750. PMID 20185244 13
Page 1 and 2: AN ESICM MULTIDISCIPLINARY DISTANCE
Page 3 and 4: Pathophysiology ...................
Page 5 and 6: INTRODUCTION Most emergency medical
Page 7 and 8: 1/ PRE-HOSPITAL/IMMEDIATE CARE Prio
Page 9 and 10: Intravenous cannulae/needles and fl
Page 11 and 12: Fluid resuscitation (0-24 hrs) Burn
Page 13 and 14: Fluid resuscitation in patients wit
Page 15: Electrical burn injury is addressed
Page 19 and 20: Early tangential excision was first
Page 21 and 22: performed for these individuals and
Page 23 and 24: 4/ MANAGING CONCURRENT INJURIES AND
Page 25 and 26: Clinical signs of CO poisoning rela
Page 27 and 28: Although diagnosing CN poisoning is
Page 29 and 30: Electrical injuries Electrical inju
Page 31 and 32: 5/ CRITICAL CARE CONSIDERATIONS SPE
Page 33 and 34: Pruitt BA Jr. The diagnosis and tre
Page 35 and 36: Lam NN, Tien NG, Khoa CM. Early ent
Page 37 and 38: Sheridan RL, Yu YM, Prelack K, Youn
Page 39 and 40: hydromorphone) is preferred. In the
Page 41 and 42: 6/ PERIOPERATIVE MANAGEMENT OF INTE
Page 43 and 44: Know your hospital guidelines for t
Page 45 and 46: 7/ BURNS IN CHILDREN Epidemiology a
Page 47 and 48: One can also use a modified Parklan
Page 49 and 50: 8/ OUTCOME, ETHICS & RESEARCH In a
Page 51 and 52: CONCLUSION In patients with burns c
Page 53 and 54: Initial resuscitation specific to b
Page 55 and 56: With due preparation and skilled as
Page 57 and 58: After wound debridement and escharo
Page 59 and 60: Sepsis diagnosis Catheter-related i

Burns injury - PACT - ESICM

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