Burns injury - PACT - ESICM

Table of content
Introduction .......................................................................................................... 1
Epidemiology ............................................................................................... 1
1/ Pre-hospital/immediate care .................................................................................. 3
Priorities including the primary survey ................................................................. 3
Cooling ............................................................................................... 3
Hypothermia ........................................................................................ 3
Airway management on scene ................................................................... 4
Intravenous cannulae/needles and fluid resuscitation ....................................... 5
Wound care ......................................................................................... 5
2/ Hospital admission – the first 24 hours ....................................................................... 6
Initial hospital management ............................................................................. 6
Burn centre referral criteria ..................................................................... 6
Fluid resuscitation (0–24 hrs)..................................................................... 7
Surgical assessment and procedures (0–24 hrs) ....................................................... 9
Burn types .......................................................................................... 10
Escharotomy ....................................................................................... 11
Burn mass casualties ..................................................................................... 12
3/ Ongoing fluid and surgical management .................................................................... 14
Fluids (24–72 hrs) ......................................................................................... 14
Surgical procedures 0–24 hrs and beyond ............................................................. 14
Excision of the burn wound...................................................................... 14
Wound grafting .................................................................................... 16
Complications of fluid management (‘fluid creep’) ................................................. 16
Preventing unwanted ‘fluid creep’ ............................................................. 17
4/ Managing concurrent injuries and poisoning ............................................................... 19
Inhalation injury .......................................................................................... 19
Incidence and diagnosis .......................................................................... 19
Airway management and ventilator treatment .............................................. 19
Specific measures after inhalation injury ..................................................... 20
Carbon monoxide poisoning ............................................................................. 20
Diagnosis............................................................................................ 20
Pathophysiology ................................................................................... 21
Treatment .......................................................................................... 21
Outcome ............................................................................................ 22
Cyanide poisoning ........................................................................................ 22
Diagnosis............................................................................................ 22