Burns injury - PACT - ESICM

INTRODUCTION
Most emergency medical services (EMS) and hospitals will, from time to time, need to
deal with the immediate management of patients with large burns. Care of these
patients will be a major challenge for most doctors. Correct initial management can
make the difference between a good and a poor outcome. Therefore, emergency
medicine physicians, intensivists, plastic and general surgeons and anaesthesiologists
require knowledge and competence in early burn assessment: depth of burn, % total
body surface area (%TBSA), early fluid therapy, airway management, surgical
principles, intensive care support and wound care. Knowledge of related
pathophysiology and anatomy is important to the assessment.
The aim of this module is to give clinical guidance on how to manage patients with
burn injury in the early and ongoing phases. Sections on basic knowledge (evaluation
of depth and extent of burn), metabolic response, nutrition and pathophysiology
provide a broad background for understanding unique aspects of burn management.
Therapy suggestions are made from our clinical experience of burn patients and from
literature where available.
Series of 12 articles in BMJ, 2004. PMIDs 15191982, 15205294, 15217876,
15242917, 15258073, 15271835, 15284153, 15297346, 15310609,
15321905, 15331482 15331482
See also the website of the American Burn Association and the European
Practice guidelines for Burn Care
http://www.euroburn.org/userfiles/users/36/pdf/guidelines/EBAGuidel
inesBurnCareVersion1.pdf
Epidemiology
There is limited information available from European countries describing the
epidemiology of burns. The American Burn Association (ABA), however, has provided
extensive data collected from different centres across the USA. The majority of burn
wounds are small and therefore treated in primary care and emergency care
facilities. One in ten burn patients are referred to the hospital and of these 10–15%
are transferred to a burn centre. In Norway, the rate of admission for burns was
15.5/100,000/year in 2007. In a review comprising data from more than 185,000
patients, the incidence of severe burns in Europe was reported as 0.2 to 2.9/10,000
inhabitants. Burn injury is more common in men than in women and flame and scald
are the most common causes. Children