Marc G. Jeschke - Burn Care and Treatment: A Practical Guide

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The initial assessment and management of a burn patient begins with prehospital care. There is a great need for efficient and accurate assessment, transportation, and emergency care for these patients in order to improve their overall outcome. Once the initial evaluation has been completed, the transportation to the appropriate care facility is of outmost importance. At this juncture, it is imperative that the patient is transported to facility with the capacity to provide care for the thermally injured patient; however, at times patients would need to be transported to the nearest care facility for stabilization (i.e., airway control, establishment of IV access).

Once in the emergency room, the assessment as with any trauma patient is composed of primary and secondary surveys (Box ). As part of the primary survey, the establishment of a secure airway is paramount. An expert in airway management should accomplish this as these patients can rapidly deteriorate from airway edema.

Even though, early and appropriate intubation is essential in the overall management of thermal injured patients, recent publication by Romanowski (2016) demonstrated that one third of patients transferred to burn centers are unnecessarily intubated [].

Once this initial assessment is complete, the disposition of the patient will be determined by the ABA criteria for burn center referral [).

Table 1

ABA criteria for referral to a burn centera

1. Partial-thickness burns greater than 10% total body surface area (TBSA)

2. Burns that involve the face, hands, feet, genitalia, perineum, or major joints

3. Third-degree burns in any age group

4. Electrical burns, including lightning injury

5. Chemical burns

6. Inhalation injury

7. Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality

8. Any patient with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality. In such cases, if the trauma poses the greater immediate risk, the patient may be initially stabilized in a trauma center before being transferred to a burn unit. Physician judgment will be necessary in such situations and should be in concert with the regional medical control plan and triage protocols

9. Burned children in hospitals without qualified personnel or equipment for the care of children

10. Burn injury in patients who will require special social, emotional, or rehabilitative intervention

aFrom Ref. []

In determining the percent total body surface area (%TBSA) burn, the rule of nines or the palm method (the surface area of the patients palm excluding the fingers = 0.5% TBSA) can be used; however, they are not as accurate as the Lund and Browder chart (Fig. ). Attention must be paid to exclude superficial burns (First-degree burns) from the TBSA calculation.