[Treatment of serious burns].
BACKGROUND
Treatment of patients with large burns is challenging.


METHODS
The article is based on clinical experience, and a non-systematic review in PubMed.


RESULTS
In patients with burns covering more than 10 - 15 % of the total body surface area, fluid resuscitation should be initiated early. Fluid induces edema, and facial burns may necessitate early orotracheal intubation to secure the airways. Reduced ventilation and-/or peripheral circulation due to deep burns should be managed by early escharotomy (and, more seldom, fasciotomy) at the primary hospital. Respiratory distress is most often due to vigorous fluid resuscitation, secretions, pneumonia and-/or sepsis. Fiber bronchoscopy may reveal inhalation injury and enables removal of secreted material from the airways. In the acute initial phase, hypotension is usually caused by hypovolemia. Subsequently a massive inflammatory response (SIRS) causes vasodilatation, hypotension and increased cardiac output. Wound and airway infections are common. SIRS may cause CRP levels above 100 and a body temperature of 38 - 39 degrees C, which makes it difficult to find the right time to start antibiotic treatment. Nevertheless, prophylactic use of antibiotics is not encouraged. Definitive surgery, excision and transplantation, should be performed early, preferably within the first week.


CONCLUSIONS
Patients with large burns should be treated according to general principles for intensive medical care, preferably in units with special experience in treatment of burns.
Guttormsen
Anne Berit
AB
Kirurgisk serviceklinikk, Haukeland universitetssykehus, 5021 Bergen og Institutt for kirurgiske fag Universitetet i Bergen, Norway. anne.guttormsen@helse-bergen.no
Onarheim
Henning
H
Thorsen
Jon
J
Jensen
Svein Arthur
SA
Rosenberg
Bjørn Erik
BE
D000328:Adult; D002053:Burn Units; D002056:Burns / Q000150:complications / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D002648:Child; D003422:Critical Care / Q000379:methods; D005440:Fluid Therapy; D006801:Humans; D015601:Injury Severity Score