title: [Treatment of serious burns].
abstract: 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.
authors.affiliation: Kirurgisk serviceklinikk, Haukeland universitetssykehus, 5021 Bergen og Institutt for kirurgiske fag Universitetet i Bergen, Norway. anne.guttormsen@helse-bergen.no
authors.forename: Anne Berit
authors.initials: AB
authors.lastname: Guttormsen
authors.forename: Henning
authors.initials: H
authors.lastname: Onarheim
authors.forename: Jon
authors.initials: J
authors.lastname: Thorsen
authors.forename: Svein Arthur
authors.initials: SA
authors.lastname: Jensen
authors.forename: Bjørn Erik
authors.initials: BE
authors.lastname: Rosenberg
mesh_terms: 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