Burn Management

A burn is an injury caused by thermal, chemical, electrical, or radiation energy. A scald injury is a burn caused by contact with a hot liquid or steam but the term ‘burn’ is often used to include scalds. Most burns heal without any problems but complete healing in terms of cosmetic outcome is often dependent on appropriate care, especially within the first few days after the burn. Most simple burns can be managed in primary care but complex burns and all major burns warrant a specialist and skilled multidisciplinary approach for a successful clinical outcome. Burn injuries should be managed appropriately because they are common, often painful and may result in long term disfiguring and disabling scarring, amputation of involved parts or even death in severe cases.

Complications of burn injuries

  • Hypovolemic shock
  • Infection
  • Multiple organ dysfunction syndrome
  • Electrolytes imbalance
  • Respiratory complications
  • Scarring

Burn injuries that require hospitalization

  • Greater than 15% burns in an adult
  • Greater than 10% burns in a child
  • Any burn in the very young, the elderly or the infirm
  • Any full thickness burn
  • Burns of special regions such as face, hands, feet and perineum
  • Circumferential burns
  • Inhalation injury
  • Patient with associated medical conditions such as diabetes mellitus or immunocompromised

The management of burn injuries

(1) Assessment of vital functions includes the airway, breathing (to exclude inhalation injury), circulation (for fluid replacement) and disability (to exclude compartment syndrome).

(2) Assessment of burn injury is to determine the burned surface area (measured in percentage), depth of burn (first degree, second degree or third degree)  and other considerations.

(3) Treatment of burn injuries may include the removal of dead tissue (debridement or escharotomy), applying specific dressings to the wound, fluid resuscitation, pain control, administering antibiotics and skin grafting.

(4) Supportive care of burn injuries includes nutritional support, physiotherapy and rehabilitation therapy.

Prognosis of burn injuries

The prognosis of burn injury depends primarily on total body surface area percentage and the age of the person. The presence of smoke inhalation injury, other significant injuries such as long bone fractures and serious co-morbidities (heart disease, diabetes, psychiatric illness, suicidal intent etc.) will also adversely influence prognosis. Advances in resuscitation, surgical management, intensive care, control of infection, control of the hyper-metabolic response and rehabilitation have resulted in dramatic improvement in burn mortality and morbidity.