Burn Resuscitation and Management(Archived)

Most small burns are treated at home or by local providers as outpatients. This topic focuses on the initial resuscitation and management of severe burns. (Also see Burns, Evaluation and Management and Burns, Thermal). The patient's age determines burn severity classification, the percentage of total body surface area burned (%TBSA), depth of burn, type of burn, and whether specific body parts are involved. Patients are classified as having severe burns if they have any of the following; >10% TBSA in children (<10 years old) or elderly (>50 years old). >20% TBSA in adults. >  5% full thickness; high-voltage electrical burns; significant burns to the face, eyes, ears, joints, or genitalia . Other factors that should be considered and increase the patient’s morbidity and mortality include associated inhalation injury, associated traumatic injury, and the patient’s baseline medical conditions like heart disease or lung disease. Several factors may predispose the specific group of patients to more complicated injuries. Severe burns cause not only significant injury at the local burn site but also a systemic response throughout the body. Inflammatory and vasoactive mediators such as histamines, prostaglandins, and cytokines are released, causing a systemic capillary leak, intravascular fluid loss, and large fluid shifts. These responses occur mostly over the first 24 hours, peaking around 6 to 8 hours after injury. This response, along with decreased cardiac output and increased vascular resistance, can lead to marked hypovolemia and hypoperfusion, called “burn shock.”  This can be managed with aggressive fluid resuscitation and close monitoring for adequate, but not excessive, IV fluids.It is important to remember that burns alone do not cause significant hypotension initially, and “burn shock” develops over the first few hours. If the patient is profoundly hypotensive initially, other causes of hypotension should be sought.