DOCSLIB.ORG

Provincial Clinical Practice Guidelines for the Management of Major Burn Trauma

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Provincial Clinical Practice Guidelines for the Management of Major Burn Trauma Sol Gregory, MD, Mark Vu, MD, FRCPC, David Sweet, MD, MPH, FRCPC, Erik Vu, MD, FRCPC, Gordon Finlayson, MD, FRCPC, Ross Brown, OMM, CD, MA, MD, FRCPC, FACS, Alec Ritchie, MD, FCCFP, Donald Griesdale, MD, MPH, FRCPC, Vinay Dhingra, MD, FRCPC, Anthony Papp, MD, FRCPC Provincial clinical practice guidelines for the management of major burn trauma A multidisciplinary working group has developed guidelines based on a literature review and an audit of major burn resuscitation at the BC Professional Fire Fighters’ Burn, Plastic and Trauma Unit. ABSTRACT: The impact of major burn ajor burn trauma (MBT) tury, made clear that patients with trauma on patients and health care represents a relatively small major burn trauma commonly died systems is enormous. This is due in Msubset of major trauma, yet from severe hypovolemia and acute part to the complex physiology of the impact on patients and health care renal failure in the early days post- burns and the need for multidiscipli- systems is enormous, in part due to trauma. Seminal research by Under- nary medical and surgical manage- the complex physiology of burns and hill, Cope, Moore, and others was fol- ment. Some aspects of this manage- the need for multidisciplinary medical lowed by the work of Drs Baxter and ment are the subject of ongoing and surgical management. Shires at Parkland Memorial Hospital clinical controversy. To address the in Dallas, Texas, that further recog- challenges faced by medical person- History of major burn nized and promoted the importance of nel caring for burn patients in differ- trauma resuscitation early, aggressive fluid resuscitation to ent settings, a multidisciplinary group Historical experience, especially from re-establish intravascular volume to of physicians collaborated in 2010 world conflicts in the early 20th cen- improve early survival.1,2 In a retro- to systematically review the litera- ture on burn resuscitation and con- duct an internal audit of burn care at Dr Gregory is senior resident in the Division Anesthesiology and Perioperative Care. Dr the BC Professional Fire Fighters’ of Plastic Surgery at the University of Brown is medical director of trauma serv- Burn, Plastic and Trauma Unit in Van- British Columbia. Dr Mark Vu is section ices for the British Columbia Provincial couver. The results of the literature head, Trauma Anesthesia in the Depart- Health Services Authority. He is also a staff review and audit were then used to ment of Anesthesiology and Perioperative surgeon in the Division of General Surgery develop the Adult Major Burns Clini- Care at Vancouver General Hospital (VGH). at VGH. Dr Ritchie is former head of the cal Practice Guidelines now avail- Dr Sweet is a staff physician in the Division Department of Emergency Medicine at able to practitioners throughout of Critical Care Medicine at VGH and in the Lions Gate Hospital. Dr Griesdale is a staff BC. These guidelines include best- hospital’s Department of Emergency Med- physician in the Division of Critical Care practice protocols and serve as a icine. Dr Erik Vu is a staff physician in the Medicine at VGH and in the hospital’s resource for the resuscitation of Department of Emergency Medicine at Department of Anesthesiology and Periop- adult major burn patients in prehos- VGH and the Department of Critical Care at erative Care. Dr Dhingra is a staff physician pital, rural, and tertiary care set- Surrey Memorial Hospital, and a medical in the Division of Critical Care Medicine at tings. The guidelines recognize that consultant for the British Columbia Ambu- VGH. Dr Papp is director of the BC Profes- comprehensive major burn care lance Service. Dr Finlayson is a staff physi- sional Fire Fighters’ Burn, Plastic and Trau- requires the skills of many health cian in the Division of Critical Care Medicine ma Unit at VGH. He is also a staff surgeon professionals, including rural emer- at VGH and in the hospital’s Department of in the hospital’s Division of Plastic Surgery. gency physicians and critical care transport paramedics. This article has been peer reviewed. 456 BC MEDICAL JOURNAL VOL. 54 NO. 9, NOVEMBER 2012 www.bcmj.org Provincial clinical practice guidelines for the management of major burn trauma spective analysis of major burn trau- first 24 hours, with the lower figure in gery, though comprehensive care is ma, Baxter noted that patients who this range being half of what the Park- multidisciplinary and includes para- were resuscitated in the first 24 hours land formula endorses.4 Many other medics, emergency physicians, inten- posttrauma with a crystalloid solution major trauma systems have adopted re - sive care physicians, trauma surgeons, of between 3 and 5 millilitres per kilo- suscitation formulas of less than 4 mL/ and anesthesiologists, as well as spe- gram per percentage of total body sur- kg/%TBSA in the first 24 hours,4-9 cialized nurses and other allied health face area (mL/kg/%TBSA) burned including formulas based on the Lund- care professionals. had lower mortality rates than patients who received less fluid. The resusci- tation benchmark of 4 mL/kg/%TBSA in the first 24 hours posttrauma be - came known as the Parkland formula. This remains the burn resuscitation formula most widely used today. Bax- Recently, burn specialists began ter also experimented with different to notice an important subset of kinds of resuscitation fluids, includ- ing crystalloids, colloids, and blood patients suffering significant products. Over 40 years later, the morbidity and mortality related to choice of resuscitation fluid remains a topic of ongoing controversy.1 over-resuscitation with fluids. The intersection of modern military conflicts and advanced trauma care has significantly increased our experi- ence with major burn trauma.3,4 Rela- tively recently, burn specialists began to notice an important subset of patients Browder chart.10 In addition to new With burn care changing, an ad suffering significant morbidity and concepts in fluid resuscitation for hoc working group on major burn mortality related to over-resuscitation burns, novel therapies such as high- trauma was assembled in 2010 to with fluids.5-7 Complications such as dose vitamin C,9,11,12 early colloid review the literature and update re - acute respiratory distress syndrome, administration, and selective use of gional practice standards for major congestive heart failure, cerebral ede- vasoactive agents to improve perfu- burn resuscitation. The MBT group ma, sepsis, and extremity or abdomi- sion pressures are also gaining trac- sought to engage tertiary and rural nal compartment syndrome were spe - tion in complex burn care.9 care providers to improve province- cifically associated with re suscitation wide burn management using an volumes in excess of 6 mL/kg/%TBSA Management of major inclusive, multidisciplinary model. burned in the first 24 hours and were burn trauma in BC Specialist physicians from plastic sur- also associated with a steep increase In British Columbia major burn care gery, trauma surgery, anesthesiology, in mortality.4 “Fluid creep,” as it be - is delivered in two centres. The Royal critical care medicine, emergency came known, emerged as a new threat Jubilee Hospital Burn Unit in Victoria medicine, and prehospital care were to major burn trauma patients, and provides burn care for the Vancouver represented. This group met regularly experts called for a re assessment of Island Health Authority (VIHA) and over a 1-year period and performed resuscitation protocols to address handles select provincial referrals. a systematic review of the medical these potentially avoidable complica- The BC Professional Fire Fighters’ literature to scrutinize international tions.5,6,8 Burn, Plastic and Trauma Unit (BPTU) practice patterns and standards for In light of changing perspectives at Vancouver General Hospital (VGH) major burn resuscitation. An internal on burn pathophysiology, the Cana- serves as the quaternary referral cen- audit of major burn resuscitation was dian and American military and the tre for major burn trauma for the also performed at the BPTU to identi- American Burn Association now province. Primary burn medical and fy areas of clinical strength and areas specify a resuscitation formula of 2 surgical care is led by clinical special- for improvement. Over the course of to 4 mL/kg/%TBSA burned for the ists from the Division of Plastic Sur- this process, the MBT group focused on www.bcmj.org VOL. 54 NO. 9, NOVEMBER 2012 BC MEDICAL JOURNAL 457 Provincial clinical practice guidelines for the management of major burn trauma Table. Issues identified by the MBT group and actions recommended to improve major burn trauma resuscitation in British Columbia. Issue Consequence Action 1. 50% of major burn trauma patients referred Rural emergency physicians, family physicians, Major Burns Clinical Practice Guidelines to the BC Professional Fire Fighters’ Burn, and paramedics spend an important portion of (CPGs) were developed to improve assessment Plastic and Trauma Unit (BPTU) over the last the first 24 hours posttrauma with major burn and early management. Recommendations 10 years were from outside the Lower patients. include resuscitation algorithms that Mainland. Transfer times ranged from 2–26 prehospital and rural medical care providers hours (mean, 18 hours). can use. 2. Estimates of total body surface area (TBSA) Fluid resuscitation based on inaccurate TBSA A TBSA estimation chart based on the Lund- burned made by different care providers estimates can lead to complications. Higher Browder chart was included in the Major varied enormously. rates of abdominal compartment syndrome Burns CPGs to improve inter-user reliability and were noted in patients when TBSA calculations reduce the variability of resuscitation fluid were overestimated (unpublished data volumes administered. collected by Drs Gregory and Papp at the BPTU in 2011). 3. 85% of major burn patients referred to the Inadvertent over-resuscitation with crystalloid The resuscitation formula in the Major Burns BPTU were over-resuscitated by an average (beyond 4 mL/kg/%TBSA in the first 24 hours) CPGs (3 mL/kg/%TBSA in the first 24 hours) of 10%.
Load more

Recommended publications
  • Emergency Medical Retrieval Service (EMRS)
    Emergency Medical Retrieval Service (EMRS) www.emrs.scot.nhs.uk Standard Operating Procedure Public Distribution Title Burns Version 7 Related Documents British Burns Care Review Author A. Inglis, R. Price, A. Hart Reviewer C McKiernan Aims · To ensure appropriate treatment and triage of major burns patients Background · The team is involved in the retrieval and pre-hospital care of patients with burns. Assessment and early management of actual and potential airway and respiratory compromise is essential, as is adequate fluid resuscitation. · National Burns Care Review recommends that failure to admit complex burns cases into burns service site within 6 hours be “regarded as a critical incident and the reasons investigated” Application EMRS team members SAS Paramedics Burns Unit, GRI / ARI / St John’s, Livingston SOP-Burns 1 Patients appropriate for retrieval team activation · Adult burns cases where advanced medical intervention is appropriate to optimise safe transfer Advice to GP prior to team arrival · High volume irrigation of chemical burns, cold water immersion/ irrigation of thermal / electrical burns) + immediate dressings (Clingfilm) · Oxygen, opioid analgesia, crystalloid fluids (normal saline / Hartmann’s by Parkland formula). · Warming / hypothermia prevention Medical management on scene PRIMARY SURVEY A Airway burns (perioral/ nasal stigmata; altered voice; stridor) - early intubation B Smoke inhalation (circumstances; nasal / pharyngeal soot) CO poisoning (oximetry unreliable). Commence oxygen. C Early shock is due to other injury! Escharotomy considered only after transfer D Other injuries; cardiac / neurological / diabetic / drug event? E Extent of burn, ocular burn? Core temperature? Avoid hypothermia • Have a low threshold for endotracheal intubation if air transfer is indicated. • Use an Uncut ETT for intubation SOP-Burns 2 SECONDARY SURVEY Total Body Surface Area Assessment Wallace Rule of nines to assess BSA.
    [Show full text]
  • Trauma Clinical Guideline: Major Burn Resuscitation
    Washington State Department of Health Office of Community Health Systems Emergency Medical Services and Trauma Section Trauma Clinical Guideline Major Burn Resuscitation The Trauma Medical Directors and Program Managers Workgroup is an open forum for designated trauma services in Washington State to share ideas and concerns about providing trauma care. The workgroup meets regularly to encourage communication among services, and to share best practices and information to improve quality of care. On occasion, at the request of the Emergency Medical Services and Trauma Care Steering Committee, the group discusses the value of specific clinical management guidelines for trauma care. The Washington State Department of Health distributes this guideline on behalf of the Emergency Medical Services and Trauma Care Steering Committee to assist trauma care services with developing their trauma patient care guidelines. Toward this goal, the workgroup has categorized the type of guideline, the sponsoring organization, how it was developed, and whether it has been tested or validated. The intent of this information is to assist physicians in evaluating the content of this guideline and its potential benefits for their practice or any particular patient. The Department of Health does not mandate the use of this guideline. The department recognizes the varying resources of different services, and approaches that work for one trauma service may not be suitable for others. The decision to use this guideline depends on the independent medical judgment of the physician. We recommend trauma services and physicians who choose to use this guideline consult with the department regularly for any updates to its content. The department appreciates receiving any information regarding practitioners’ experience with this guideline.
    [Show full text]
  • BURN MASS CASUALTY INCIDENT (BMCI) SURGE PLAN: Pediatric Annex
    BURN MASS CASUALTY INCIDENT (BMCI) SURGE PLAN: Pediatric Annex State Burn Coordinating Center (SBCC) Phone #: 734-936-2876 Fax #: 734-232-4892 Version 24 10/22/2018 Page Intentionally Left Blank Version 24 2 10/22/2018 Table of Contents Attachment 1: Pediatric Burn Mass Casualty Incident .................................................................................................... 75 Basic Treatment Considerations ................................................................................................................................ 78 Special Airway Considerations for the Pediatric Patient ................................................................................. 79 Rapid Sequence Intubation Agents ........................................................................................................................... 80 Equipment and Supplies ................................................................................................................................................ 81 Ventilator Management .................................................................................................................................................. 82 Sedation: ............................................................................................................................................................................... 83 Burn Assessment .............................................................................................................................................................
    [Show full text]
  • BURN CARE Original Release/Approval 1 Oct 06 Note: This CPG Requires an Annual Review
    Joint Theater Trauma System Clinical Practice Guideline BURN CARE Original Release/Approval 1 Oct 06 Note: This CPG requires an annual review. Reviewed: May 2012 Approved: 25 June 2012 Supersedes: Burn Care, 21 Nov 08 Minor Changes (or) Changes are substantial and require a thorough reading of this CPG (or) Significant Changes Multiple updates on burn care in theater; PI monitoring plan added 1. Goal. The goal of this CPG is to provide practical, evidence-based, recommendations for optimal care of burn casualties who generally fall into one of two categories: military casualties who most frequently sustain burns related to an explosion and can be rapidly evacuated out of theater for definitive care; and local national patients, often children, who commonly sustain burns from accidents, who present for care at military medical facilities with no possibility of definitive care beyond that provided in theater. 2. Background. Optimal treatment of burn patients is a very labor intensive process which can consume enormous personnel and logistical resources. Despite the best efforts of providers at each level of care, the mortality for burn casualties, who cannot be evacuated out of the combat theater, is significantly higher than that experienced in stateside facilities (Table 1). Experience among US military treatment facilities in the past 9 years reveals no survivors among local nation casualties in OIF and OEF sustaining full thickness burns to 50% or greater total body surface area (TBSA). The spread of infection in large open wards is a real concern, and can threaten the clinical outcome of non-burn patients. These factors must be considered and are incorporated into this CPG to assist the physician in making patient management decisions unique to the deployment environment.
    [Show full text]
  • Region 2 Trauma Plan
    Region 2 Trauma Plan June 2017 Region 2 Trauma Plan 1) Identification of Regional Trauma Centers Scope ………………………………...2 Introduction ................................................................................................................... 3 Section 515.200 Emergency Medical Services Regions ............................................ 4 Section 515.2000 Trauma Center Designation .......................................................... 7 Region 2 Hospitals..................................................................................................... 9 Region 2 Systems ......................................................................................................... 16 Region 2 Specialty Referral Hospitals....................................................................... 20 Integration of EMSC Into Region 2 Trauma Plan .................................................. 22 Section 515.100 Definitions ........................................................................................ 23 2) Triage .......................................................................................................................... 35 Field Triage.................................................................................................................. 36 Field Triage Medical Legal Considerations ............................................................. 37 Section 515.APPENDIX C Minimum Trauma Field Triage Criteria ................... 38 Region 2 Triage Criteria ...........................................................................................
    [Show full text]
  • INITIAL CARE of the BURN PATIENT Jessica Summers MD Medical Director Clark Burn Center REACH Trauma Conference April 14, 2021
    3/31/2021 INITIAL CARE OF THE BURN PATIENT Jessica Summers MD Medical Director Clark Burn Center REACH Trauma Conference April 14, 2021 FUNCTIONS OF SKIN • Epidermis • Barrier against the environment • Thermal and fluid regulation • Dermis • Principal cell is fibroblast • Durability and elasticity • Epidermal appendages • Hair follicles, sweat glands BURN TRAUMA • Skin damage • Direct injury from heat or caustic chemicals • Inflammatory response • Sources Flame Chemical Contact Electric Scald Radiation 1 3/31/2021 FIRST DEGREE BURN • Only epidermis has been damaged • Erythematous, blanches, painful to touch, hypersensitivity, uncomfortable • Heals with minimal effort, symptomatic relief (NSAIDS), soothing topical • Usually heals within a week • NOT used in the calculation of the TBSA percentage! 2 3/31/2021 SECOND DEGREE/PARTIAL THICKNESS (SUPERFICIAL) • Epidermis and superficial (papillary dermis) are damaged • Erythematous, wet and often blistering occur. Extreme pain • Usually heals in 7-14 days. Requires coverage with topical antimicrobials or artificial skin covering SUPERFICIAL PARTIAL THICKNESS SECOND DEGREE/PARTIAL THICKNESS (DEEP) • Epidermis, papillary dermis and varying depths of deep dermis have been damaged • Pale, pink-white, or cherry red. Dry appearance common. Does not blanch • Can convert to full thickness (third degree) • Remains painful to pinprick but presents with less pain than superficial 2nd degree 3 3/31/2021 DEEP PARTIAL THICKNESS • Can heal but may take 3-4 weeks • Excisional debridement with temporary or permanent skin coverage may be required • Would likely benefit from admission to a burn center. THIRD DEGREE (FULL THICKNESS) • Epidermis, papillary and deep dermis, and different depths of SQ tissue have been damaged • Sensory terminations to skin destroyed (painless) • Hard leathery eschar that is white, black, or tan in color.
    [Show full text]
  • Effective Skin and Wound Management in Non-Complex Burns
    I NTERNATIONAL BEST PRACTICE BEST PRACTICE GUIDELINES: EFFECTIVE SKIN AND WOUND MANAGEMENT OF NON-COMPLEX BURNS 3 BEST PRACTICE GUIDELINES: EFFECTIVE SKIN AND WOUND MANAGEMENT OF NON-COMPLEX BURNS FOREWORD Supported by an educational This document is a practical guide to the management of burn injuries for grant from B Braun healthcare professionals everywhere who are non-burns specialists. With an emphasis on presenting hands-on and relevant clinical information, it focuses on the evaluation and management of non-complex burn injuries The views presented in this that are appropriate for treatment outside of specialist burns units. However, document are the work of the it also guides readers through the immediate emergency management of all authors and do not necessarily burns and highlights the importance of correctly and expediently identifying reflect the opinions of B Braun. For further information about B Braun complex wounds that must be transferred rapidly for specialist care. Finally, it wound care products, please go to: looks at the ongoing management of newly healed burn wounds and post- http://www.woundcare-bbraun.com discharge rehabilitation. © Wounds International 2014 The document acknowledges the importance of continuous and integrated Published by input from all members of the multidisciplinary team, where such a team Wounds International exists, while recognising the role and resources of singlehanded and outreach A division of Schofield Healthcare Media Limited generalists providing a complete care service. Enterprise House 1–2 Hatfields Although strategies vary within and between regions, this document seeks to London SE1 9PG, UK www.woundsinternational.com present the essential key best practice principles that can be applied univer- sally and adapted according to local knowledge and resources.
    [Show full text]
  • Iowa Trauma Patient Data Dictionary
    Iowa Trauma Patient Data Dictionary January 2017 Iowa Department of Public Health (IDPH) Bureau of Emergency and Trauma Services (BETS) 321 E. 12th Street Des Moines, Iowa 50319-0075 1 Contents Introduction ................................................................................................................................................ 10 Definition .................................................................................................................................................... 10 Trauma Registry Inclusion Criteria .............................................................................................................. 10 Data Submission and Forms ........................................................................................................................ 11 HIPAA Statement ........................................................................................................................................ 14 Acknowledgements ..................................................................................................................................... 16 Software ...................................................................................................................................................... 16 Demographic Information........................................................................................................................... 17 ImageTrend Registry Number ................................................................................................................
    [Show full text]
  • Burns Injury
    RUSSELLS HALL HOSPITAL EMERGENCY DEPARTMENT CLINICAL GUIDELINE BURN INJURY This guideline describes the management of burn injuries in the Emergency Department (ED) at Russells Hall Hospital. A detailed description of burn pathophysiology and further management are beyond the scope of the guideline but further information can be found in the ‘ABC of Burns’ series, available as downloads from http://www.bmj.com/ - 1 - Contents (click to go to page) Major Burn – Acute Management Flowchart Airway and breathing Circulation and fluid management Disability and exposure Assessment of burn area Assessment of burn type and depth Burns dressings Referral to Regional Burns Centre Further reading Appendices 1. Lund and Browder chart 2. Non-accidental injury - 2 - Major Burn – Acute Management Flowchart Assess ABCDE Remember cervical spine control Assess for other injuries – deal with problems which require more urgent treatment first Obtain adequate IV access FBC,U&E,glucose,G&S,clotting,CK ANALGESIA - titrate IV morphine as necessary (intranasal diamorphine useful in children) Start IV fluids Measure core temp. and maintain >36°C BSA=Burn Surface Area TBSA=Total Body Surface Area Assess BSA, type and depth of burn **Complex Burn IF ANY OF THE FOLLOWING: *Special Areas ° Child with any burn greater 2 to ionising radiation Face than 2% TBSA Suspicion of NAI Adult with any burn greater Hand than 3% TBSA Coexisting diseases Perineum or genitals Full thickness burn Pregnancy Inhalational injury Feet Special areas* Extremes of age Flexures (particularly
    [Show full text]
  • Copyrighted Material
    Index abbreviated injury score AMPLE, 48 (AIS), 21 anaerobic metabolism, 37 abdominal anatomy, 122 analgesia, 46, 144 four quadrants of the burns, 187 abdomen, 123 children, 211 retroperitoneum, 123 older people, 223 abdominal assessment, 129 anatomical and physiological abdominal injuries, 121 changes in pregnancy, A,B,C,D,E, 28 232 advanced warning, 27 anatomical and physiological aerobic metabolism, 37 differences in children, ageing (physiological 196 changes associated anatomy of the head, 54 with), 219 anatomy of the pelvis, airbags, 11 139 airway adjuncts, 32 anatomy of the spine, 101 nasopharyngeal airway, 32 spinal column, 101 oropharyngeal airway, 32 spinal cord, 101 airway assessment, 30 anatomy of the thorax, 76 airway burns, 177 angiography and airway management, 30 embolisation, 150 paediatric patients’, 200 anterior-posterior pelvic airway obstruction, 30, 80 injuries, 141 airway with cervical spine antiemetic, 46 control,COPYRIGHTED 29 arterial MATERIAL blood gases, 38 altered vital signs arterial injury, 165 hypovolaemic older assaults, 15 patients, 224 assessment of extremity pregnancy, 238 trauma, 167 275 Index assessment of level of brain, 57 consciousness, 44 brain regions, 54 assessment of the injured breaking bad news, 268 child, 200 breathing assessment ‘look, assessment of pelvic injury, listen and feel’, 38, 94 144 breathing and ventilation, 37 assessment of the pregnant burn depth 181 trauma patient, 235 burn injury referrals, 189 assessment of thoracic burn surface area, 183 injury, 93 burn wound care, 188
    [Show full text]
  • History of Burns: the Past, Present and the Future
    Burns & Trauma, October 2014, Vol 2, Issue 4 Review Article History of burns: The past, present and the future Kwang Chear Lee, Kavita Joory, Naiem S. Moiemen The Healing Foundation Burn Research Centre, University Hospital Birmingham Foundation Trust, Birmingham, United Kingdom Corresponding author: Naiem S. Moiemen, The Healing Foundation Burn Research Centre, University Hospital Birmingham Foundation Trust, Birmingham, United Kingdom. E-mail: [email protected] Received: 23-06-2014, Revised: 25-08-2014, Accepted: 27-09-2014 ABSTRACT Burn injuries are one of the most common and devastating affl ictions on the human body. In this article we look back at how the treatment of burns has evolved over the centuries from a primarily topical therapy consisting of weird and wonderful topical con- coctions in ancient times to one that spans multiple scientifi c fi elds of topical therapy, antibiotics, fl uid resuscitation, skin excision and grafting, respiratory and metabolic care and nutrition. Most major advances in burn care occurred in the last 50 years, spurred on by wars and great fi res. The use of systemic antibiotics and topical silver therapy greatly reduced sepsis related mortality. This along with the advent of antiseptic surgical techniques, burn depth classifi cation and skin grafting allowed the excision and cover- age of full-thickness burns which resulted in greatly improved survival rates. Advancements in the methods of assessing the surface area of burns paved way for more accurate fl uid resuscitation, minimising the eff ects of shock and avoiding fl uid over-loading. The introduction of metabolic care, nutritional support and care of inhalational injuries further improved the outcome of burn patients.
    [Show full text]
  • Technical and Medical Aspects of Burn Size Assessment and Documentation
    medicina Review Technical and Medical Aspects of Burn Size Assessment and Documentation Michael Giretzlehner 1,*, Isabell Ganitzer 1 and Herbert Haller 2 1 Research Unit for Medical Informatics, RISC Software GmbH, Johannes Kepler University Linz, Upper Austrian Research GmbH, A-4232 Hagenberg, Austria; [email protected] 2 Trauma Hospital Berlin, Trauma Hospital Linz (ret), HLMedConsult, A-4020 Leonding, Austria; [email protected] * Correspondence: [email protected] Abstract: In burn medicine, the percentage of the burned body surface area (TBSA-B) to the total body surface area (TBSA) is a crucial parameter to ensure adequate treatment and therapy. Inaccu- rate estimations of the burn extent can lead to wrong medical decisions resulting in considerable consequences for patients. These include, for instance, over-resuscitation, complications due to fluid aggregation from burn edema, or non-optimal distribution of patients. Due to the frequent inaccurate TBSA-B estimation in practice, objective methods allowing for precise assessments are required. Over time, various methods have been established whose development has been influenced by contemporary technical standards. This article provides an overview of the history of burn size estimation and describes existing methods with a critical view of their benefits and limitations. Traditional methods that are still of great practical relevance were developed from the middle of the 20th century. These include the “Lund Browder Chart”, the “Rule of Nines”, and the “Rule of Palms”. These methods have in common that they assume specific values for different body parts’ surface as Citation: Giretzlehner, M.; Ganitzer, a proportion of the TBSA. Due to the missing consideration of differences regarding sex, age, weight, I.; Haller, H.
    [Show full text]