Article
Initial Management of Patients with Extensive Burn Injury
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Authors
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Lee C. Woodson
- Department of Anesthesiology, University of Texas Medical Branch, Anesthesia Shriners Hospital for Children, Galveston, Texas, U.S.A.
| Published: | August 7, 2012 |
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Outline
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The initial evaluation of patients who have experienced extensive burn injury and/or inhalation injury presents several unique challenges. All organ systems can be affected. Prompt, decisive intervention is necessary to minimize morbidity and mortality. Diagnosis of inhalation injury is generally made on the basis of history and physical exam with confirmation by bronchoscopy. However, due to individual variation in the inflammatory response to injury this diagnosis does not always predict which patients will experience progressive respiratory failure.
Early pre-emptive tracheal intubation can be life saving when indicated. However, unnecessary intubation exposes patients to serious risk without benefit. An algorithm is available to identify patient who will benefit from early intubation of the trachea. It can be very difficult to secure an endotracheal tube in patients with facial burns because of wet exudates and edema-related changes in swelling of soft tissues. Laryngeal injuries are common in patients with inhalation injury. Early recognition and consultation with a laryngologist can minimize the impact of such injuries.
Formulas for fluid resuscitation of burn patients provide only a starting point for therapy. Optimal therapy requires individualization and titration of volume resuscitation. Multiple factors influence fluid requirements in burn patients. There is no single physiological endpoint to guide fluid administration. Several variables must be monitored to properly manage these challenging patients. Recent findings related to vascular endothelial function may influence our choice of fluids in the future.
Burn injuries elicit severe pain that can be difficult to control. In addition, there are individual differences in response to analgesics. It is necessary to understand several strategies for pharmacologic pain control in order to manage the more challenging patients.
There may be significant individual variation in burn patient response to all our therapeutic interventions. It is important to be aware of these differences and maintain a flexible approach to management.
