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Practice review
Major burns in adults: a practice review
  1. Alice Gwyn-Jones1,
  2. Tijesu Afolabi1,
  3. Samantha Bonney2,
  4. Dilnath Gurusinghe1,
  5. Ascanio Tridente1,
  6. Tushar Mahambrey3,
  7. Patrick Nee1,4
  1. 1 Emergency Department, St Helens and Knowsley Hospitals NHS Trust, Prescot, UK
  2. 2 Transfusion Department, Whiston Hospital, Prescot, UK
  3. 3 Intensive Care, Stockport NHS Foundation Trust, Stockport, UK
  4. 4 Liverpool John Moores University, Liverpool, UK
  1. Correspondence to Professor Patrick Nee; patrick.nee{at}sthk.nhs.uk

Abstract

There are approximately 180 000 deaths per year from thermal burn injury worldwide. Most burn injuries can be treated in local hospitals but 6.5% require specialist burn care. The initial ED assessment, resuscitation and critical care of the severely burned patient present significant challenges and require a multidisciplinary approach. The management of these patients in the resuscitation room impacts on the effectiveness of continuing care in the intensive care unit. The scope of the present practice review is the immediate management of the adult patient with severe burns, including inhalation injury and burn shock. The article uses an illustrative case to highlight recent developments including advanced airway management and the contemporary approach to assessment of fluid requirements and the type and volume of fluid resuscitation. There is discussion on new options for pain relief in the ED and the principles governing the early stages of burn intensive care. It does not discuss minor injuries, mass casualty events, chemical or radiation injuries, exfoliative or necrotising conditions or frost bite.

  • burns
  • resuscitation
  • critical care

https://doi.org/10.1136/emermed-2024-214046

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    Footnotes

    • Handling editor Jason E Smith

    • X @SamSambonney

    • Contributors All authors made substantial contributions. AG-J proposed the project and wrote an early introduction. TA wrote the discussion on initial assessment and resuscitation. SB wrote the discussion on transfusion of blood and products. DG wrote the discussion on surgical management. AT wrote the discussion on the organisation of burn services and some parts of the discussion on ICU management. TM wrote the discussion on fluid management. PN prepared the final draft for submission and is the guarantor for the paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.