Skip to main content
SpringerLink
Log in

The Initial Surgical Management of the Critically Ill Burn Patient

  • Chapter
Key Topics in Management of the Critically Ill

  • 1408 Accesses

Abstract

The initial surgical management of the critically ill burn patient is a multidisciplinary task that combines the expertise of the Intensive care and Plastic Surgery and Burns team together with a miriad of associated health professionals. The management of these patients according to recognised protocols of trauma resuscitation is an effort to restore anatomy and physiology to pre trauma status. This chapter will discuss the staged progression of a major burn who is critically ill from early admission to the surgical management of the wounds and the modulation of altered physiology in the Burns Intensive Care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ATLS:

Advanced Trauma Life Support

EMSB:

Emergency Management of Severe Burns

SSSS:

Staphylococcal scalded skin syndrome

TBSA:

Total body surface area

TENS:

Toxic epidermal necrolysis syndrome

TSS:

Toxic shock syndrome

References

  1. Association BB (2013) National Burn Care Review Committee report: standards and strategy for burn care. A review of burn care in the British Isles. British Burns Association, Manchester. http://www.britishburnsassociation/org/downloads/NCBR2001.pdf

  2. Shariff Z, Rodrigues JN, Anwar U, Austin O, Phipps A (2015) Burns in patients over 90: a fifteen-year series from a regional burns centre. Burns 41:297–300

    Article  PubMed  Google Scholar 

  3. Heng JS, Atkins J, Clancy O et al (2015) Geographical analysis of socioeconomic factors in risk of domestic burn injury in London 2007–2013. Burns 41:437–445

    Article  PubMed  Google Scholar 

  4. Rutan TC, Herndon DN, Van Osten T, Abston S (1986) Metabolic rate alterations in early excision and grafting versus conservative treatment. J Trauma 26:140–142

    Article  CAS  PubMed  Google Scholar 

  5. Hart DW, Wolf SE, Mlcak R et al (2000) Persistence of muscle catabolism after severe burn. Surgery 128:312–319

    Article  CAS  PubMed  Google Scholar 

  6. Venter TH, Karpelowsky JS, Rode H (2007) Cooling of the burn wound: the ideal temperature of the coolant. Burns 33:917–922

    Article  CAS  PubMed  Google Scholar 

  7. Baldwin A, Xu J, Attinger D (2012) How to cool a burn: a heat transfer point of view. J Burn Care Res 33:176–187

    Article  PubMed  Google Scholar 

  8. Tobalem M, Harder Y, Tschanz E, Speidel V, Pittet-Cuenod B, Wettstein R (2013) First-aid with warm water delays burn progression and increases skin survival. J Plast Reconstr Aesthet Surg 66:260–266

    Article  CAS  PubMed  Google Scholar 

  9. Varley A, Sarginson J, Young A (2013) How to cool a burn: a heat transfer point of view. British Burns Association first aid position statement. Manchester. http://www.britishburnsassociation.org/downloads/BBA_First_Aid_Position_Statement_8.10.14.pdf

  10. Aggarwal S, Smailes S, Dziewulski P (2009) Tracheostomy in burns patients revisited. Burns 35:962–966

    Article  PubMed  Google Scholar 

  11. Orgill DP, Piccolo N (2009) Escharotomy and decompressive therapies in burns. J Burn Care Res 30:759–768

    Article  PubMed  Google Scholar 

  12. Hershberger RC, Hunt JL, Arnoldo BD, Purdue GF (2007) Abdominal compartment syndrome in the severely burned patient. J Burn Care Res 28:708–714

    Article  PubMed  Google Scholar 

  13. Association ECoANZB (2012) Emergency management of severe burns course manual (UK Edn). Manchester. British Burns Association

    Google Scholar 

  14. Burd A, Noronha FV, Ahmed K et al (2006) Decompression not escharotomy in acute burns. Burns 32:284–292

    Article  PubMed  Google Scholar 

  15. Sherren PB, Hussey J, Martin R, Kundishora T, Parker M, Emerson B (2014) Lethal triad in severe burns. Burns 40:1492–1496

    Article  CAS  PubMed  Google Scholar 

  16. Corallo JP, King B, Pizano LR, Namias N, Schulman CI (2008) Core warming of a burn patient during excision to prevent hypothermia. Burns 34:418–420

    Article  PubMed  Google Scholar 

  17. Vanni SM, Braz JR, Modolo NS, Amorim RB, Rodrigues GR Jr (2003) Preoperative combined with intraoperative skin-surface warming avoids hypothermia caused by general anesthesia and surgery. J Clin Anesth 15:119–125

    Article  PubMed  Google Scholar 

  18. Wallace AB (1951) The exposure treatment of burns. Lancet 1:501–504

    Article  CAS  PubMed  Google Scholar 

  19. Lund CC, Browdler NC (1944) The estimation of areas of burns. Surg Gynecol Obstet 79:352–358

    Google Scholar 

  20. Du Bois D, Du Bois EF (1989) A formula to estimate the approximate surface area if height and weight be known. 1916. Nutrition 5:303–311; discussion 12–3

    PubMed  Google Scholar 

  21. Berry MG, Evison D, Roberts AH (2001) The influence of body mass index on burn surface area estimated from the area of the hand. Burns 27:591–594

    Article  CAS  PubMed  Google Scholar 

  22. Nagel TR, Schunk JE (1997) Using the hand to estimate the surface area of a burn in children. Pediatr Emerg Care 13:254–255

    Article  CAS  PubMed  Google Scholar 

  23. Freiburg C, Igneri P, Sartorelli K, Rogers F (2007) Effects of differences in percent total body surface area estimation on fluid resuscitation of transferred burn patients. J Burn Care Res 28:42–48

    Article  PubMed  Google Scholar 

  24. Martin NA, Lundy JB, Rickard RF (2014) Lack of precision of burn surface area calculation by UK Armed Forces medical personnel. Burns 40:246–250

    Article  PubMed  Google Scholar 

  25. Shokrollahi K, Sayed M, Dickson W, Potokar T (2007) Mobile phones for the assessment of burns: we have the technology. Emerg Med J 24:753–755

    Article  PubMed  PubMed Central  Google Scholar 

  26. Goldberg H, Klaff J, Spjut A, Milner S (2014) A mobile app for measuring the surface area of a burn in three dimensions: comparison to the Lund and Browder assessment. J Burn Care Res 35:480–483

    Article  PubMed  Google Scholar 

  27. Jackson DM (1953) The diagnosis of the depth of burning. Br J Surg 40:588–596

    Article  CAS  PubMed  Google Scholar 

  28. Cubison TC, Pape SA, Parkhouse N (2006) Evidence for the link between healing time and the development of hypertrophic scars (HTS) in paediatric burns due to scald injury. Burns 32:992–999

    Article  PubMed  Google Scholar 

  29. Kim LH, Ward D, Lam L, Holland AJ (2010) The impact of laser Doppler imaging on time to grafting decisions in pediatric burns. J Burn Care Res 31:328–332

    Article  PubMed  Google Scholar 

  30. Wang XQ, Mill J, Kravchuk O, Kimble RM (2010) Ultrasound assessed thickness of burn scars in association with laser Doppler imaging determined depth of burns in paediatric patients. Burns 36:1254–1262

    Article  PubMed  Google Scholar 

  31. Baxter C (1979) Fluid resuscitation, burn percentage, and physiologic age. J Trauma 19:864–865

    CAS  PubMed  Google Scholar 

  32. Demling RH (2005) The burn edema process: current concepts. J Burn Care Rehabil 26:207–227

    Article  PubMed  Google Scholar 

  33. Berger MM, Bernath MA, Chiolero RL (2001) Resuscitation, anaesthesia and analgesia of the burned patient. Curr Opin Anaesthesiol 14:431–435

    Article  CAS  PubMed  Google Scholar 

  34. Latenser BA (2009) Critical care of the burn patient: the first 48 hours. Crit Care Med 37:2819–2826

    Article  CAS  PubMed  Google Scholar 

  35. Saffle JI (2007) The phenomenon of “fluid creep” in acute burn resuscitation. J Burn Care Res 28:382–395

    Article  PubMed  Google Scholar 

  36. (NNBC) NNfBC (2012) Referral guidelines. British Burns Association. http://www.britishburnsassociation.org/downloads/National_Burn_Care_Referral_Guidance_5.2.12.pdf

  37. Gauglitz GG, Finnerty CC, Herndon DN, Williams FN, Jeschke MG (2012) Modulation of the hypermetabolic response after burn injury. In: Herndon DN (ed) Total burn care, 4th edn. Elsevier, London, pp 355–357

    Chapter  Google Scholar 

  38. Sterling JP, Heimbach DM (2011) Hemostasis in burn surgery – a review. Burns 37:559–565

    Article  PubMed  Google Scholar 

  39. Sheridan RL, Szyfelbein SK (2001) Trends in blood conservation in burn care. Burns 27:272–276

    Article  CAS  PubMed  Google Scholar 

  40. Kwan P, Gomez M, Cartotto R (2006) Safe and successful restriction of transfusion in burn patients. J Burn Care Res 27:826–834

    Article  PubMed  Google Scholar 

  41. Cartotto R, Musgrave MA, Beveridge M, Fish J, Gomez M (2000) Minimizing blood loss in burn surgery. J Trauma 49:1034–1039

    Article  CAS  PubMed  Google Scholar 

  42. Doufas AG (2003) Consequences of inadvertent perioperative hypothermia. Best Pract Res Clin Anaesthesiol 17:535–549

    Article  PubMed  Google Scholar 

  43. Prunet B, Asencio Y, Lacroix G et al (2012) Maintenance of normothermia during burn surgery with an intravascular temperature control system: a non-randomised controlled trial. Injury 43:648–652

    Article  PubMed  Google Scholar 

  44. Davis JS, Rodriguez LI, Quintana OD et al (2013) Use of a warming catheter to achieve normothermia in large burns. J Burn Care Res 34:191–195

    Article  PubMed  Google Scholar 

  45. Cubison TC, Pape SA, Jeffery SL (2006) Dermal preservation using the Versajet hydrosurgery system for debridement of paediatric burns. Burns 32:714–720

    Article  PubMed  Google Scholar 

  46. Chang DW, DeSanti L, Demling RH (1998) Anticatabolic and anabolic strategies in critical illness: a review of current treatment modalities. Shock 10:155–160

    Article  CAS  PubMed  Google Scholar 

  47. Herndon DN, Tompkins RG (2004) Support of the metabolic response to burn injury. Lancet 363:1895–1902

    Article  CAS  PubMed  Google Scholar 

  48. Hart DW, Wolf SE, Ramzy PI et al (2001) Anabolic effects of oxandrolone after severe burn. Ann Surg 233:556–564

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Plastic Surgery and Burns, Chelsea and Westminster Hospital, 369 Fulham Rd, London, SW10 9NH, UK

    Jorge Leon-Villapalos MBBS, MSc, Dipl IC, FRCS (Plast)

Authors
  1. Jorge Leon-Villapalos MBBS, MSc, Dipl IC, FRCS (Plast)
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jorge Leon-Villapalos MBBS, MSc, Dipl IC, FRCS (Plast) .

Editor information

Editors and Affiliations

  1. Anaesthesia and Intensive Care Medicine, Chelsea and Westminster Hospital, London, United Kingdom

    Marcela P. Vizcaychipi

  2. Cardiothoracic Anaesthesia and Intensive, St George's Hospital, London, United Kingdom

    Carlos M. Corredor

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Leon-Villapalos, J. (2016). The Initial Surgical Management of the Critically Ill Burn Patient. In: Vizcaychipi, M., Corredor, C. (eds) Key Topics in Management of the Critically Ill. Springer, Cham. https://doi.org/10.1007/978-3-319-22377-3_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-22377-3_10

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-22376-6

  • Online ISBN: 978-3-319-22377-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation