Intensive care management and control of infection

doi:10.1136/bmj.329.7459.220

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ education articles:

From

Limit by

The BMJ iPad app brings you the best of print and online, including live links to the latest news, blogs, video, and podcasts. Get the BMJ iPad app.
You can use bmj.com to help you with your continuing medical education. Find out about CME/CPD credits for BMJ articles
Keep up to date with cardiology: Access the latest cardiovascular medicine resources from across BMJ Group.
Countdown to London 2012: BMJ Group's Olympics portal highlights latest Olympics and sports medicine-themed research, comment and learning

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

Mark Ansermino,
Carolyn Hemsley

Intensive care management

The goal in management of an acute burn is to limit the extent of the systemic insult. Intensive care management should not be seen as rescue for failed initial treatment but as a preventive measure in patients at high risk of organ failure. Intensive care units have the resources for improved monitoring and expertise in managing acute physiological changes. Intensive care management should not, however, become an obstacle to early aggressive surgical excision of the burn wound, which is associated with improved outcome.

Patient with burns in intensive care unit. Note the bilateral slings raising the burnt hands, air fluidised mattress, warm air heater, haemofiltration, and ventilator

Airway burns

The term “inhalational injury” has been used to describe the aspiration of toxic products of combustion, but also more generally any pulmonary insult associated with a burn injury. Patients with cutaneous burns are two to three times more likely to die if they also have lower airway burns. Death may be a direct result of lung injury but is usually due to the systemic consequences of such injury. It may be impossible to distinguish lung injury caused at the time of the burn directly to the lungs by a burn from injury due to the systemic consequences of the burn.Q

View this table:

In this window
In a new window

Warning signs of airway burns

Diagnosis of lower airway burns is largely based on the patient's history and clinical examination. Clinicians should have a high index of suspicion of airway burns in patients with one or more of the warning signs. Special investigations will support clinical suspicion. However, severity of injury or prediction of outcome is not aided by additional tests.

The pathophysiology of airway burns is highly variable, depending on the environment of the burn and the incomplete products of combustion. The clinical manifestations are often delayed for the first few hours …