Clinical Review

ABC of burns

Intensive care management and control of infection

BMJ 2004; 329 doi: 10.1136/bmj.329.7459.220 (Published 22 July 2004)
Cite this as: BMJ 2004;329:220

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  1. Mark Ansermino,
  2. 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.


    Embedded Image

    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

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    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 …

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