Acute care for burn patients: fluids, surgery, and what else?

Abstract

Purpose Recently published initiatives spanning the burn care spectrum have substantially changed the standard of care in burn care. The purpose of this article is to describe new impactful concepts in burn first aid, triage, resuscitation, and treatment as well as their impact on future research. Recent findings First aid after burn injury traditionally consists of extinguishing the burn and applying dressings. Recent evidence suggests that applying 20 min of cool tap water to the burn wound in the first 3 h postburn mitigates burn injury extent. National burn center transfer criteria have been updated, impacting patient initial transfer and management. The adverse effects of hydroxocobalamin, a commonly used antidote for cyanide toxicity, have been delineated. Initial burn resuscitation recommendations for both volume and potentially fluid type are being reexamined. The emergence of innovative skin substitutes may improve burn survival by providing a physiologically stabilizing intermediate dressing. Finally, formal clinical practice guidelines for early mobility in the ICU after burn injury have been defined. Summary These changes in burn care, triage, resuscitation, and treatment have challenged traditional burn care standards, created new standards, and are the basis for future prospective randomized trials.

Editorial: Acute trauma management in a changing environment

“…Recently a Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC) and b Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Campus Cologne-Merheim, Cologne, Germany published initiatives embracing the spectrum of burn care have changed the standard of burn care substantially. Palmieri provides a summary of new impactful therapeutic concepts spanning from the simple but now revisited concept of cool running water as first aid, to modified fluid resuscitation formulas to novel skin substitutes [13].…”