Follow American Burn Association criteria for referral of a patient to a regional burn center.
Never administer prophylactic antibiotics other than tetanus vaccination.
Early excision and grafting of full-thickness and deep partial-thickness burns improve outcomes.
Intravenous fluid resuscitation for patients with burns >20% of total body surface area (children with burns >15% of total body surface area) should be titrated to mean arterial pressure (MAP) >60 mmHg and appropriate urine output.
Surgical care of the burned patient has evolved into a specialized field incorporating the interdisciplinary skills of burn surgeons, nurses, burn therapists, and other healthcare specialists. However, recent mass casualty events have been a reminder that healthcare systems may be rapidly pressed to care for large numbers of burn patients. Naturally, general surgeons may be at the forefront in these events, so it is crucial that they are comfortable with the care of burned patients and well equipped to provide the standard of care.
Burn injury historically carried a poor prognosis. With advances in fluid resuscitation1 and the advent of early excision of the burn wound,2 survival has become an expectation even for patients with severe burns.3 Continued improvements in critical care and progress in skin bioengineering herald a future in which functional and psychologic outcomes are equally important as survival alone. With this shift in priority, the American Burn Association (ABA) has emphasized referral to specialized burn centers after early stabilization. Specific criteria should guide transfer of patients with more complex injuries or other medical needs to a burn center (Table 8-1). The ABA has published standards of care4 and created a verification process to ensure that burn centers meet those standards.5 Because of increased prehospital safety measures, burn patients are transferred longer distances for definitive care at regional burn centers6; data from one burn center with a particularly wide catchment area confirmed that even transport times averaging several hours did not affect the long-term outcomes of burn patients.7
Table 8-1Guidelines for referral to a burn center ||Download (.pdf) Table 8-1 Guidelines for referral to a burn center
|Partial-thickness burns greater than 10% TBSA |
|Burns involving the face, hands, feet, genitalia, perineum, or major joints |
|Third-degree burns in any age group |
|Electrical burns, including lightning injury |
|Chemical burns |
|Inhalation injury |
|Burn injury in patients with complicated preexisting medical disorders |
|Patients with burns and concomitant trauma in which the burn is the greatest risk. If the trauma is the greater immediate risk, the patient may be stabilized in a trauma center before transfer to a burn center. |
|Burned children in hospitals without qualified personnel for the care of children |
|Burn injury in patients who will require special social, emotional, or rehabilitative intervention |