RT Book, Section A1 Latenser, Barbara A. A2 Hall, Jesse B. A2 Schmidt, Gregory A. A2 Kress, John P. SR Print(0) ID 1107713731 T1 Critical Care of the Burn Patient T2 Principles of Critical Care, 4e YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 9780071738811 LK accessmedicine.mhmedical.com/content.aspx?aid=1107713731 RD 2024/03/28 AB Focusing burn care in centers with an entire team dedicated to the burn patient has resulted in burn research that has led to improved physical and psychosocial outcomes, fewer complications, better pain management strategies, and shorter lengths of hospital stay.Airway evaluation and management strategies in patients with inhalation injury and/or a large thermal injury differ from nonburn patients.Ventilator management strategies for burn patients must include the same ventilator-associated pneumonia (VAP) bundle and the daily sedation vacation to assess readiness for extubation that is used in nonburn patients. In addition, specific assessment of airway edema must be performed.Burn shock is a physiologic insult combining hypovolemic and distributive shock. The optimal patient outcome is provided by proper fluid resuscitation using large bore peripheral intravenous access and urine output monitored by a Foley catheter.Prophylactic systemic antibiotic therapy does not prevent systemic infection but daily wound cleansing with soap and water followed by topical antimicrobial therapy is efficacious.Patients with burns >20% total body surface area who have a transpyloric feeding tube placed on admission and high-protein feedings continued throughout operative procedures have better wound healing and shorter length of hospital stay.The primary goal for wound care is wound closure. Full-thickness burns should be excised within the first 7 days, and treated with autografting if appropriate or allografting/xenografting/dermal replacement therapy if the burn size is too great for immediate autografting.Burn pain is best treated with intravenous opioids and longer acting analgesic agents. Anxiolytics should also be used to decrease pain and for procedures such as hydrotherapy.Rehabilitation therapy begins at admission for optimal outcomes, including positioning, splinting, early mobilization even while on the ventilator, and strengthening to promote healing.