Treatment of burn injuries

More than 60% of the 40,000 hospitalizations each year for serious burn injuries now occur at the 125 hospitals with specialized burn centers. This percentage of specialized hospitalizations has increased steadily in the last 30 years as emergency care and transportation has improved.

Until the last decade, the goal in the treatment of severe burns was simply enabling the patient to survive. As the range of therapies has increased, and survival rates have improved, burn specialists have widened their goals. In a recent article burn specialist Robert L Sheridan, MD, Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital and Associate Professor of Surgery, in the Division of Trauma and Burns, Massachusetts General Hospital and Harvard Medical School wrote that the goal of burn treatment is to reintegrate the burn patient into the community. Working towards this goal means that the tasks of the burn care treatment team have broadened well beyond wound closure.

This effort involves three broad aspects: rehabilitation, reconstruction, and reintegration. An active focus on long-term rehabilitation goals must be part of the treatment plan from the beginning of acute care.

Stabilizing the patient

The first tasks after a serious burn injury involve stabilizing the patient: providing fluids, usually intravenously, to reduce shock and prevent dangerous drops in blood pressure, and monitoring the patient’s breathing, assisting if necessary. The skin is the body’s principal barrier against infection, and after a serious burn injury, the victim is at significant risk for infection. Immediate treatment aims at preventing infection with IV antibiotics and antibiotics in cream or ointment form applied directly to the burned areas.

Even while a patient is still critically ill and in the ICU, rehabilitation goals are part of the treatment. The aim is to limit loss of range of motion, ROM, to reduce edema, the presence of excess fluid in tissues which contributes to joint stiffening, and to use positioning and splinting to prevent contractures. This process generally involves twice-a-day therapy sessions timed when anesthetics are strongest, so that aggressive joint ROM therapy can occur.

During this time survival may be uncertain. The burn injury survivor will experience anxiety, fear, pain, delirium, sleep deprivation, and confusion, which must be managed by the ICU team and psychiatric consultants.

As the patient stabilizes, the burn treatment team begins a careful assessment of the extent of the burn damage, and plans the course of treatment.