Treatment of burns in the first 24 hours: simple and practical guide by answering 10 questions in a step-by-step form

Abstract

Residents in training, medical students and other staff in surgical sector, emergency room (ER) and intensive care unit (ICU) or Burn Unit face a multitude of questions regarding burn care. Treatment of burns is not always straightforward. Furthermore, National and International guidelines differ from one region to another. On one hand, it is important to understand pathophysiology, classification of burns, surgical treatment, and the latest updates in burn science. On the other hand, the clinical situation for treating these cases needs clear guidelines to cover every single aspect during the treatment procedure. Thus, 10 questions have been organised and discussed in a step-by-step form in order to achieve the excellence of education and the optimal treatment of burn injuries in the first 24 hours. These 10 questions will clearly discuss referral criteria to the burn unit, primary and secondary survey, estimation of the total burned surface area (%TBSA) and the degree of burns as well as resuscitation process, routine interventions, laboratory tests, indications of Bronchoscopy and special considerations for Inhalation trauma, immediate consultations and referrals, emergency surgery and admission orders. Understanding and answering the 10 questions will not only cover the management process of Burns during the first 24 hours but also seems to be an interactive clear guide for education purpose.

Figure 1

Rule of nines: This figure shows the different parts of the body that equal 9% of the body surface area (i.e. complete upper thigh = 9%, complete lower thigh = 9%, complete leg = 18%).

Figure 2

Third degree burns (Note the thrombotic vessels formation).

Figure 3

Escharotomy lines: Example of typical ways to incise the eschar. Note that the incisions should be made horizontally when crossing a joint.

Figure 4

a: Harvesting a skin graft with a dermatome, b: MESH skin graft with different sizes, c: the donor site after harvesting the skin graft, d: the appearance of the skin graft after its attachment to the Recipient area (3 Weeks later).

Figure 5

This figure shows the most widely used instruments for skin debridement and harvesting of the graft.