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FOLLOW-UP

Second degree burns > 10% TBSA Third degree burns > 5% TBSA Second or third degree burns inovlving critical areas such as the hands, feet, face, perineum, genitalia and major joints Burns with associated inhalation injury Electrial or lightning burns Severe burns complicated by co-existing trauma. It may be necessary to first send the patient to a trauma center, if the traumatic injuries pose a higher risk to the patient. -Burn victims with significant pre-exisitng disease that could complicate their management should be sent to a burn center. Chemical burns with threat of cosmetic or functional compromise. Circumferential burns of extremity or chest. Children with severe burns should be sent to a facility that has personnel and equipment to manage pediatric burns patients.

• Prior to transfer, the referrring physician needs to assure that the following have been accomplished

• Respiratory Support- If the patient is at risk for airway compromise or deterioration, intubation should be performed prior to transfer. Support with 100% oxygen

• Circulatory Status should be stabilized by fluid resuscitation. Administer Ringer's at the rates predicted by the Parkland Formula and adjusted for clinical status (urine output, etc.) Adequate vasuclar access for fluid resuscitation and administration of analgesics is necessary. Transporting personnel should have orders defining the rate and amount of analgesics that can be administered during transport.

• Care of the Burn Wound:

  Patients being transfered should be covered with a dry sheet. Transport crews should exercise care to prevent the patient from becoming hypothermic. Use of saline soaked dressings increases risk of hypothermia. Application of antimicrobial creams may delay transfer and these agents must be removed once the patient arrives at the burn center

• It is essential that prior to transfer, physician to physician contact be established. The accepting physician at the burn center can provide advice in the management of the burn patient and often can assist in arranging the transfer. Documentation should accompany the patient indicating what was found and done for the patient at the referring facility.

Complications:

• Scarring
• Cosmetic deformity
• Burn wound sepsis
• ARDS
• Sepsis
• Death

Prognosis:

Varies depending on the severity of the burn; from excellent to poor.

Patient Education:

Prevention is our best tool in the management of burn injuries. Campaigns stressing the use of smoke detectors and the adoption of laws mandating their used have significantly decreased mortality from burns in North America.

Emergency physicians should work with their local fire service to develop burn prevention programs as part of the fire service's fire prevention strategies.

Discussions with patients who have sustained burn injuries should look for the mechanism of how the injury was sustained and what steps can be taken to prevent recurrence. As part of our discussions with parents, regarding risks in the home, one should ask the parent if the water heater is set to 120 F. If the answer is unknown, encourage them to find out and have it adjusted. Simple interventions, such as that can have significant impact upon the lives of many.