1 Resuscitation and monitoring

Abstract

Burns are a common accidental, and occasionally non-accidental injury. They may be devastating both in terms of morbidity and mortality and often produce life-long disfigurement and functional disability in survivors. Any doctor who comes into contact with burn victims must have a good working knowledge of emergency management of thermal injury and all anaesthetists must know the basics of airway management and resuscitation of such patients.

Appropriate pre-hospital assessment and initial treatment at the scene of accident may be life-saving. Following removal of the casualty to a place of safety, the focus will be upon respiratory system management and the restoration of circulation. Steps should be taken to keep burns clean and to make the patient as comfortable as possible. On arrival at hospital a thorough reassessment should take place. Management of the respiratory system may be complicated by associated trauma or smoke inhalation. Initial fluid requirements can only be gauged once an assessment of the nature and extent of the burn injury has been undertaken.

Fluid resuscitation of burn victims has been, and continues to be, the subject of much research. In the UK most fluid resuscitation regimens are colloid based, but crystalloid protocols using lactated Ringer's solution are much more common on a world-wide basis. The monitoring of resuscitation is also the subject of continued research, in particular regarding the use of indwelling central venous catheters.

Whilst aggressive resuscitation undoubtedly saves lives the mortality associated with severe burns remains depressingly high. In future immunotherapy may offer the opportunity to modulate the whole body response to thermal injury but it is still too early to establish what impact this will have on burn mortality.