Initial management of patients with burns and combined injuries for acute care surgeons: What you need to know.

Abstract

There are nearly 700,000 adults and children with burn injuries who seek care in America each year. While most patients with major burn injuries are cared for at American Burn Association-verified burn centers, many of them present to nonburn centers initially or present with combined burns and other injuries. Despite this, burn surgery is no longer mandated by the Accreditation Council for Graduate Medical Education for general surgery residency and is rarely a meaningful component of surgical critical care fellowships. However, general surgeons are called to participate in and, occasionally, lead the care of adults and children with burn injuries when burn expertise is not available, for patients with combined burns and other injuries, when procedures are required, in intensive care units, and/or during multiple casualty incidents and disasters. Fundamental burn care knowledge and skills deployed during these moments can radically impact patients' chances of survival and future quality of life. This clinical review covers burn-specific aspects of the primary survey and follows the ABCDE approach. Additional details about core burn care principles (e.g., inhalation injury, resuscitation, wound care) and special considerations in combined burns and other injuries are also presented (e.g., burns with concomitant abdominal, thoracic, skeletal, and/or intracranial injury(ies)).