Hospital Treatment of Burn Injury

 Criteria for Hospitalization:

The criteria for hospital transfer recommended by the American Burn Association are as follows :

1. Second or third-degree burns greater than 10 percent total body surface area (TBSA) in patients younger than 10 years or older than 50 years.

2. Second or third-degree burns greater than 20 percent TBSA in persons of other age groups.

3. Second or third-degree burns that involve the face, hands, feet, genitalia, perineum, or major joints 

4. Third-degree burns are greater than five percent TBSA in persons of any age group.

5. Electrical burns, including lightning injury.

6. Chemical burns.

7. Inhalational injury.

8. Burn injury in patients with pre-existing medical disorders IHD, renal failure, diabetes mellitus, etc. that could complicate management, prolong recovery, or affect mortality.

9. Any burn patient with associated injury, e.g. fracture or head injury, in which the burn injury poses the greatest risk of mortality. In such cases, firstly the patient is treated in the trauma center, then after being stable he/she is transferred to the burn center. 

10. As a general rule an adult with more than 20 percent of the burn surface area involvement, or a child with more than 10 percent of the body surface area involvement will require intravenous fluid replacement. However, an intravenous line may be necessary to achieve adequate analgesia for much smaller burn and in children, fluid replacement may be required because of vomiting. 

Escharotomy:

When the deep second and third-degree burn wounds encompass the circumference of an extremity, peripheral circulation to the limb can be compromised by a hard, unyielding layer of the dead dermis and subcutaneous tissue, called the eschar. Eschar impedes venous outflow and affects arterial inflow to the distal beds. 

Fig. 1: Common sites for escharotomy

Eschar complication is recognized by numbness and tingling in the limb and increased pain in the digits. Such patients require escharotomy, which consists of the release of the eschar at the bedside by incising the lateral and medial aspects of the extremity with a scalpel (Fig. 1).