Emergency care of moderate and severe thermal burns in adults
In worldwide thermal burns are the leading cause of accidental injury and death. In spite of the fact that the vast majority of injuries do not require hospitalization, severe burns can lead to significant morbidity and death.
The overall severity of the burn injury (minor, moderate, severe) can be determined by a combination of the burn mechanism, burn depth, extent, and anatomic location, which gives general guidance for the preferred disposition and care of these patients. In this manner it is essential that clinicians properly characterize the size and severity of their patients' burns. Reassessment of thermal burn size and depth is important, especially early in the management of patients with severe injuries, as the extent of injury often increases.
Initial Assessment and Treatment:
Initial treatment and assessment of severe burn cases is performed simultaneously with trauma resuscitation. The main focus for initial management is to stabilizing the airway, breathing, and circulation (ABC's).Evidence of respiratory distress, smoke inhalation injury, monitoring  cardiovascular status, looking for different injuries, and monitoring  the depth and extent of burns are includes in the primary assessment.
Airway management:
Assessment: Inhalation injury remains a leading or main cause of death in adult burn victims, despite advances in ventilatory management. Depending upon the extent of the burn, the risk of inhalation injury increases. While assessing the airway, clinicians should immobilize the patient's cervical spine as appropriate. It is critical to keep the airway and provide supplemental oxygen in patients with major burns.
Diagnostic tests: Although the initial results may be normal, studies to assess pulmonary function should be obtained in patients at risk for inhalation injury. These include an arterial blood gas (ABG) and a chest radiograph. These are particularly useful early in a patient’s course.
Treatments: Supplemental oxygen and airway protection are most important of treatment for inhalation injury. The severe burn patients often require tracheal intubation. Although fluid resuscitation is critically essential in managing patients with significant burns, fluid status should be closely monitored in order to avoid overhydration.

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