Objectives

1. Describe the classification system of burn depth.

2. Outline the initial assessment of the severely burned patient.

3. Determine burn size using the Lund–Browder Diagram.

4. Assess the airway and the need for intubation.

5. Determine the fluid requirements for burn resuscitation.

6. Determine the requirement for escharotomy.

7. Describe the potential benefits and complications of early burn excision and grafting.

Modern advances in surgery, anesthesia, and critical care have had a significant impact on the treatment of severe burn injuries [1, 2]. Cohorting burn victims in specialized care burn facilities resulted in clinical research studies that led to reductions in hypovolemic shock, respiratory and renal failure, sepsis, and malnutrition. As a result, the burn size that confers a 50 percent probability of death in patients aged 15–45 years has increased from 50 percent total body surface area (TBSA) in 1950 to 80 percent TBSA in 2000 (Table 20.1). Morbidity and mortality following a major burn injury are related to age of the patient, burn size, and the presence of an inhalation injury [3–5]. The greater the burn size the greater the fluid and heat loss to the environment, both of which contribute to organ hypoperfusion and shock. The inflammatory mediator response also increases with burn size as does the degree of immunosuppression. Bacterial colonization increases with the size of the open wound and, in conjunction with the increase in immunosuppression, results in increased risk of life-threatening burn wound infection. Inhalation injury causes pulmonary dysfunction that is exacerbated by the large fluid resuscitation required following major burn injury.