Burns – head to toe of the ebb and flow
Keywords:burns, fluid resuscitation, burn shock
Burns are the fourth most common type of trauma worldwide, with over 95 per cent of deaths attributed to burns occurring in lowto middle-income countries.1 Anaesthetists are involved in the full spectrum of care for burn patients, from the initial resuscitation post injury through to reconstructive surgery and management of chronic pain that may result.
The World Health Organization (WHO) defines a burn as “an injury to the skin or other organic tissue primarily caused by heat or due to radiation, radioactivity, electricity, friction or contact with chemicals”.2 Burns are classified according to severity through an assessment of depth, width and regions involved.3 Significant burns result in distinct local pathophysiological changes, which then result in a systemic response that affects all major organ systems in the body.
The effect of burns on the cardiovascular system results in a distinct form of shock – burn shock.3 The treatment for this is appropriately managed fluid resuscitation, especially within the initial 24 hours post injury. Fluid resuscitation that maintains tissue perfusion without being excessive has a survival benefit.3 There is currently no robust data that dictates the type, amount or timing of the fluid used or the ideal endpoints of resuscitation.4 Patients with major burns should be managed in specialised burn centres under the care of experienced clinicians for the best possible outcomes.
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