[...]... nutrition and pharmacological intervention restore it, malnutrition and organ dysfunction develop Bacterial contamination of tissues Complications from vital organs The successful treatment of burn patients includes the intervention of a multidisciplinary burn team (Table 1) The purpose of the burn center and the burn team is to care for and treat persons with dangerous and potentially disabling burns... available Primary and secondary assessments are summarized in Tables 2 and 3 Burn Wound Assessment After the patient’s stabilization and initial resuscitation, physicians should focus on the burn wound Burns are gently cleansed with warm saline and antiseptics, and the extent of the burn is assessed Burn injury must be categorized as the exact percentage of BSA involved The rule of nines is a very... Determining burn depth requires experience It is an important part of the burn assessment because the depth of the burn will determine the treatment option and the patient’s outcome It must be noted, however, that even in the hands of experienced burn surgeons clinical inspection alone can be misleading in more than 40% of patients, leading to an under-or overestimate of the depth of the burn wound... good rule of thumb is measuring the extent of the injury with the palm of the burn victim, which is estimated as 1% BSA The area burned is transformed as the number of hand palms affected and then multiplied by 1% TABLE 3 Secondary Assessment 1 Initial trauma assessment and primary assessment completed 2 Thorough head-to-toe evaluation 3 Careful determination of trauma other than obvious burn wounds... second-, and thirddegree First-degree burns are superficial and involve just the epidermis Typified by sunburn, first-degree burns are inconsequential in subsequent burn management They heal in 5–7 days Oral intolerance and severe discomfort requiring hospitalization may accompany large first-degree burns These burns have a red, hyperemic appearance of the surface, which, along with the hypersensibility and. .. resuscitation, hospitalization, and appropriate burn care Additional criteria for major burns include deep burns of the hands, feet, eyes, ears, face, or perineum; inhalation injuries; associated medical conditions; extreme age; and electrical burns All the former are formal criteria for transfer to a burn center Moderate thermal burns of 15–25% BSA or 3–10% BSA full-thickness often require hospitalization to ensure... a standard nomogram to determine the body surface area and burned surface area of the patient (see Fig 4) Measuring and weighing the patient in centimeters and kilograms provides the surface area of the patient in square meters This measurement will help to calculate metabolic needs, blood loss, hemodynamic parameters, and skin substitutes At this point, the specific anatomical location of the burn. ..viii Contents 8 The Small Burn 187 Juan P Barret 9 The Major Burn 221 Steven E Wolf 10 Surgical Approaches to the Major Burn 249 Juan P Barret 11 The Hand 257 ´ ´ ´ ´ ´ Tomas Gomez-Cıa and Jose I Ortega-Martınez 12 The Face 281 Juan P Barret 13 Burn Wound Care and Support of the Metabolic Response to Burn Injury and Surgical Supportive Therapy... Full-Thickness Burns Immediate burn wound excision protocol (24 h): – Telfa clear or plastic film Early burn wound excision protocol (72 h): silver sulfadiazine or cerium nitrate–silver sulfadiazine Staged excision protocol (first week): cerium nitrate silver sulfadiazine of burn depth It provides good mapping of the depth of the wound, especially in those burns defined as of indeterminate depth (Fig 6) Burn. .. high mortality Patients with burns of less than 15% (10% in children) BSA who are conscious and cooperative can often be resuscitated orally The patient with more than 15% (10% in children) BSA burn requires IV access Begin infusion of Ringer’s lactate solution of about 1000 ml/h in adults, 400–500 ml/m2 BSA/h in children, until more accurate 6 Barret assessments of burn size and fluid requirements can . PRINCIPLES AND PRACTICE OF BURN SURGERY DK1132_title 9/1/04 9:41 AM Page 1 PRINCIPLES AND PRACTICE OF BURN SURGERY Juan P. Barret-Nerín, M.D. St. Andrew’s. Management and Preparation for Surgery 85 Juan P. Barret and Peter Dziewulski 5. Anesthesia for Acute Burn Injuries 103 Lee C. Woodson 6. Principles of Burn Surgery