1. Follow American Burn Association criteria for transfer
of a patient to a regional burn center.
2. IV fluid resuscitation for patients with burns greater than 20% total
body surface area (children with >15% total body surface
area) should be titrated to mean arterial pressure (MAP) greater
than 60 mmHg and urine output greater than 30 mL/h.
3. Never administer prophylactic antibiotics other than tetanus
4. Patients with upper airway injury, partial pressure of arterial
oxygen:fraction of inspired oxygen ratio less than 200 or carbon
monoxide toxicity should be intubated for inhalation injury.
5. Early excision and grafting of full thickness and deep partial
thickness burns improves outcomes.
Surgical care of the burn patient has evolved into a specialized
field incorporating the interdisciplinary skills of burn surgeons,
nurses, therapists, and other health care specialists. However,
recent mass casualty events have been a reminder that health systems
may be rapidly pressed to care for large numbers of burn patients.
Naturally, general surgeons will be at the forefront in these events,
so it is crucial that they are comfortable with the care of burned
patients and well equipped to provide standard of care.
Burn injury historically carried a poor prognosis. With advances
in fluid resuscitation1 and the advent of early
excision of the burn wound,2 survival has become
an expectation even for patients with severe burns. Continued improvements
in critical care and progress in skin bioengineering herald a future
in which functional and psychological outcomes are equally important
as survival alone. With this shift in priority, the American Burn
Association has emphasized referral to specialized burn centers
after early stabilization. Specific criteria should guide transfer
of patients with more complex injuries or other medical needs to
a burn center (Table 8-1). The American Burn
Association has published standards of care
created a verification process to ensure that burn centers meet those
standards.4 Because of increased prehospital safety
measures, burn patients are being transferred longer distances to
receive definitive care at regional burn centers; recent data from
one burn center with a particularly wide catchment area confirmed
that even transport times averaging 7 hours did not affect the long-term outcomes
of burn patients.5
Table 8-1 Guidelines for Referral
to a Burn Center |Favorite Table|Download (.pdf)
Table 8-1 Guidelines for Referral
to a Burn Center
|Partial-thickness burns greater than 10% TBSA|
|Burns involving the face, hands, feet, genitalia, perineum,
or major joints|
|Third-degree burns in any age group|
|Electrical burns, including lightning injury|
|Burn injury in patients with complicated pre-existing medical
|Patients with burns and concomitant trauma in which the burn
is the greatest risk. If the trauma is the greater immediate risk,
the patient may be stabilized in a trauma center before transfer
to a burn center....|
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