Emergency management of severe burns

EpidemiologyIn the UK, approximately 250 000 people are burnt each year. Of these, 175 000 attend accident and emergency departments, and 13 000 of these are admitted to hospital. Some 1000 patients have severe enough burns to warrant formal fluid resuscitation; half of these are children under 12 years. In an average year, 300 burn deaths occur. These UK figures are representative of most of the developed countries, although some, such as the US, have a higher incidence.Burns are also a major problem in the developing world. Over two million burn injuries are thought to occur each year in India (population 500 million), but this may be a substantial underestimate. Mortality in the developing world is much higher than in the developed world. For example, Nepal has approximately 1700 burn deaths a year for a population of 20 million, giving a death rate 17 times that of the UK. Most burns are due to flame injuries. Burns due to scalds are the second most common.The most infrequent burns are those caused by electrocution and chemical injuries. The type of burns suffered is related to the type of patient injured. It is therefore useful to break down burn aetiology by patient groups as this reveals the varying causes of injury. In most groups, there is a male predominance. The only exception is in elderly people, among whom more women are injured because of the preponderance of women in that population.Children aged up to 4 years comprise 20% of all patients with burn injuries. Most injuries (70%) are scalds due to children spilling hot liquids or being exposed to hot bathing water. These mechanisms can lead to large area burns. Because of changes in the design and material of night clothing, flame burns are less common than they were. Boys are more likely to be injured, a reflection of the behavioural differences between boys and girls. Ten percent of burns happen to children between the ages of 5 and 14. Teenagers are often injured from illicit activities involving accelerants, such as petrol, or electrocution.Most burns (> 60%) occur in patients’ aged 15-64. These are mainly due to flame burns, and up to a third are due to work related incidents. Some 10% of burns occur in people aged over 65. Various effects of ageing (such as immobility, slowed reactions, and decreased dexterity) mean elderly people are at risk from scalds, contact burns, and flame burns. Burn victims’ health is often compromised by some other factor, such as alcoholism, epilepsy, or long-term psychiatric or medical illness. All such problems need to be addressed when managing patients in order to speed recovery and prevent repetition of injury.

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