Administering effective emergency care for severe thermal injuries: Initial strategies for respiratory support, fluid resuscitation, wound care

Patients with severe burns require immediate airway assessment and supplemental oxygen; when inhalation injury is suspected, urgent endotracheal intubation may be needed. Also, during the first 24 hours after thermal trauma, intravascular fluid is rapidly lost into the interstitium; without resuscitation, acute renal failure or even death may ensue from hypovolemic shock. The fluid infusion rate must be carefully calculated from an accurate estimate of the total body surface area burned and titrated according to the physiologic response. Administering excessive amounts of fluid aggravates interstitial edema Escharotomy should be performed when constricting eschar results in the diminution of a peripheral pulse. Finally, the possibility of nonthermal injury must not be neglected.