Answer
After the patient has been fully evaluated and stable hemodynamics and gas exchange are ensured, evaluate the burn wound in detail. [28] Evaluate burn wounds initially for extent, depth, and circumferential components. Decisions regarding the type of monitoring, wound care, hospitalization, and transfer are made based on this information. [22, 23] The American Burn Association burn center transfer criteria are as follows: [22]
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Second- or third-degree burns greater than 10% total body surface area (TBSA) in patients younger than 10 years or older than 50 years [29]
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Second- or third-degree burns greater than 20% TBSA in persons of other age groups
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Second- or third-degree burns that involve the face, hands, feet, genitalia, perineum, or major joints
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Third-degree burns greater than 5% TBSA in persons of any age group
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Electrical burns, including lightening injury
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Inhalational injury [20]
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Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality
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Any patients with burns or concomitant trauma (eg, fracture) in which the burn injury poses the greatest risk of morbidity or mortality: In such cases, if the trauma poses the greater immediate risk, the patient may be treated initially in a trauma center until stable before being transferred to a burn center. Physician judgment is necessary in such situations and should be in concert with the regional medical control plan and triage protocols. [22]
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A lack of qualified personnel or equipment for the care of children (transfer to facility with these qualities) [32]
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Initial evaluation and management of the burn patient. Burn size is best estimated using a chart that corrects for changes in body proportion with aging.
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Initial evaluation and management of the burn patient. Second-degree burns are often red, wet, and very painful. Their depth, ability to heal, and tendency to result in hypertrophic scar formation vary enormously.
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Initial evaluation and management of the burn patient. Third-degree burns are usually leathery in consistency, dry, and insensate. These wounds do not heal.
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Initial evaluation and management of the burn patient. Management of burn blisters is controversial. Burn blisters occasionally obscure the presence of full-thickness wounds.
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Initial evaluation and management of the burn patient. Burn wound cellulitis manifests with increasing erythema, swelling, and pain in uninjured skin around the periphery of a wound.
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Initial evaluation and management of the burn patient. Invasive burn wound infection implies that bacteria or fungi are proliferating in eschar and invading underlying viable tissues. These wounds display a change in color, new drainage, and often a foul odor. These infections are life-threatening.
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Initial evaluation and management of the burn patient. If hand positioning and therapy are ignored while overlying burns heal, poor long-term function may result.
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Initial evaluation and management of the burn patient. Estimating the burn area in an adult patient.
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Initial evaluation and management of the burn patient. Estimating the burn area in a child.
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Initial evaluation and management of the burn patient. Escharotomy incisions.
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Partial-thickness burn.
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A 2-year-old child with a scald burn to the hand.
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Proper functional positioning for splinting of serious hand burns is the metacarpophalangeal joints are at 70-90° of flexion, the interphalangeal joints are in extension, the wrist is at 20° of extension, and the first web space is open.
