Importance of proper initial treatment of moderate and major burns

Abstract

Background/Aim. Burns are common injuries with frequency depending on human factors, development of protection, industry and traffic, eventual wars. Organized treatment of major burn injuries has tremendous medical, social and economic importance. The aim of this study was to analyze initial treatment of major and moderate burns, to compare it with the current recommendations and to signify the importance of organized management of burns. Methods. In a prospective study 547 adult patients with major burns were analyzed, covering a period of eight years, with the emphasis on the initial hospital admission and emergency care for burns greater than 10% of total body surface area (TBSA). Results. In the different groups of major burns, the percentage of hospital admission was: 81.5 in burns greater than 10% TBSA, 37.7 in burns of the functional areas, 54.5 in the III degree burns, 81.6 in electrical burns, 55.9 in chemical burns, 61.9 in inhalation injury, 41.0 in burns in patients with the greater risk and 100 in burns with a concomitant trauma. In the group of 145 patients with burns greater than 10% TBSA, intravenous fluids were given in 87 patients, analgesics in 45, corticosteroids in 29, antibiotics in 23 and oxygen administration in 14. In the same group, wound irrigation was done in 14.4%, removing of the clothing and shoes in 29.6%, elevation of the legs in 8.9% and prevention of hypothermia in 7.6% of the victims. There were no initial estimations of burn extent (percentage of a burn), notes about the patient and injury and tetanus immunizations. Conclusion. Based on these findings, it is concluded that there should be much more initial hospital admissions of major burns, and also, necessary steps in the emergency care of burns greater than 10% TBSA should be taken more frequently. On the other side, unnecessary or wrong steps should be avoided in the initial burn treatment.Uvod/Cilj. Opekotine su ceste povrede cija incidencija zavisi od ljudskih faktora, stepena zastite, industrijalizacije i saobracaja, kao i mogucih ratnih dejstava. Organizovano lecenje teskih opekotina ima veliki medicinski, socijalni i ekonomski znacaj. Cilj rada bio je da se ispita inicijalni tretman teskih i srednje teskih opekotina, uporedi sa sadasnjim preporukama i da se ukaze na znacaj organizovanog lecenja. Metode. U prospektivnoj studiji analizirano je 547 teskih opekotina kod odraslih u periodu od osam godina (1997-2004). Ispitana je inicijalna hospitalizacija teskih opekotina i primarno lecenje opekotina koje su zahvatile vise od 10% ukupne povrsine tela (UPT). Rezultati. U grupi opekotina koje su zahvatale preko 10% UPT bilo je hospitalizovano 81,5% povredjenih, od opekotina funkcionalnih regija 37,7%, opekotina III stepena 54,5%, elektricnih opekotina 81,6%, hemijskih opekotina 55,9%, inhalacionih povreda 61,9%, opekotina kod osoba sa povecanim rizikom 41,0% i od opekotina sa udruzenim povredama 100% povredjenih. Kod osoba sa opekotinama na preko 10% UPT (n = 145) infuziona terapija data je kod 87 bolesnika, analgetska terapija kod 45, kortikosteroidi kod 29, antibiotici kod 23 i oksigenoterapija kod 14 povredjenih. Od inicijalnih postupaka, ispiranje rana ucinjeno je kod 14,4% opekotina, skidanje odece i obuce kod 29,6%, elevacija donjih ekstremiteta kod 8,9% i utopljavanje kod 7,6% povredjenih. Ni kod jednog bolesnika iz ove grupe nisu inicijalno odredjeni procenti opecenih povrsina, notirani vazni podaci o mehanizmu povredjivanja i povredjenom i nije sprovedena antitetanusna profilaksa. Zakljucak. Veci broj bolesnika sa teskim opekotinama trebalo bi hospitalizovati, a kod opekotina koje zahvataju vise od 10% UPT trebalo bi cesce primeniti neophodne inicijalne mere lecenja. Sa druge strane, u pocetnom lecenju opekotina trebalo bi da se izbegavaju nepotrebni ili stetni postupci.