Thermal injury

The burned patient is a challenging problem to the emergency physician. The vast majority of burns are minor and can be managed effectively on an outpatient basis. There are many therapeutic options, and specific burn care must be based on an understanding of the pathophysiology, tailoring it to the patient's needs. The major burn victim may have life-threatening circulatory and pulmonary problems that must be addressed through aggressive fluid therapy and airway management. Multisystem complications may follow, and one needs to be aware of these to prevent their occurrence. Specific directed therapy begins in the field and continues through the Emergency Department until the patient is stabilized and sent to his or her final destination. Early assessment of burn extent, location, and severity is important in determining therapy and disposition. Close monitoring of the patient and accurate record keeping is essential, as thermal injury is a dynamic process. Transfer to burn center often will be necessary and requires early contact with the center to ensure appropriate treatment and transfer arrangement. Certain other injuries require close follow-up care by physicians experienced in burn care.