Key Principles
- Early recognition and withdrawal of offending agents
- Multidisciplinary supportive care in burns centre
- Strict infection control as per BAD guidelines
Initial Resuscitation & Supportive Care
- ABC approach treating abnormalities as found:
- May require intubation if significant airway involvement
- Careful fluid assessment and resuscitation with ongoing maintenance
- IV access through non-lesioned skin, regularly replace
- Maintenance fluids calculated with Parkland formula or more restrictive variant
- Multimodal analgesia with opiate sparing agents
- Multidisciplinary approach towards supportive care:
- Strict asepsis, nurse in side room
- Regular infection surveillance
- Attention to thromboprophylaxis
Specific Management
- Withdraw offending agent and treat underlying cause
- Management of skin lesions:
- Regularly cleanse wounds and intact skin by irrigation
- Apply emollients and topical antimicrobial
- Leave detached epidermis in situ
- Necrotic lesions may need surgical debridement and skin grafting
- Careful MDT approach to management of ocular, oral, genital and respiratory tract lesions:
- Vigilant care of eyes with lubricants and drops
- Experimental treatment - centre dependent:
- IVIG
- Ciclosporin
- Corticosteroids (generally not recommended)
Monitoring, Referral & Deposition
- Skin area >10% should be managed in a burns centre or medical ICU
- Senior MDT approach:
- Burns surgeon
- Dermatologist
- Ophthalmologist