References
Initial management of the burn wound patient
Abstract
Wounds are a common occurrence in veterinary medicine, ranging from traumatic injuries to surgical complications, but most of these wounds will not require as comprehensive multimodal management as the severe burn patient. A burn wound is defined as thermal damage to the two main skin layers which causes coagulation and microvascular reactions. This leads to increased capillary and extravascular permeability and vasodilation, subsequently these reactions can cause numerous complications including burn shock, sepsis, severe oedema, multisystem organ failure and death. If appropriate management is initiated from when the patient is first presented, then an attempt can be made to prevent these adverse events from occurring. This article aims to cover the initial emergency stabilisation of the burn patient and some of the wound management options available.
Burn injuries have a reputation for being extremely traumatic, and in human medicine often result in high morbidity and mortality rates (Sheridan, 2018). The definition of a burn is generally described as damage to the two main skin layers which has been caused by extremes in temperature or by contact of caustic substances, electricity or radiation (Pope, 2009). When tissue is burned it involves direct coagulation and microvascular reactions which can cause the injury to spread into the surrounding dermal layers.
This is known as the iceberg effect, where on initial presentation the wound may only appear to cover a small surface area, however if left untreated these microvascular thermal reactions continue and cause further devitalisation of the surrounding tissue (Sheridan, 2018). The severity of these injuries can depend on the aetiology and extent of the burn - larger burn injuries where there is a significant loss of the skin barrier and release of wound mediators are associated with a systemic response that can lead to sub-sequent infections (Sheridan, 2018). These factors along with the patient's age, body condition or any other pre-existing medical conditions can significantly alter the management plan and overall outcome for the patient. Severe burn cases require a systematic wound management plan that maps initial stabilisation and long-term care (Vigani and Culler, 2017). The initial aims when managing a burn patient should include minimising the thermal damage by cooling the area and/or removing any chemical substances, ensuring adequate analgesia, preventing contamination and infection, removal of devitalised tissue and reconstruction options (Niles, 2009). This article aims to look at the common types of burns typically seen in practice and the treatment methods available. It will cover stabilisation of the emergency burn patient, and the wound management options available for burn wounds.
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