Clinical guidelines on inpatient burn management (primarily for patients whose burns require that they be hospitalized for about 4 weeks post injury) were published in April 2022 by the Japanese Society for Burn Injuries (JSBI), in Acute Medicine & Surgery.
The severity of an inhalation injury can be diagnosed via bronchofiberscopy and chest computed tomography (CT) scanning, but no single definitive severity indicator currently exists.
Patients with burns who need initial fluid resuscitation include the following:
Adult patients whose burn area is greater than 15% of their total body surface area (TBSA) and children with a burn area greater than 10% of their TBSA
Patients with burn areas that are clearly greater than 20% of their TBSA
Resuscitation should be carried out using a salt-containing fluid infusion as based on weight and percentage burn in adult patients with a burn area greater than 20% of their TBSA and pediatric patients with a burn area greater than 10% of their TBSA
The use of silver-containing Hydrofiber wound dressings is strongly recommended as local therapy for partial-thickness burns within 1 week post injury.
It is recommended that cryopreserved allogeneic skin grafting be employed during surgery for extensive burns.
To prevent infection, isolation in a private room should be provided to patients with burns covering more than 20% of their TBSA.
In patients with severe burns, commencement of enteral nutrition as early as possible within 24 hours post injury is strongly recommended.
In patients with severe burns, immunonutrition with glutamine is strongly recommended.
It is strongly recommended in electrical burn patients that if compartment pressure increases or neuropathy or blood flow disorders are present, surgical decompression including fasciotomy be carried out.
In patients with chemical injury, irrigation with water as soon as possible post injury is strongly recommended to remove or dilute the attached chemical agent.
In burn patients, it is recommended that deep vein thrombosis be prevented with mechanical prophylaxis. However, "the indication should be carefully decided" in patients who have lower limb burns.
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Cite this: Burn Care Clinical Practice Guidelines (JSBI, 2022) - Medscape - May 27, 2022.