The key management issue in burns is to make sure that the bodies vital systems are protected from the secondary trauma resulting from the burn. It is critical that the bodies intake of oxygen is not impaired, and that the impact of smoke inhalation be assessed. Too often, the issue of brain injury secondary to interference with blood and oxygen to the brain is overlooked in the crisis management of the grotesque external injuries.

• The most common complication of major thermal injuries requiring treatment at the scene is carbon monoxide poisoning. Inhaling carbon monoxide binds the available hemoglobin and therefore limits adequate tissue oxygenation. Symptoms of carbon monoxide poisoning include headache, dizziness and nausea.
• Another less common complication of thermal injury is laryngeal spasm which may require endotracheal intubation to maintain an adequate airway. Rapid transport to an emergency care facility is especially critical in these cases as laryngeal swelling and airway obstruction can occur.

In treating severe burns, it is critical to:

• Elevate burned extremities;
• Start IV fluids as soon as equipment and emergency personnel are available to calculate fluid requirements;
• Obtain medical history;
• Assess for circumferential full thickness injuries;
• Administer tetnus propylaxis, if needed;
• Administer pain medication in small IV doses;
• Provide information and support for the patient and family.

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