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When treating patients with thermal burns, the major surgical procedures will be debridement/excision, grafting, and reconstruction. This activity reviews burn care and highlights the role of the healthcare team in treating patients who undergo burn surgery. Objectives: Outline the presentation of a patient with burn injuries. Describe the treatment considerations for patients with burn injuries. Summarize the management considerations for patients with burn injuries. Explain the importance of collaboration and communication amongst the interdisciplinary team to improve outcomes for patients affected by burns. Access free multiple choice questions on this topic.

In 2015 it was recorded that burn injuries caused 500000 burns victims and 40000 hospitalizations in the United States. Over $7.9 billion is estimated to be spent on emergency room visits and hospital burn care per year. Survival after burns is attributed to a better understanding of when to transfer to burn centers, resuscitation protocols, and early excision and grafting. Over the last 50 years, there have been significant developments in the assessment and treatment of burn patients attributable to interprofessional care and increasing knowledge in the critical care of the burn patient.[1] These advances in treatment contribute to the improved morbidity and mortality of patients with over 20% total body surface area (TBSA) burns that would have previously not survived or had poor outcomes. Evidence-based data has significantly increased in recent years and is now defining the best treatment decisions as more literature gets published.[2][3]

Arguably the most crucial aspect of burn care is the interprofessional team approach. Management of burns can be expensive, and the interprofessional team must be flexible and able to adapt. When assessing patients and their needs, the team should determine what resources are available in addition to the overall skills of the interprofessional team. The burn team includes, but is not limited to: surgeons, intensivists, anesthetists, nurses, physical and occupational therapists, respiratory therapists, social workers, pharmacists, dieticians, and researchers. The surgeon usually provides oversight and overall management of the patient, including the timing of the various procedures. The surgeon should lead daily rounds and include most, if not all, interprofessional teams.  Nursing staff, dieticians, and physical/occupational therapists must work hand in hand to progress the patient to a point where they can heal appropriately. Nursing will provide wound care, monitor the patient, and administer medication. Infection concerns should of necessity involve a board-certified infectious disease pharmacist to help enact appropriate antimicrobial therapy. Physical, occupational, and exercise therapy is an important component of the interprofessional team for splinting needs and the patients’ functional recovery to achieve a good quality of life. While researchers may not actively participate in patient care, they are essential in the collection and reporting of patient data and outcomes for the burn registry, which allows for continual quality assessment and process improvement.[1][15] All these various areas need to collaborate and coordinate their efforts as an interprofessional team to provide optimal burn care leading to better patient outcomes. [Level 5]

The surgeon usually provides oversight and overall management of the patient, including the timing of the various procedures. The surgeon should lead daily rounds and include most, if not all, interprofessional teams.  Nursing staff, dieticians, and physical/occupational therapists must work hand in hand to progress the patient to a point where they can heal appropriately. Nursing will provide wound care, monitor the patient, and administer medication. Infection concerns should of necessity involve a board-certified infectious disease pharmacist to help enact appropriate antimicrobial therapy. Physical, occupational, and exercise therapy is an important component of the interprofessional team for splinting needs and the patients’ functional recovery to achieve a good quality of life. While researchers may not actively participate in patient care, they are essential in the collection and reporting of patient data and outcomes for the burn registry, which allows for continual quality assessment and process improvement.[1][15] All these various areas need to collaborate and coordinate their efforts as an interprofessional team to provide optimal burn care leading to better patient outcomes. [Level 5] The burn intensive care unit (BICU) needs to specialize in the care of acute burn patients, focusing on strict infection control policies, temperature regulation, and hydrotherapy. Burn patients are at increased risk of acquiring infection due to the loss of skin and the innate immune protection it provides to the body. Strict infection control protocols should be enforced by all members of the healthcare team and include hand hygiene, use of personal protective gear, microbial surveillance, and antibiotic stewardship. Housekeepers are an important part of the interprofessional team that clinical staff should not overlook due to their importance in maintaining a clean BICU. Temperature regulation is important in the BICU as well as in the operating room. Care must be taken by all members of the burn team to recognize and maintain an appropriate temperature for the acute burn patient. Increased ambient temperatures within patients' BICU room and in the operating room up to temperatures ranging to over 100 degrees Fahrenheit is necessary to hypothermia and prevent an increase in the patient’s metabolic rate, which will worsen the hypermetabolic and hypercatabolic state. Hydrotherapy refers to a dedicated shower area or area where patients are washed thoroughly to remove any gross contaminants, debride wounds to display the full extent of the burn, and jump-start wound care.[15]