الفهرس 
(Initial management of burn)Only 14 pages are availabe for public view
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Abstract
The International Society for Burn Injuries defines a burn as an injury to the skin or other organic tissue caused by thermal trauma. A skin burn is the destruction of some, or all, of the different layers of cells in the skin by a hot liquid (scald), a hot solid (contact burn), or a flame (flame burn).
Globally, about 11 million people seek medical treatment, and 300,000 die from burns each year. About 90 % of burns occur in the developing world.
Significant thermal injuries induce a state of immune-suppression that predisposes burn patients to infectious complications. There is number of risk factors for burn infections including total body surface area burnt (TBSA %), age of the person, associated injuries and preexisting diseases.
Each burn center should determine the predominant organisms present in the facility, track any time related bacteriology changes in individual patients, antimicrobial susceptibility profiles of recovered isolates and monitor for nosocomial outbreaks.
The critical first step in the “Initial Assessment” of seriously injured patient is primary survey as it provides quick and efficient way to identify if the patient has a life threatening injury and management simultaneously. This evaluation and treatment are based on the ABCDE.
Significant burns are associated with hemodynamic changes including decreased cardiac output, extravascular fluid shifts, vasodilation and fluid loss and may result in burn shock or hypoperfusion at the tissue level. The purpose of fluid resuscitation post-burn is to restore and maintain tissue perfusion in the patient with major burns.
Early management of burn shock is critical for surviving burns >20–25% TBSA. This depends more on timing than on the type of fluid infused.
No prophylactic antibiotic treatments are typically initiated at admission or for routine perioperative prophylaxis. This is principally to avoid creation of antibiotic resistances with more difficult subsequent treatment. Effective topical antimicrobial therapy and early burn wound excision significantly reduces the overall occurrence of invasive burn wound infections.
Specific systemic antibiotic therapy is instituted based on the current results of the burn center’s microbiology surveillance program and modified on the basis of the sensitivity tests.
Recent factors contributing to the development of burn wound infection including the nature and extent of the burn injury, secondary immunosuppression, prevention of burn wound infection and therapeutic strategies employed by specialized burn care facilities.
Sources of organisms may be endogenous as patient’s own normal flora or exogenous from environmental or from health care personnel. Organisms associated with infection in burn patients include gram-positive, gram-negative and yeast or fungal organisms.
In burn patients the primary mode of transmission of infection is direct or indirect contact, by the hands of the personnel caring for the patient or from contact with contaminated equipment and this include contact, droplet and airborne.
There are many risk factors that associate with the outcome in burn patients such as age as extremes of ages are more liable for complications,immunocompromied patients and patients with chronic diseases as DM. Individuals with self-inflicted burn injuries and the disabled have more severe injuries with longer hospital stays than those with accidental injuries.