Cutting-edge burn care techniques, pain management, and the American Burn Association (ABA)’s updated Guidelines for Burn Patient Referral were among the topics covered during yesterday’s Burn Care: A Decade of Evolution Panel Session. The presentations were aimed at general surgeons, who may provide interventions before transfer to burn care subspecialists can occur. Each panelist’s presentation complemented and deepened insights into the next.
Todd F. Huzar, MD, FACS, from The University of Texas in Houston, shared insights into burn shock, an inflammatory response that occurs when burns cover more than 20% of total body surface area (TBSA) and includes decreased cardiac output, increased vascular resistance, and hypovolemia.
Dr. Huzar reviewed methods for fluid resuscitation, which used intravenous fluids to support organ perfusion until burn shock resolves. “Every institution seems to do their resuscitation a little different,” he noted, explaining that the Parkland formula, a calculation devised in 1968 for how much fluid to infuse based on TBSA, provides an imperfect guideline for patient care but remains the “test answer” for trainees.
Plastic surgeon Lourdes Castañón, MD, FACS, from the University of Arizona in Tucson, presented an array of options for pain control for burns, ranging from NSAIDs to ketamine, gabapentin, and regional anesthesia. Dr. Castañón emphasized that existing painkiller use is a baseline to which burn-related pain control options should be added. She also noted that use of regional anesthesia increases vasodilation, possibly requiring adjustments in fluid resuscitation: “Depending on the amount of the anesthetic that we have given, we can change the fluid amount. We just account for it.”
Trauma surgeon Theresa L. Chin, MD, FACS, of the University of California, Irvine, presented a wide array of options for partial thickness burn care. Starting with basic wound care, Dr. Chin shared a range of care options, up to xenografting and spray-on skin cells. She also described enzymatic debridement with cutting-edge NexoBrid (anacaulase-bcdb), a proteolytic enzyme derived from pineapple that can remove eschar from full-thickness burns.
“This is really painful, so we’re able to do this only if they have a regional block or are intubated,” she said, reinforcing Dr. Castañón’s discussion of pain management options.
Finally, Alisa Savetamal, MD, FACS, a member of the ABA Board of Directors, shared the ABA’s 2022 Guidelines for Burn Patient Referral, which inform general surgeons on when to transfer patients to regionalized care.
Moderator Juvonda S. Hodge, MD, FACS, noted that the importance of burn care is increasing: “As the world becomes smaller, burns are an important part of natural disasters, and sometimes people don’t think about it until a disaster happens. So, I think having some knowledge of burn care is important for everyone.”
Amalia L. Cochran, MD, FACS, was a co-moderator of the session, which is now available on demand.
