CHAPTER 104 ■ BURNS ANGELA M ELLISON, MARGARET EMILY SAMUELS-KALOW GOALS OF EMERGENCY CARE As with any acute situation, the goals of emergency care for the burned patient include the protection of the airway, and maintenance of breathing and circulation For the burned patient in particular, this will include attention to the potential for inhalational injury and airway edema, consideration of burn location and need for escharotomy to allow effective chest wall movement, and early careful fluid resuscitation of burn shock Beyond immediate resuscitative interventions, appropriate wound care can significantly improve both mortality and functional outcomes Concomitant control of pain is also an important aspect of care for the burned patient, both to prevent unnecessary discomfort and to facilitate required procedures Finally, burn management aims at decreasing the risk of infection created by disruption of barrier function of the skin, and promoting healing and optimal cosmetic outcomes KEY POINTS Burns should be described by estimated depth (superficial, partial thickness, or full thickness) and total-body surface area (TBSA) involved Significant burns are often accompanied by other injuries (including ocular, inhalational, or traumatic) that may require emergent assessment and treatment Full-thickness burns will be insensate due to destruction of the cutaneous nerves of the dermis Severe burn injury requires intravenous fluid resuscitation, often calculated using the Parkland formula: IV fluid volume (mL) = (weight in kg) × (% TBSA burned) × Half of this volume is given in the first hours and the remaining half during the subsequent 16 hours, in addition to maintenance fluids