Prise en charge initiale du grand brûlé

Severe burn injury represents a medico-surgical emergency involving a multi-disciplinary team. Severity assessment is essential on the scene in order to provide the most suitable care and guide the patient to the appropriate structure. Indeed, early upper airway management is mandatory and some patients need to be intubated before the occurrence of respiratory distress, especially in case of face or neck burns associated with smoke inhalation. In this situation, a delayed laryngeal oedema may occur and skin oedema may prevent a safety intubation. The initiation of volemic expansion is also an emergency to prevent hypovolemia and organ failure. The fluid infusion should be started as soon as possible, intensively but should aim at limiting the interstitial oedema formation leading to a significant morbidity. The third emergency is the evaluation of the need to perform escharrotomy in case of circumferential deep burn inducing ischemia. The standard care also implies nutritional support and wound treatment to prevent infectious complications.