Les premières heures du brûlé grave

The severe burn is defined by: a skin loss greater than 25% of the total body surface area, by specific locations, or by associated lesions. It affects all age groups, but children and young adults are most exposed. Local destruction causes leads to inflammatory mediator's release that triggers SIRS. Local destruction then becomes systemic disease. Initial evaluation is based on the assessment of the burned area. Several formulas exist, but Lund and Browder's chart is the most accurate. Depth makes the prognosis of the disease. Fluid resuscitation is estimated by formulas and must be delivered in continuous infusion rather than bolus to prevent interstitial leakage. Venous access is the first step of burn management. Venous canulas should be well-dimensioned. In emergency settings, peripheral venous accesses are the easiest devices, focusing on healthy areas. The airway must be controlled, especially when there is a deep burn of the face, endotracheal tube should not be delayed. Analgesia should be multimodal and includes first and third step pain relief drugs. Small doses of ketamine provide an efficient analgesia in addition to opioids. Local treatment is based on application of a anti-infectious topical (Flammazine®). Antibiotic therapy is not indicated in emergency, but tetanus vaccination status must be checked. Legal affairs in burns are important; managing clinical record must be particularly rigorous.