Yishino (2016) – The wound burn guidelines – 6 Guidelines for the management of burns

Background of Burn Management Guidelines

Burns are common injuries treated at various medical facilities, ranging from private clinics to specialized hospitals. The treatment approach varies from topical treatments for minor burns to systemic management and possible skin grafting for moderate to severe burns. Inappropriate or delayed treatment can negatively affect the recovery process, making accurate assessment and prompt initiation of suitable treatment crucial.

Development and Position of Burn Management Guidelines

These guidelines were developed by the Wound/Burn Guidelines Committee of the Japanese Dermatological Association to assist in the appropriate diagnosis and initial treatment of burns, covering cases from minor to severe. They do not include recommendations for specific surgical procedures but aim to standardize care based on current Japanese practices.

Sponsorship and Evidence Collection

The guidelines were funded by the Japanese Dermatological Association without external influence. Evidence was gathered from major medical databases, focusing on systematic reviews, randomized controlled trials (RCTs), and other relevant studies from January 1980 to December 2008.

Determination of Evidence and Recommendation Levels

The guidelines classify evidence from I (systematic reviews) to VI (expert opinions) and recommendations from A (strongly recommended) to D (not recommended). These classifications help in determining the strength of the guidelines’ suggestions.

Review and Update Policies

The guidelines are to be reviewed and potentially updated every 3-5 years, with adjustments made as necessary based on new evidence.

Terminology and Diagnostic/Therapeutic Algorithms

The guidelines clarify terms related to burn depth, severity assessment methods, and introduce algorithms for evaluating and treating burn injuries, including the importance of assessing burn depth, estimating burned area, and determining the need for fluid resuscitation and surgical interventions.

Management of Burns: Key Points
  • Severity Evaluation: Utilizes clinical findings to estimate burn depth and severity, recommending methods like the rule of nines or Lund and Browder Chart for estimating burned area.
  • Systemic Management and Fluid Resuscitation: Highlights the criteria for initiating fluid resuscitation based on burn extent and emphasizes early resuscitation efforts using isotonic solutions like lactated Ringer’s solution.
  • Airway Management in Inhalation Injuries: Suggests indicators for airway injury and the use of bronchoscopy for diagnosis, with recommendations for preventive intubation in high-risk cases.
  • Infection Control: Discusses the role of prophylactic antibiotics, emphasizing targeted use rather than uniform application, and the potential benefits of fecal diversion in perianal burns to prevent infection.
  • Topical Treatments and Dressing Materials: Recommends various dressing materials for second-degree burns and outlines suitable topical agents for both second-degree and small third-degree burns, emphasizing the need for necrotic tissue removal in the latter.
Concluding Remarks

These guidelines provide a comprehensive framework for the management of burns, from initial assessment to specific treatment strategies, aligning with current evidence and practices within the Japanese medical context.

Keywords: burn index, deep burn, deep dermal burn, epidermal burn, superficial dermal burn.

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