Almost three quarters of patients with extensive burns die of the consequences of a severe infection. In the current edition of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2009; 106[38]: 607-13), Timo A. Spanholtz of the Cologne-Merheim Burn Center and his coauthors discuss the acute therapy and follow-up care of burn disease.
Optimal treatment of severely burned patients necessitates collaboration between primary care physicians, emergency physicians and specialist departments for plastic surgery. During first aid from the emergency physician, the patient is removed from the danger zone and is administered adequate fluid, and drugs, over several intravenous accesses. Additional first aid measures include cooling and sterile covering of the burned skin.
The Central Office for Burn Injuries in Hamburg then organizes the necessary transfer to a specialist department. There are about 100 beds in Germany for severely burned patients, including 10 in the Cologne-Merheim Burn Center of Witten/Herdecke University. The lives of these patients are at risk from pneumonia, pulmonary failure, sepsis, and acute respiratory distress syndrome (ARDS). Bacterial infection of the wound is a frequent complication.
After intensive medical treatment, the patient may be given further wound care, physiotherapy, ergotherapy, and the necessary psychiatric treatment in a special follow-up ward. The primary care physician providing follow-up care must be able to recognize scar contractures leading to functional restriction and may refer the patient to the Burn Center once again for a new operation.