Neftaly Burn Management Protocols

Introduction

Burn injuries require prompt and effective management to reduce complications, promote healing, and improve patient outcomes. The Neftaly Burn Management Protocols provide a comprehensive, step-by-step guide for healthcare professionals to assess, treat, and manage burn injuries of varying severity.

Objectives

• To ensure standardized and evidence-based care for burn patients.
• To minimize infection risks and complications.
• To promote optimal wound healing and functional recovery.
• To provide clear criteria for referral and advanced care.

Initial Assessment and Triage

1. Primary Survey (ABCs)
   • Airway: Assess for inhalation injury, secure airway if compromised.
   • Breathing: Ensure adequate ventilation and oxygenation.
   • Circulation: Check pulse, control bleeding, initiate IV access.
2. Burn Assessment
   • Determine burn depth: superficial, partial thickness, full thickness.
   • Calculate Total Body Surface Area (TBSA) affected using Lund-Browder chart or Rule of Nines.
   • Identify presence of chemical, electrical, or inhalation burns.
3. Immediate Interventions
   • Remove source of burn and contaminated clothing.
   • Cool the burn area with running water (10-20 minutes).
   • Avoid ice or prolonged cooling to prevent hypothermia.
   • Cover burns with sterile, non-adherent dressings.

Fluid Resuscitation

• Use the Parkland Formula to guide fluid replacement in burns >15% TBSA:
  • 4 mL × body weight (kg) × %TBSA burned.
  • Administer half of the fluid in the first 8 hours, remainder over the next 16 hours.
• Monitor urine output (>0.5 mL/kg/hr in adults) to guide fluid therapy.

Wound Care and Infection Prevention

• Clean wounds gently with sterile saline.
• Debride necrotic tissue as indicated.
• Apply appropriate topical antimicrobials (e.g., silver sulfadiazine).
• Change dressings according to wound condition and institutional guidelines.
• Monitor for signs of infection: increased pain, redness, swelling, purulent discharge, fever.

Pain Management

• Administer analgesics based on severity of pain (NSAIDs, opioids).
• Use procedural sedation for dressing changes if necessary.
• Consider psychological support for anxiety related to burn injury.

Nutritional Support

• Initiate early nutritional assessment.
• Provide high-calorie, high-protein diet to support healing.
• Consider enteral feeding for extensive burns or inability to eat orally.

Referral and Transfer Criteria

• Burns involving >15% TBSA in adults or >10% in children.
• Burns affecting face, hands, feet, genitalia, perineum, or major joints.
• Electrical, chemical, or inhalation injuries.
• Patients with pre-existing medical conditions complicating burn care.
• Refer to specialized burn centers for advanced care and surgery.

Rehabilitation and Follow-Up

• Early mobilization to prevent contractures and maintain function.
• Scar management with pressure garments, silicone sheets.
• Psychological support and counseling.
• Long-term follow-up for functional and cosmetic outcomes.

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