Many burns are serious, life-threatening injuries that need prompt, careful treatment in the hospital, preferably in a specialized burn center. Critical care immediately after a serious burn and treatment in a burn center may be necessary to save a victim's life. The amount of area burned, the location of the burn and the amount of tissue destroyed all determine the seriousness of the burn; burns are classified as superficial, partial thickness or full thickness. Good hospital care is essential to recovery with as few complications as possible.
Airway Maintenance
Ensuring an open airway is the first and most important task of the hospital team. Smoke inhalation or burns to the neck, chest and face can cause the airway to swell closed. Victims should be placed on a mechanical ventilator by respiratory therapy as soon as possible after hospital admission if any signs of airway swelling are present.
Hospital nursing staff should administer oxygen by mask to victims with burns and smoke inhalation and constantly watch for signs of carbon monoxide poisoning. Confusion, lethargy, coma and altered judgment are signs of possible carbon monoxide poisoning. Hyperbaric oxygen, which may not be available in all hospitals, may be required if ventilation doesn't improve blood levels; transfer to another hospital may be required.
Hydration
Burn victims who are burned on more than 20 percent of their total body surface need IV hydration started immediately in the hospital, according to Burnsurgery.org. Burn victims lose a tremendous amount of fluid from leaking capillaries and open wounds very quickly. Shock can result if enough fluid is lost, according to the Merck Manual; assessing a burn victim for shock should be done quickly after hospital admission. Lactated ringer solution, a balanced (isotonic) saline solution, helps maintain electrolyte balance. Hospital nursing personnel must ensure adequate IV access and also check for overhydration, which may increase tissue swelling.
Skin Care
Skin around the burn needs immediate assessment and treatment. Tissue edema occurs very quickly. Because burned tissue loses its elasticity and doesn't stretch to accommodate fluid under the skin, blood supply to tissues can be cut off. It's often necessary for hospital staff to perform an escharotamy, a cut through the burned tissue that allows expansion in edema so blood flow isn't obstructed, according to the Merck Manual.
Skin and tissue act as a natural barrier to bacteria, so burn victims are prone to infection. Intravenous antibiotics should be started immediately by nursing staff under doctor's orders, and burned areas must be kept very clean, with bandages changed under sterile technique several times a day and ointments to aid healing applied. The Merck Manual states that skin grafting may be started in the hospital to repair areas that can't regenerate on their own.
Nutrition
Hospital nutritionists should calculate proper intake and assess whether tube feeding or hyperalimentation (intravenous calories) is needed to supply the calories required to repair damaged tissue, according to Burnsurgery.org. Burn victims require a tremendous number of calories to keep their body functioning. Marked protein loss combined with increased metabolic rate makes it almost impossible for a burn victim to take in enough calories without supplementation. Weighing the patient and keeping track of nutritional status should be done daily by the nursing team.
Emotional Support
Hospital social workers or family support teams should work with both the victim and the family as soon as possible after hospital admission. Burns are one the most traumatic injuries, especially if they result in severe disfigurement. Burn victims can "give up," and stop trying to get better if they aren't given adequate emotional support. Families of burn victims also need psychological help to get through an extremely trying experience.
