There has been a sustained improvement in outcome following thermal injury as is evident in the progressive increase in the LD 50 (the extent of burn in percentage of surface area associated with a 50 per cent mortality) that has occurred since 1950. Figure 1 shows this improvement for a 21-year-old patient, but during the period noted the LD5C for every age group has increased. Much of this improvement has resulted from the use of physiologically based fluid resuscitation, which essentially eliminates the occurrence of early renal failure and its high attendant mortality, and the development of effective topical antimicrobial creams, which control the microbial density of the burn wound and prevent invasive wound infection. Continued advances in our understanding of the pathophysiology of injury have led to further improvements in the care of the thermally injured. These include accurate diagnostic modalities and effective management techniques for inhalation injury, early excision and grafting of burn wounds, and the implementation of effective infection control policies.
Fig. 1 The LD50 following thermal injury for a 21-year-old patient for the years 1950 to 1992.
Inhalation injury accompanies burn injury in up to 35 per cent of those admitted to burn centers and adds further physiological stress to an already burdened patient, resulting in higher morbidity and mortality. However, accurate diagnosis of the injury, understanding of its pathophysiology, and subsequent institution of targeted therapies have been instrumental in reducing the comorbid effect of inhalation injury following thermal injury ( Shirani.et,al 1987).
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