The complexities of managing severe burns with associated trauma

The combined injuries of trauma and a burn pose an infrequent but challenging management problem. Approximately 5% of burn admissions to inner-city trauma burn centers have associated trauma. Those with inhalation injuries and combined injuries have the highest mortality rate, approaching 40%. The authors discuss the initial management of this combined injury group, the management of the most frequent comorbid injuries, and the state-of-the-art ICU care. The caveats of the initial management remain the ''ABCs'' of optimal trauma care. Significant changes in the diagnostic milestones of the response to initial management, however, may obscure the actual severity of underlying or associated injuries. The mechanism of injury alerts one to the possible associated injuries that may complicate a burn. The distinct problems and pitfalls in the initial care of combined-injury patient care are discussed. Specific traumatic injuries are presented with respect to their surgical and ICU treatment when they accompany a burn injury.