Treatment of severely burned patients transferred from remote areas after mass casualties

Objective: To analyze the treatment of life-threatening complications of severely burned patients transferred from remote areas after mass casualties. Methods: 13 patients injured in 2 mass casualties were transferred to our burn institue 3-4 days after the injury.The mean burn area was 75% TBSA, in which a mean of 63% TBSA were full-thickness burns.All of them had escar lysis, and most of them manifested hypovolemic shock, hypernatremia, leucopenia, hypoproteinemia, and stress ulcer separately or simultaneity on admission.Physical and laboratory examinations were performed on admission to define life-threatening complications.Hypovolemic shock was treated under Swan-Gans catheter monitoring, and hypernatremia was treated with heparin-free hemodialysis as soon as the diagnosis was established.Escharectomy and micro-skin and allgraft transplantation were performed as soon as the general condition was stabilized, average about 3-5 day after burns.Broad-spectrum antibiotics were also used and systemic support measures including immunomodulation were taken. Results: Most patients recovered smoothly.Five patients whose burned areas were over 95% TBSA developed other complications as sepsis and organ disfunction about 2 weeks after the injury, and 3 of the 5 patients were cured and the other 2 patients died of wound sepsis due to lack of donor site and acute hepatitis B respectively. Conclusion: Those patients who were severely burned in mass casualties, and were transferred from remote areas in relatively early stage after the injury, were usually complicated by life-threatening morbid states on admission.When the wounds could not be totally covered due to lack of donor area, severe sepsis would occur about 2 weeks after the injury and result in death.Be cognizant of those complications and treat them properly as early as possible were the key to save the patients.