Indian Journal of Burns

EDITORIAL
Year
: 2020  |  Volume : 28  |  Issue : 1  |  Page : 1--3

Burn management during COVID-19 era: An overview


Vijay Kumar 
 Department of Plastic Surgery, King George Medical University, Lucknow, Uttar Pradesh, India

Correspondence Address:
Prof. Vijay Kumar
1/78, Vishesh Khand, Gomtinagar, Lucknow - 226 010, Uttar Pradesh
India




How to cite this article:
Kumar V. Burn management during COVID-19 era: An overview.Indian J Burns 2020;28:1-3


How to cite this URL:
Kumar V. Burn management during COVID-19 era: An overview. Indian J Burns [serial online] 2020 [cited 2021 Jun 19 ];28:1-3
Available from: https://www.ijburns.com/text.asp?2020/28/1/1/316583


Full Text



 Introduction



The novel coronavirus, SARS-COV2 responsible for COVID-19 pandemic had already spreaded to the entire world. Now this, devastating Covid-19 pandemic is toward its end as many Pharma companies already applied for the emergency approval of vaccine for the mass use. In conjunction with new ray of hope, the burn centers also gearing up for the pandemic and they must keep a balance between contributing to the pandemic response and providing optimum burn care in a safe and ethical manner. The authors of the present communication represent seven burn centers we are sharing our experience with the virus to date, our strategic approach to burn center function under these critical circumstances and lessons learned. The purpose of this communication is to share our experiences, which may assist you with continued preparations to help burn centers during this COVID-19[1] era.

In this brief overview, we stressed upon the clinical experience during this COVID-19 era and published literature, we highlight the key considerations for burn care providers while dealing with burn patients during the COVID-19 pandemic. Although individual hospital guidelines and practices may be different in relation to burn care, there should be uniformity in their management during this critical era.

The burn service as a whole is a working unit of great difficulties and able to handle the onerous care of the nauseous patients with the utmost care. As a result, the burn service represents an important component of the response to the COVID-19 surge.

As part of coping with and reducing virus spread, many countries announced that all nonessential and nonurgent elective surgeries and medical treatments were postponed until further notice. This policy freed health systems to focus their workforce and other resources on crucial treatments for COVID-19 patients.

Even though pediatric cases are a minority of all COVID-19 patients (~2% worldwide), their presentation is atypical and might be confusing. Therefore, any patient in the burn department should be a suspect COVID-19 carrier until proven otherwise and should be managed carefully. Due to the enforcement of lockdown, there are increase number of household accidents leading to burn, especially in the pediatric age group.

A burn is an acute condition associated with many systemic disorders, most notably coagulopathy,[2] which is also a major complication in COVID-19 patients.[3] Apart from the coagulopathy, breathing difficulty is the most common symptom in COVID-19, which is very troublesome in burns of the face and chest.

 Burns with COVID-19 Checklist



All new burn patients, including pediatric burn patients, should undergo solitary isolation for 4–7 days, 2 weeks is recommended if possible, for medical observationPreliminary screening, which includes blood routine and chest computed tomography (CT) examinations, is performed routinely on all newly admitted patientsSevere burns in pediatric age group, burns in elderly, and in special conditions (comorbid conditions, pregnancy, and epilepsy) patients should be admitted to burn intensive care unit and should be treated as the suspects of COVID-19 until proven otherwiseAirway interventions such as frequent sputum suctioning, airway lavage, and other invasive procedures should be minimizedFor urgent surgeries, lung CT and routine blood tests must be performed right before any surgical procedure, and the COVID-19 PCR test should be performed based on the clinical symptoms and epidemiologySurgery is the highest risk point of COVID-19 infection exposure, especially in the early treatment of burn patients; proceed with surgery if it is very necessary but consider all patient as COVID-19 suspected and positive, so take all necessary precautionsAll surgical procedures have to be administrated in negative-pressure operating rooms, and health-care staff must take proper protective precautions.

 Advice for Emergency Burn Units



Minor burns

Minor burns should receive first aid, primary care at home if possible in the form of cooling the burn with running tap water for 20–30 min followed by a clean dressing. Video consultation may be taken for primary care at home.

Moderate and major burns

The coronavirus disease has a long mean incubation period and the disease spectrum may range from asymptomatic, mild to severe infections. Taken this note in mind, treat every patient of burn in an emergency as a COVID patient.[4] Restrict the entry at main entrance of patient reception area and all screened for the temperature. Take a proper history of burn, any close contact with corona patients, history of recent travel, etc., If a history is dubious or positive, treat that patient as positive till the negative test report come. Attending doctor should wear proper protective gears and keep a safe distance of 2 m while taking the history and avoid any unnecessary contact while examining the patient.

At the time of admission, separate consent should be taken for the risk of COVID-19 infection during the hospital stay and during surgical procedures.

Examination and dressing of burns

While examining the patient doctor should wear proper protective gears as mentioned early and perform hand hygiene before and after the procedure. For regular burn dressings, the frequency of dressing change should keep to a minimum according to the level of wound exudation and stage of healing.

 Burn Surgeries with COVID-19



American College of Surgeons and Royal college of Surgeons provided the guidelines for triaging the burn surgeries according to the need. All life or limb salvaging surgeries with burns should be given priority.

 In Operation Room



The standard protection actions for the operations of Class A infectious diseases must be strictly implemented by all medical workers involved in the operation following Ma et al.[5] recommendations.

All objects and surfaces should be disinfected and sterilized efficiently according to the disinfection regimen according to Xiong et al.[6]

Simple and efficient measures for the operation must be taken as the circumstance allows.

Operation time must be reduced as much as possible and exposure of deep vital tissue should be avoided.[5]

Postoperative care

All operated patients should be managed with caution and care in isolation room with negative pressure provided with video monitoring.

Discharge and follow-up

For a COVID-19-infected patient in addition to meeting the discharge criteria for burns, they must also fulfill the discharge criteria for coronavirus disease. They must also follow the necessary isolation and observation after discharge even at home.

Postdischarge follow-up can be handled remotely using video consultation by using various electronic media platforms.

 Take Home Messages



Having high risk of contamination for both burn patients and service providers, it is essential to follow the strict strategies of management in each burn center aiming to control the spread of COVID-19In general, these strategies should focus on educating people on the first aid treatment for minor burns at home if possible to reduce the exposure of individuals to the hospital environmentHospitalization of burn patients, regardless of the burn degree, has a severe impact by this COVID-19 pandemicHence, as the service providers, it is our duty to find an effective balance between providing the best possible care to our patients and limiting the spread of COVID-19.

References

1Du Xiaolu Ma L, Zhu J. Neonatal management during coronavirus disease (COVID-19) outbreak: Chinese experiences. Neo Rev 2020;21:e293.
2Blake M, Roadley-Battin R, Torlinski T. Prophylactic anti-coagulation after severe burn injury in critical care settings. Acta Med Litu 2019;26:38-45.
3Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood 2020;135:2033-40.
4Lauer SA, Grantz KH, Qifang Bi, Jones FK, Zeng Q, Meredith HR, et al. The incubation period of coronavirus disease 2019 (covid-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med 2020;172:577-82.
5Ma S, Yuan Z, Peng Y, Chen J, Li H, Luo Q, et al. Experience and suggestion of medical practices for burns during the outbreak of COVID-19. Burns 2020;46:749-55.
6Huang Z, Zhuang D, Xiong B, Deng DX, Li H, Lai W. Occupational exposure to SARS-CoV-2 in burns treatment during the COVID-19 epidemic: Specific diagnosis and treatment protocol. Biomed Pharmacother 2020;127:110176.