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(Dilaudid), or a continuous infusion of fentanyl. For sedation, 9. Keck M, Herndon DH, Kamolz LP, et al. Pathophysiology of
current practice in critical care is to minimize the use of ben- burns. Wien Med Wochenschr. 2009;159(13–14):327–336.
zodiazepines, although pre-procedural use of oral lorazepam is 10. Bittner EA, Shank E, Woodson L, Martyn JJ. Acute and perioper-
useful to address anticipatory anxiety before painful procedures ative care of the burn-injured patient. Anesthesiology. 2015;122
(2):448–464.
in ward patients. Patients must be closely monitored when be- 11. Jeschke MG, Gauglitz GG, Kulp GA, et al. Long-term persistence
ing treated with narcotics or sedatives, with specific attention of the pathophysiologic response to severe burn injury. PloS
to a patient’s cardiovascular and respiratory physiology. 10 ONE. 2011;6(7):e21245.
12. Muehlberger T, Ottomann C, Toman N, et al. Emergency pre-
hospital care of burn patients. Surgeon. 2010;8(2):101–104.
Conclusion 13. Chen MC, Chen MH, Wen BS, et al. The impact of inhalation
injury in patients with small and moderate burns. Burns. 2014;
Providing medical care for patients with burn injuries is a 40(8):1481–1486.
complex task. Caring for this patient population in long-range 14. Tredget EE, Shankowsky HA, Taerum TV, et al. The role of in-
rescue scenarios brings an additional set of challenges and op- halation injury in burn trauma. A Canadian experience. Annals
portunities. For the pararescue missions referenced in the case Surg. 1990;212(6):720.
study, nine out of the 10 major burn patients survived their 15. Kauvar DS, Cancio LC, Wolf SE, et al. Comparison of combat
injuries due to the advanced medical care they received in the and non-combat burns from ongoing US military operations. J
Surg Res. 2006;132(2):195–200.
pre- hospital setting. This statistic reinforces the importance of 16. Walker PF, Buehner MF, Wood LA, et al. Diagnosis and manage-
burn management for out of hospital providers, particularly in ment of inhalation injury: an updated review. Crit Care. 2015;19
the prolonged field care setting. (1):1–12.
17. Foncerrada G, Culnan DM, Capek KD, et al. Inhalation injury in
We have highlighted a series of treatments and considerations the burned patient. Ann Plast Surg. 2018;80(3 Suppl 2):S98–S105.
that providers should consider in such scenarios, including air- 18. Harshman J, Roy M, Cartotto R. Emergency Care of the Burn
way management, fluid resuscitation, wound care including Patient before the burn center: a systematic review and meta-anal-
ysis. J Burn Care Res. 2019;40(2):166–188.
debridement and escharotomies, temperature and pain man- 19. Hassan Z, Wong JK, Bush J, et al. Assessing the severity of inha-
agement, infection control, and pain management. Providers lation injuries in adults. Burns. 2010;36(2):212–216.
must also be prepared to deliver such interventions over the 20. Ryan CM, Fagan SP, Goverman J, Sheridan RL. Grading inhala-
course of many hours and potentially days. While such care tion injury by admission bronchoscopy. Crit Care Med. 2012;40
may be challenging, working with this unique and complex (4):1345–1346.
population provides opportunities to use interventions that 21. McCulloh C, Nordin A, Talbot LJ, et al. Accuracy of prehospi-
hold the potential to drastically improve survival and quality tal care providers in determining total body surface area burned
in severe pediatric thermal injury. J Burn Care Res. 2018;39(4):
of life. 491–496.
22. Pham C, Collier Z, Gillenwater J. Changing the way we think
Disclosures about burn size estimation. J Burn Care Res. 2019;40(1):1–11.
We have no conflicts to disclose. 23. Freiburg C, Igneri P, Sartorelli K, Rogers F. Effects of differences
in percent total body surface area estimation on fluid resuscitation
of transferred burn patients. J Burn Care Res. 2007;28(1):42–48.
Funding 24. Goverman J, Bittner EA, Friedstat JS, et al. Discrepancy in initial
We received no funding for this effort. pediatric burn estimates and its impact on fluid resuscitation. J
Burn Care Res. 2015;36(5):574–579.
Disclaimer 25. Feng JY, Chien JY, Kao KC, et al. Predictors of early onset mul-
The opinions or assertions contained herein are the private tiple organ dysfunction in major burn patients with ventilator
view of the authors and are not to be construed as official or support: Experience from a mass casualty explosion. Sci Reports.
2018);8(1):1–9.
as reflecting the views of the United States Government, De- 26. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and
partment of Defense, its Services, or the Department of State. organ failure and guidelines for the use of innovative therapies in
sepsis. Chest. 1992;101(6):1644–1655.
References 27. Hettiaratchy S, Papini R. Initial management of a major burn: II—
1. Mix JW, DeSoucy ES, Hilser A, et al. A case series of Air Force assessment and resuscitation. BMJ. 2004; 329(7457):101–103.
pararescue long-range ocean rescues. J Spec Oper Med. 2020;20(3): 28. Devgan L, Bhat S, Aylward S, Spence RJ. Modalities for the as-
122–127. sessment of burn wound depth. J Burns Wounds. 2006;5:e2.
2. Arturson G. Pathophysiology of the burn wound. Ann Chir Gynae- 29. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield
col. 1980;69(5):178–190. (2001-2011): implications for the future of combat casualty care.
3. Hettiaratchy S, Dziewulski P. ABC of burns: pathophysiology and J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S431–S437.
types of burns. BMJ. 2004;328(7453):1427–1429. 30. Chung KK, Wolf SE, Cancio LC, et al. Resuscitation of severely
4. Kara YA. Chapter 2: Burn etiology and pathogenesis. In: Kartal SP, burned military casualties: fluid begets more fluid. J Trauma
Bayramgurler D, eds. Hot Topics in Burn Injuries. London, UK: Acute Care Surg. 2009;67(2):231–237.
IntechOpen; 2018:17–33. 31. Bracco D. Burn fluid resuscitation: Let the autopilot do it!. Crit
5. Singh M, Prakash S. Chapter 24: Burn: A Clinical Perspective. In: Care Med. 2011;39(9):2178–2180.
Shrivastava, D. Theory and Applications of Heat Transfer in Hu- 32. Friedrich JB, Sullivan SR, Engrav LH, et al. Is supra-Baxter resus-
mans. New York, NY: John Wiley & Sons; 2018:513–527. citation in burn patients a new phenomenon? Burns. 2004;30(5):
6. Horton JW, White J, Maass D, Sanders B. Arginine in burn injury 464–466.
improves cardiac performance and prevents bacterial transloca- 33. Hulse EJ, Thomas GO. Vascular access on the 21st century mili-
tion. J Appl Physio. 1998;84(2):695–702. tary battlefield. BMJ Mil Health. 2010;156(Suppl 4):S385–S390.
7. Pham TN, Cancio LC, Gibran NS. American Burn Association 34. Saffle JR. The phenomenon of “fluid creep” in acute burn resus-
practice guidelines burn shock resuscitation. J Burn Care Res. citation. J Burn Care Res. 2007;28(3):382–395.
2008;29(1):257–266. 35. Greenhalgh DG. Early management of burn patients and fluid
8. Kaddoura I, Abu-Sittah G, Ibrahim A, et al. Burn injury: review of resuscitation. In: Jeschke MG, Kamolz LP, Sjöberg F, Wolf SE.
pathophysiology and therapeutic modalities in major burns. Ann Handbook of Burns. Vol 1. Springer International Publishing;
Burns Fire Disasters. 2017;30(2):95–102. 2020:199–209.

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