The importance of initial management: a case series of childhood burns in Vietnam.

The success of treatment of childhood burns is critically dependent on how well the initial management is performed. In this case series of 695 children with burns transferred to the National Burn Institute (NBI) in Hanoi from peripheral hospitals, the initial management of each patient was assessed for the following initial management measures: removal of the cause and immediate cooling with water at the accident site; and pain relief, dry dressing, administration of oxygen, and adequate fluid replacement at the peripheral hospital. Overall, 61 of the 695 children died, but of the 95 patients who received all of these initial management measures, all survived. There were no cases of irreversible shock, acute renal failure, or multiple organ failure in the patients who received adequate initial management. Provision of adequate initial management was also significantly protective against septicaemia. Thus in this group of subjects who survived until admission, effective initial management significantly reduced the risk of death and other complications such as irreversible shock, septicaemia and multiple organ failure.