BURN

INJURY
Contents

1. Introduction and Pathophysiology of Burn Injury

2. Initial Assessment, Resuscitation, Wound Evaluation and Early
Care
3. Wound Care
Introduction

▪ A burn is defined as damage to the

skin and underlying tissues caused
by heat, chemicals, or electricity.

In the United States 450,000 people

receive medical attention for burn
injuries. An estimated 4,000 people
die annually due to fires and burns
 Local Changes

Burn depth is determined by the time of

exposure, the temperature at which the burn
occurred, and the caloric equivalent of the burn
media.
 Systemic Changes

The release of cytokines and other inflammatory mediators at the site of injury
has a systemic effect once the burn reaches 20–30 % of total body surface area
(TBSA)

Edema Formation

release of cytokines and extravasation of plasma

other inflammatory edema, hypovolemia,
into the burn wound and
mediators at the site of shock
the surrounding tissues
injury
 Systemic Changes

Hemodynamic and Cardiac

Changes Post Burn

• reduction in plasma volume

• neurogenic response to
receptors in the thermally reduced venous reduced cardiac
injured skin or increased return output (CO)
circulating vasoconstrictor
mediators
Systemic Changes

▪ Hypermetabolic Response Post-Burn

Marked and sustained increases in catecholamine, glucocorticoid,

glucagon, and dopamine secretion are thought to initiate the
cascade of events leading to the acute hypermetabolic stress
response with its ensuing catabolic state.

Resting Energy Glucose and Gastrointestinal

Expenditure Lipid Metabolism System

Muscle
Catabolism Renal System Immune System
Initial Assesment

▪ Primary and Secondary Survey

▪ Burn size and depth
 burn encompassing
>15 % TBSA will
require fluid
resuscitation
 Parkland (Baxter) Formula

• While the Parkland formula provides with the total amount for 24 h and
starting level for initiation of resuscitation, it is not an absolute.
• The fluid resuscitation should be guided by physiological parameters and
laboratory findings to prevent under/over-resuscitation.

The addition of
Endpoint of Burn Resuscitation  urinary output, measurements of base
heart rate, and blood pressure deficit and lactate has
become commonplace as
markers of adequate
resuscitation
colloids are not recommended in the initial 12 h phase of resuscitation
(however, there is no clear evidence as to the exact timing for initiation of colloids).
The colloid of choice is albumin (5% concentration), given as an infusion to decrease
the crystalloid requirements.
 • Decrease fluid volumes as
quickly as possible
• Monitor intra-abdominal
• Abdominal compartment pressures in all patients with
syndrome (ACS) >30 % TBSA burn
• Extremity compartment • Perform escharotomies on full-
Fluid Over-resuscitation
syndrome thickness torso burns and if
• Pulmonary edema and inadequate
pleural effusions • Consider aggressive diuresis if
evidence of over-resuscitation
• Consider neuromuscular
blockade to alleviate
abdominal muscle tone
escharotomies
 Wound Care

require no dressing and are

treated with topical salves to
First-degree wounds
decrease pain and keep the
skin moist.

daily dressing changes with

Second-degree
topical antibiotics, cotton
wounds
gauze, and elastic wraps.
 require excision and grafting for
sizable burns, and the choice of initial
Deep second-degree and dressing should be aimed at holding
third-degree wounds bacterial proliferation
Reference