Burn Injuries: Pathophysiology, Assessment, and Management

Burns

Serious soft-tissue injuries resulting from the transfer of destructive energy, primarily thermal, electrical, or radiation. Temperatures exceeding 44ºC causing tissue damage.

Integument

Another name for the skin; serves several vital functions including protection, temperature regulation, water regulation, and sensory reception.

Thermal Burns

Burns caused by heat energy, including flame, scald, contact, steam, and flash burns.

Burn Shock

A systemic response to severe burns involving fluid loss leading to hypovolemic and distributive shock.

Inhalation Injuries

Critical complications of fires that include thermal inhalation burns and smoke inhalation, leading to airway compromise.

Thermal Inhalation Burns

Direct heat damage to the airway tissue, which can cause "rapid and serious airway compromise." Swelling, particularly in the upper airway (supraglottic), can completely obstruct the airway and be fatal

Smoke Inhalation

The majority of fire-related deaths are due to "inhalation of toxic gases," upper airway compromise, and pulmonary injury. Smoke contains numerous toxic chemicals, leading to thermal burns, hypoxia (from lack of oxygen), and tissue damage.

Carbon Monoxide Intoxication

A dangerous condition caused by CO binding to hemoglobin, leading to hypoxia and should be suspected in multiple individuals with headaches or nausea.

Chemical Burns

Burns caused by exposure to corrosive materials, requiring immediate flushing with water. Materials include, Acids, Alkalis or bases, Oxidizing agents, Phosphorous, Vesicants Mechanisms

Electrical Burns

Burns often classified as major, with significant internal damage, caused by electrical current. Include contact, flash, and flame burns.

Contact burns

The most common type.

Flash burns

Electrothermal injury.

Flame burns

Thermal injury secondary to electrical current. Electrical burns can cause significant internal damage beyond visible surface wounds. "Alternating current (AC) is considerably more dangerous than direct current (DC); it can freeze the victim to the conductor." Non-burn injuries associated with electricity include asphyxia, cardiac arrest, neurologic complications, kidney damage, and muscle spasms leading to fractures.

TASER Effects

Injuries caused by TASER devices, typically resulting in minor injuries but may require medical care.

Lightning Injuries

Injuries from lightning, which carries immense electrical power and requires specific management similar to high-voltage line injuries.

Radiation Burns

Burns caused by ionizing radiation, measured in rad, rem, or gray; can lead to acute radiation syndrome.

Superficial burn

Epidermis only, red, painful (e.g., sunburn).

Partial-thickness burn

Epidermis and dermis. Superficial: Red, blisters/moisture, painful, heals spontaneously but may scar. Deep: Extends into dermis, very painful, often caused by hot liquids/steam/grease.

Full-thickness burn

All skin layers destroyed, white/pale/brown/leathery/charred, no pain sensation, usually requires skin grafting.

Burn Depth

Classification of burns based on their severity, including superficial, partial-thickness, and full-thickness burns.

Rule of Nines

A method to estimate total body surface area (TBSA) affected by burns, dividing the body into sections.

Rule of Palms

Patient's palm is approximately 1% TBSA, useful for smaller or irregularly shaped burns.

Lund and Browder Chart

Provides more specific regional divisions for accuracy.

Fluid Resuscitation

An essential treatment for burn patients covering more than 20% of TBSA, using methods like the consensus formula.

Consensus Formula (Parkland formula)

 ◦ Fluid needed in first 24 hours: 2 to 4 mL solution × body weight (in kg) × percentage of body surface burned.

    ◦ Half of this fluid is given in the first 8 hours, the second half over the next 16 hours.

Pediatric Burn Patients

Children, especially preschoolers, are particularly vulnerable to fire-related injuries.

Geriatric Burn Patients

Older adults who have a higher risk of fire-related injuries and may require special considerations in management.

Burn Centre Criteria

Partial-thickness burns > 10% TBSA.

• Burns of face, hands, feet, genitalia, perineum, or major joints.

• Any full-thickness burns.

• Any electrical burns (including lightning).

• All chemical burns.

• All inhalation burns.

• Burns complicated by pre-existing medical conditions or other traumatic injuries.

• Burns to children in hospitals without qualified personnel or equipment.

• Burns requiring special rehabilitation.

Long-Term Consequences

The lasting effects of severe burns on rehabilitation, thermoregulation, motor function, and sensory function.