Overview of Burn Resuscitation and Management
Minor burns can usually be treated at home or through a local health care provider. This article will talk about how severe burns are handled right at the start, including the initial treatment and care, and the important steps needed in managing these severe burns.
There are several factors to consider when identifying the severity of a burn. A patient’s age is one factor that notifies burn severity along with the percentage of the total body surface area that’s burned (%TBSA), how deep the burn is, what type of burn it is, and if specific parts of the body, like the face or joints, are burned. For instance, a burn can be classified as severe if one or more of the following apply;
- A child under 10 or an elderly person over 50 has more than 10% of their body burned.
- An adult has more than 20% of their body burned.
- More than 5% of the burn is a full thickness, meaning it has burned all layers of the skin and possibly even further into the body.
- The burn was caused by a high-voltage electrical shock.
- Significant burns are present on sensitive areas like the face, eyes, ears, joints, or genitals.
Other factors can impact the patient’s health and their ability to recover from the burn, such as inhalation injury, other physical injuries, and the patient’s pre-existing health conditions like heart disease or lung disease. Some patients may be more prone to severe injuries due to specific reasons.
Severe burns cause substantial damage not only on the surface of the skin but can also lead to a bodily response. This response involves the release of certain substances like histamines, prostaglandins, and cytokines that can lead to fluid leakage from the blood vessels. This effect, combined with reduced blood flow and increased blood vessel resistance, could lead to a significant loss of bodily fluid and low blood flow, a condition known as “burn shock”.
This shock can be managed with vigorous fluid replacement and careful monitoring to ensure that the patient is adequately hydrated but not overloaded. This happens mostly in the first day after the burn, with the most intense effects seen 6 to 8 hours after injury. Remember, the burn itself does not initially cause significantly low blood pressure. If a patient has drastically low blood pressure immediately following burns, other causes must be explored.
Anatomy and Physiology of Burn Resuscitation and Management
Burn injuries on sensitive areas like the face, eyes, ears, joints, hands, or private areas are usually more serious. Thus, they typically need treatment at a specialist burn center.
Why do People Need Burn Resuscitation and Management
Adults and children who have burns covering more than 20% of their total body surface area (TBSA) should receive fluid treatment. This helps restore the lost fluids in the body due to the burn. The amount of fluid required is calculated based on the person’s body weight and the extent of the burn. Typically, they would need between 2-4 milliliters of a fluid called crystalloid per kilogram of their body weight for each percentage of TBSA burned. This is usually given during the first 24 hours after a burn.
When a Person Should Avoid Burn Resuscitation and Management
If a burn patient is stable, meaning their blood is circulating properly, they shouldn’t receive too many fluids. This is because if a patient gets too many fluids, it can lead to swelling or “edema” in their body.
Preparing for Burn Resuscitation and Management
If there’s a possibility that a person has sustained severe burns in an accident, medical professionals need to be well-prepared to provide immediate and effective treatment. This includes being ready to replace lost fluids, using sterile sheets for protection, and having pain relief medication readily available. This preparation is crucial since it helps to provide the necessary quick-care in severe burn incidents.
How is Burn Resuscitation and Management performed
If you experience a serious burn, it’s crucial that you get immediate medical help. Burns can sometimes distract from other potentially life-threatening complications, so they require a careful and precise approach by healthcare professionals.
First of all, the ongoing burning process should be stopped as soon as possible and any hot items should be removed from skin contact. The healthcare provider will need to quickly assess your overall condition and get some key information from you, like any allergies you have, any medication you’re on, past medical issues, and what you last ate. They’ll then check your airway, breathing, and circulation, evaluate if there’s severe bleeding, and monitor your blood pressure, heart rate, and pulses. This is to make sure your basic bodily functions are stable.
Once this initial assessment is done, the healthcare professional will then thoroughly examine your body to identify all injuries. As a part of this process, they’ll take a closer look at the burn itself. This involves determining the percentage of your body that was burned and how deep into the skin the burn goes. Therethree levels of burns: superficial or first-degree burns which affect just the outer layer of your skin, partial-thickness or second-degree burns which extend to the second layer, and full-thickness or third-degree burns which reach the deepest layer.
If the burn covers more than 20%-25% of the body, a process called IV fluid resuscitation will be carried out. This process delivers fluids directly into your bloodstream to prevent shock that can be caused by the burn. There are several formulas to determine the amount of fluid needed, but most commonly the Parkland Formula is used. It calculates the volume of fluid needed based on the area of your body that’s burned and your weight. The calculated volume is then delivered over the first 24 hours after the burn, with half given in the first 8 hours. This volume is a starting point, and adjustments will be made based on your body’s response to the treatment.
Additionally, depending on the severity of the burn, a nasogastric tube may be put in as most people with severe burns tend not to be able to digest food properly. A Foley catheter might also be inserted to monitor urine output. Heart rate and oxygen levels will be closely watched, and you’ll receive pain relief through an IV. Tetanus shots may also be given if you haven’t received one in the past 5 years. If your burn was due to a fire, the healthcare professional might also consider the possibility of smoke inhalation injuries, carbon monoxide, or cyanide poisoning.
Your wounds will be gently cleaned and covered with clean dressings, and, if necessary, you may be urgently transferred to a burn center for more specialized care. Sometimes, a surgical procedure called an escharotomy may be necessary to be performed before transfer. This procedure helps to mitigate complications from severe burns by cutting through the hardened burned skin layer, allowing for better blood circulation or ventilation.
This is a rough outline of how healthcare professionals respond to severe burns, and should give you a better idea of what to expect in such a situation. Each person’s case will vary though, and the healthcare professionals taking care of you will make decisions based on your specific needs and condition.
Possible Complications of Burn Resuscitation and Management
If you suffer from deep or extensive burns, you might experience a few complications. These could include breathing problems, problems with your bones and joints, getting unusually cold, infection and sepsis, which is a severe infection that can harm your organs. You might also experience low blood volume, scarring, and tetanus, which is a serious bacterial infection that causes muscle stiffness and spasms.
The most common problem is infection. This could be pneumonia, which affects your lungs, cellulitis, a skin infection, infections in your urinary tract, or respiratory failure. Pneumonia is especially common if you have burns in your airways.
Partial-thickness burns are a type of burn that reach into the second layer of skin. These burns produce blisters within 24 hours, are painful, red, and leak fluid. They might initially seem less serious than they actually are, but they usually heal within 1 to 3 weeks without leaving a scar, although they may change the color of the skin slightly.
Deep partial-thickness burns are more serious and reach down to the deep second layer of skin. These burns involve hair follicles and glandular tissue and typically form blisters. They are wet or waxy dry and have uneven color. Deep burns do not become white when pressure is applied. If they don’t get infected and heal without needing a skin graft, they heal in 2 to 9 weeks. However, they always result in hypertrophic scarring, which is a thick, raised scar. If a deep partial-thickness burn does not heal in 2 weeks, it may be considered a full-thickness burn, which is the most severe type of burn affecting all layers of skin and underlying tissue.
There are also other complications you could go through. Anemia, which is a blood condition that leaves you feeling tired, is common if you have full-thickness burns on more than 10% of your body. If you have an electrical burn, it might result in compartment syndrome, which is a painful condition that occurs when pressure within the muscles builds to dangerous levels, or rhabdomyolysis, a serious syndrome due to a direct or indirect muscle injury. It could also create blood clots in the veins of your legs, and can cause long-term issues like loss of bone density and muscle mass. You may also develop keloids, which are overstretched scars, and go through psychological trauma, PTSD, and body image issues due to scarring. If you live in a developing country, major burns may also lead to societal isolation, poverty, or child abandonment.
What Else Should I Know About Burn Resuscitation and Management?
Burns can often be avoided with care. The treatment you will require depends on how serious the burn is. Minor burns can usually be treated by gently cleaning the burn and medication to help with pain. More severe burns needs long-term treatment.
If you have a mid-level severity burn (referred to as a ‘partial-thickness’ burn), it should be cleaned with soap and water and then a special dressing will be applied. The most severe type of burns (‘full-thickness’ burns) often need surgery, such as skin grafting, where new skin is transplanted to the burn area.
Extensive burns can cause severe fluid loss and swelling because the tiny blood vessels leak. Because of this, these patients often need a lot of fluid given through an IV (a special drip directly into the vein).
Burns commonly lead to infections. There’s also an increased risk of getting tetanus, a serious bacterial disease. If your tetanus vaccination is not up-to-date, you should get a booster, called a tetanus toxoid, about every 5 years.
Burns are common and accounts for over 30 million injuries a year in the United States, leading to approximately 3 million hospital stays and 240,000 deaths a year. Thankfully, in the United States, about 96% of people admitted to a special burn center survive their injuries. Quick and proper treatment is crucial for a good outcome, and all healthcare providers should know how to evaluate a burn and refer the patient to the right level of care.
