Episode Details

Burn Classification & TBSA Assessment Burn severity depends on depth, extent (TBSA), location, and patient risk factors. Depth is classified as partial-thickness (epidermal/dermal; painful, red, blistered) or full-thickness (dermal destruction, painless, leathery eschar, visible thrombosed vessels). TBSA is estimated using the Rule of Nines for adults or the Lund-Browder chart for children. Referral to a burn center is indicated for partial-thickness burns >10% TBSA, chemical/electrical burns, inhalation injury, or burns of the face, hands, feet, genitalia, perineum, or joints. Face, neck, and circumferential torso burns threaten ventilation. Circumferential limb burns impair perfusion, requiring escharotomy.

Emergent Phase Pathophysiology & Resuscitation The emergent phase (first 72 hours) prioritizes burn shock and gas exchange. Loss of capillary seal triggers a massive fluid shift from the intravascular to the interstitial space (third spacing), causing severe hypovolemia, hemoconcentration, high blood viscosity, and increased peripheral resistance. Damaged cells release potassium (hyperkalemia), and sodium moves into the interstitium (hyponatremia). Inhalation injuries (carbon monoxide, above/below glottis) cause mucosal edema, obstruction, and pneumonia (the leading cause of death). Myoglobinuria (from electrical muscle damage) can block renal tubules, causing acute kidney injury (AKI). Priority care includes early intubation, 100% humidified O2, and resuscitation. The ABA formula dictates 2–4 mL Lactated Ringer's per kg per % TBSA in the first 24 hours (half in the first 8 hours). Target clinical parameters are MAP >65 mmHg, HR <120 bpm, and adult urine output of 0.5–1 mL/kg/hr (75–100 mL/hr for electrical burns).

Acute, Rehabilitative & Psychosocial Care The acute phase begins with diuresis and ends when wounds are nearly healed. Sepsis, often from gram-negative bacteria or Candida, is a leading cause of death during this immunosuppressed period. Stress-induced hypermetabolism causes protein catabolism and transient hyperglycemia, requiring early enteral nutrition and insulin. Excision and grafting (autograft, CEA, or Integra) are vital for full-thickness wounds. Pain is managed with continuous IV opioids, procedural breakthrough doses, and anxiolytics. Continuous physical therapy and splinting prevent contractures. In the rehabilitation phase, hypertrophic scars are minimized using custom-fitted pressure garments worn up to 23 hours daily for 12–18 months. Hydration and antihistamines help relieve severe itching. Older adults face higher mortality due to thinner skin, delayed healing, and co-morbidities. Support groups and psychiatric interventions address emotional needs, body image changes, and PTSD.