Acute and Perioperative Care of the Burn-Injured Patient

Abstract

Care of burn-injured patients requires knowledge of the pathophysiologic changes affecting virtually all organs from the onset of injury until wounds are healed. Massive airway and/or lung edema can occur rapidly and unpredictably after burn and/or inhalation injury. Hemodynamics in the early phase of severe burn injury are characterized by a reduction in cardiac output, increased systemic and pulmonary vascular resistance. Approximately 2-5 days after major burn injury, a hyperdynamic and hypermetabolic state develops. Electrical burns result in morbidity much higher than expected based on burn size alone. Formulae for fluid resuscitation should serve only as guideline; fluids should be titrated to physiologic end points. Burn injury is associated basal and procedural pain requiring higher than normal opioid and sedative doses. Operating room concerns for the burn-injured patient include airway abnormalities, impaired lung function, vascular access, deceptively large and rapid blood loss, hypothermia and altered pharmacology.

Surgical Fires in Otolaryngology: A Systematic and Narrative Review

“…In the acute setting, emphasis should be placed on continuous respiratory monitoring, humidification, conservative fluid resuscitation, lung-protective mechanical ventilation, pulmonary toilet, and identification and treatment of carbon monoxide and cyanide poisoning; in addition, nitric oxide and nebulization of beta-2 agonists, n-acetylcysteine, anticoagulants, and anti-inflammatory agents may be helpful. 54-59 Respiratory failure may occur 12 to 48 hours after injury, and upper airway edema may take 3 to 6 days to resolve. 58,59 Patients should be monitored for tracheobronchial tree edema, mucosal sloughing, stenosis, tracheoesophageal fistula, pneumonia, pulmonary congestion/edema, pleural effusion, and pneumothorax.…”

Burn Shock and Resuscitation: Many Priorities, One Goal

“…Burns are among the most challenging and physiologically complex injuries and can be associated with the development of early hemodynamic collapse and shock [1,2]. Patients who have sustained significant burns are at risk of rapidly developing "burn shock" due to the simultaneous presence of local and systemic inflammatory response to injury that most closely resembles hypovolemic shock [3,4]. While burns themselves have the potential to be the primary source of shock, the presence of large burns should not distract the vigilant provider from ruling out additional injuries during their assessment of a trauma patient [5,6].…”

“…Management of these burns is directed at reducing further injury, pain control, and provision of comfort measures. Within the first hour, exposing the injury to cool Clinical Management of Shock -The Science and Art of Physiological Restoration 4 water or applying a cold compress can help stop the burning process and relieve pain. Topical steroids, with their vasoconstrictive effects, are often considered "first-line" treatment for acute sunburn; however, their true efficacy remains controversial [51].…”

Burn Cases, Their Management and Complications: A Review

“…Followed by the major burn injury, there will be continuous loss of plasma into burned tissue can last for first 48 h or longer. Because of intravascular fluid into burned areas and edema formation (in nonburned sites) the burn shock may occur which is characterized with impaired tissue and organ perfusion (Bittner et al, 2015).…”