8.3 Complications and advanced care considerations
3 min read•august 7, 2024
Burn injuries can lead to serious complications, affecting the entire body. Shock, , and are major concerns, requiring aggressive treatment. Proper fluid management and wound care are crucial to prevent these issues and promote healing.
Advanced burn care involves specialized techniques like and . Burn centers offer expert care for severe cases. Long-term rehabilitation is essential, focusing on , , and psychological support to improve outcomes and quality of life.
Complications
Systemic Effects
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- Shock can occur due to fluid loss, pain, and decreased cardiac output
- is common in burn patients as fluid shifts from the intravascular space to the interstitial space (third-spacing)
- may also occur due to the release of inflammatory mediators
- Dehydration results from increased fluid loss through the damaged skin barrier and evaporative losses
- Burn patients require aggressive to maintain adequate intravascular volume and organ perfusion
- can occur when heat or chemicals damage the airways and lungs
- Inhalation injury increases the risk of respiratory complications such as pneumonia and
Local Complications
- Infection is a major risk due to the loss of the protective skin barrier
- Burn wounds provide an ideal environment for bacterial growth
- Common pathogens include Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii
- can develop when swelling within a muscle compartment exceeds the capacity of the fascial sheath
- Increased pressure within the compartment compromises blood flow and tissue perfusion
- Compartment syndrome most commonly affects the extremities and requires prompt surgical intervention () to prevent tissue necrosis
Burn Management
Initial Stabilization
- Fluid resuscitation is critical to maintain intravascular volume and prevent shock
- The (4 \text{ mL} \times \text{% total body surface area (TBSA) burned} \times \text{weight in kg}) is commonly used to guide initial fluid administration
- such as lactated Ringer's are preferred for fluid resuscitation
- Escharotomy involves incising the burn eschar to relieve constriction and improve circulation
- Escharotomy is indicated when circumferential full-thickness burns compromise distal perfusion
- The procedure is typically performed at the bedside under local anesthesia
Wound Care
- involves removing devitalized tissue, debris, and foreign material from the burn wound
- Early excisional debridement within 24-72 hours of injury is associated with improved outcomes
- Debridement can be performed surgically, enzymatically (e.g., ), or through (e.g., hydrogels)
- Skin grafting is used to provide permanent wound coverage and promote healing
- are harvested from donor sites and applied to the debrided wound bed
- (from the patient) are preferred, but (from cadavers) or (from animals) may be used as temporary coverage in extensive burns
Advanced Care
Specialized Burn Treatment
- include burns >20% TBSA in adults, >10% TBSA in children, full-thickness burns, high-voltage electrical burns, and burns with associated inhalation injury or significant comorbidities
- Burn centers provide specialized expertise, resources, and multidisciplinary care to optimize outcomes
- Specialized burn treatment may include advanced wound dressings (e.g., silver-impregnated), topical antimicrobials, nutritional support, and early mobilization
- can promote granulation tissue formation and prepare wounds for grafting
- A involving burn surgeons, nurses, therapists, dietitians, and psychologists is essential for comprehensive burn care
- Regular multidisciplinary rounds facilitate communication, care coordination, and patient-centered decision-making
Rehabilitation and Long-Term Care
- Long-term rehabilitation is crucial to optimize functional outcomes and quality of life
- Physical therapy focuses on range of motion, strength, and mobility to prevent contractures and maintain function
- addresses activities of daily living (ADLs), adaptive equipment, and community reintegration
- Scar management techniques such as , , and massage can improve scar appearance and pliability
- may be necessary to address functional impairments or cosmetic concerns
- Psychosocial support is essential to address the emotional trauma associated with burn injuries
- Peer support groups and counseling can help patients cope with body image changes, chronic pain, and
Key Terms to Review (30)
Acute respiratory distress syndrome (ARDS): Acute respiratory distress syndrome (ARDS) is a severe lung condition characterized by rapid onset of widespread inflammation in the lungs, leading to respiratory failure. This syndrome is often a result of various underlying causes, including pneumonia, sepsis, or trauma, and it significantly impacts a person's ability to breathe and receive adequate oxygenation.
Allografts: Allografts are a type of tissue transplant where cells, tissues, or organs are transferred from one individual to another of the same species, but with a different genetic makeup. This procedure is often used in various medical contexts, including surgeries and wound healing, and can lead to specific complications that need careful consideration in advanced care settings.
Autografts: Autografts are surgical grafts taken from one part of a patient's body and transplanted to another site in the same individual. This type of graft is often used in procedures to repair or replace damaged tissue, minimizing the risk of rejection since the tissue is from the patient's own body.
Autolysis: Autolysis is the self-digestion or breakdown of cells and tissues by their own enzymes, typically occurring after death or injury. This process is crucial for understanding complications that arise in wound healing and can impact the effectiveness of advanced care techniques. By recognizing autolysis, healthcare providers can better assess the state of a wound and plan appropriate interventions.
Burn center referral criteria: Burn center referral criteria are specific guidelines used to determine when a patient with burn injuries should be transferred to a specialized burn center for advanced care. These criteria are essential for ensuring that patients receive the appropriate level of medical attention based on the severity and extent of their injuries, as well as potential complications that may arise from burns.
Collagenase: Collagenase is an enzyme that breaks down collagen, a primary structural protein in connective tissues. In medical contexts, collagenase is particularly important for managing wounds and ulcers, as it helps to debride necrotic tissue, allowing for improved healing and recovery. Its role in advanced care considerations often revolves around its use in specific treatments that address complications arising from chronic wounds and infections.
Compartment syndrome: Compartment syndrome is a serious condition that occurs when pressure within a muscle compartment increases to dangerous levels, impairing blood flow and potentially leading to muscle and nerve damage. This increased pressure can result from trauma, such as fractures or crush injuries, and can lead to severe complications if not addressed promptly, including permanent loss of function or amputation.
Compression garments: Compression garments are specialized clothing designed to apply pressure to specific areas of the body, often used in medical and athletic contexts. They help improve blood circulation, reduce swelling, and provide support to muscles and joints, making them an essential consideration for complications and advanced care in various situations.
Crystalloid solutions: Crystalloid solutions are fluids that contain small molecules which can easily pass through cell membranes, making them effective for hydration and electrolyte balance. These solutions are commonly used in medical settings to treat dehydration and maintain fluid balance, particularly in emergency situations. They play a vital role in managing fluid resuscitation and can lead to specific complications that need to be understood for advanced care.
Dehydration: Dehydration occurs when the body loses more fluids than it takes in, leading to an imbalance that can affect normal bodily functions. It is crucial to understand how dehydration can complicate various health situations, particularly when dealing with heat-related illnesses, as well as its prevention in extreme weather conditions. Recognizing the signs and symptoms of dehydration can significantly influence management strategies and overall outcomes.
Distributive shock: Distributive shock is a type of shock characterized by inadequate blood flow due to widespread vasodilation, which leads to a significant drop in systemic vascular resistance and blood pressure. This condition often results from severe infections, anaphylaxis, or spinal cord injuries that disrupt the body's ability to regulate blood vessel tone. Understanding distributive shock is crucial as it falls under the broader category of shock types and highlights various causes and potential complications that can arise during medical emergencies.
Escharotomy: Escharotomy is a surgical procedure that involves making incisions through the eschar, or dead tissue, that forms over burns and other injuries. This procedure is critical for alleviating pressure and restoring circulation in cases where burns cause constriction of underlying tissues, leading to complications such as impaired blood flow and potential limb loss.
Fasciotomy: A fasciotomy is a surgical procedure that involves making an incision in the fascia, which is the connective tissue surrounding muscles, nerves, and blood vessels. This procedure is typically performed to relieve pressure from conditions like compartment syndrome, where increased pressure within a muscle compartment can compromise blood flow and lead to muscle and nerve damage. Understanding fasciotomy is essential when considering complications and advanced care measures for managing injuries or conditions that may lead to severe tissue damage or impaired circulation.
Fluid Resuscitation: Fluid resuscitation is the process of replenishing bodily fluids lost due to conditions like shock, burns, or severe allergic reactions. This technique is vital in restoring blood volume, improving circulation, and maintaining adequate tissue perfusion. By addressing fluid deficits, it helps stabilize patients experiencing life-threatening situations, ensuring they receive appropriate care for various emergencies.
Hypovolemic shock: Hypovolemic shock is a life-threatening condition that occurs when the body loses a significant amount of blood or fluid, leading to inadequate circulation and insufficient oxygen delivery to the organs. This type of shock can stem from various causes such as severe bleeding, dehydration, or extensive burns, making it crucial to recognize its signs and symptoms quickly. Understanding hypovolemic shock is vital for effective first aid interventions and assessing the severity of associated injuries, like burns, as well as managing potential complications.
Infection: Infection is the invasion and multiplication of harmful microorganisms, such as bacteria, viruses, or fungi, in the body, leading to tissue damage and illness. Understanding infection is crucial when dealing with wounds and burns since they can become infected if not properly managed. The risk of infection increases significantly if wounds are not cleaned and dressed correctly or if burns are severe enough to compromise the skin's protective barrier.
Inhalation Injury: Inhalation injury refers to damage caused to the respiratory system due to inhaling harmful substances, such as smoke, chemicals, or hot gases. This type of injury can lead to severe complications, including airway obstruction, chemical pneumonitis, and acute respiratory distress syndrome (ARDS), highlighting the importance of understanding its impact on patient care.
Multidisciplinary approach: A multidisciplinary approach is a method that involves multiple disciplines or fields of expertise working collaboratively to address complex problems or situations. This strategy recognizes that various perspectives and skills contribute to a more comprehensive understanding of issues, particularly in healthcare settings where complications arise and advanced care considerations are necessary.
Negative pressure wound therapy (NPWT): Negative pressure wound therapy (NPWT) is a medical treatment that uses a vacuum to promote healing in acute or chronic wounds by creating a negative pressure environment. This technique helps to draw out excess fluid, reduce edema, and stimulate blood flow to the wound area, ultimately enhancing tissue granulation and healing rates. NPWT is widely used in various clinical settings for complicated wounds, surgical sites, and in patients with significant tissue loss.
Occupational therapy: Occupational therapy is a form of healthcare that helps individuals achieve independence in their daily activities through therapeutic techniques and interventions. This approach focuses on promoting health, well-being, and quality of life by enabling patients to engage in meaningful occupations, particularly after experiencing injury or illness. Occupational therapy plays a vital role in addressing complications and advanced care considerations by adapting environments and modifying tasks to enhance a person's functional abilities.
Parkland Formula: The Parkland Formula is a widely used method for estimating the fluid resuscitation needs of burn patients in the first 24 hours after an injury. It calculates the total amount of intravenous fluids required based on the patient's weight and the total body surface area (TBSA) affected by burns, helping healthcare providers manage complications associated with significant fluid loss and shock.
Physical therapy: Physical therapy is a healthcare profession that focuses on the evaluation, treatment, and prevention of physical impairments and disabilities through various therapeutic techniques. This practice aims to restore movement and function, alleviate pain, and improve overall quality of life for individuals recovering from injury, surgery, or chronic conditions. It plays a crucial role in addressing complications that arise during recovery and in providing advanced care considerations for patients.
Post-traumatic stress disorder (ptsd): Post-traumatic stress disorder (PTSD) is a mental health condition triggered by experiencing or witnessing a traumatic event. It can cause a range of symptoms including flashbacks, severe anxiety, and uncontrollable thoughts about the event, significantly impacting a person's daily life and functioning. Understanding PTSD is essential in managing its complications and providing advanced care for those affected, especially in high-stress environments like emergency medical situations.
Reconstructive Surgery: Reconstructive surgery is a type of surgical procedure aimed at restoring the form and function of body parts that have been damaged due to trauma, disease, or congenital anomalies. It plays a critical role in the recovery process for individuals who have suffered significant injuries or conditions that affect their appearance and functionality, addressing both physical and psychological needs.
Scar management: Scar management refers to the techniques and practices aimed at improving the appearance and functionality of scars resulting from injury or surgery. Effective scar management can minimize the physical and psychological impact of scars, as well as improve skin texture, color, and overall aesthetic appearance. Understanding various methods of scar management is essential in addressing complications that may arise after injury or surgical procedures.
Silicone gel sheets: Silicone gel sheets are medical-grade materials used to manage and improve the appearance of scars. They work by creating a moist environment that promotes healing and helps to flatten, soften, and reduce the redness of scars, making them less noticeable over time.
Skin grafting: Skin grafting is a surgical procedure that involves transplanting skin from one area of the body (the donor site) to another area (the recipient site) to cover wounds, burns, or other skin defects. This technique is essential in advanced medical care for significant skin loss, facilitating healing and restoring the integrity of the skin.
Split-thickness skin grafts (STSGs): Split-thickness skin grafts (STSGs) are a type of surgical procedure where a thin layer of skin is removed from a donor site and placed over a wound or defect. This procedure is crucial in wound healing, especially for patients with significant skin loss due to burns, injuries, or surgical procedures, as it allows for the restoration of skin integrity while minimizing complications associated with deeper grafts.
Wound debridement: Wound debridement is the medical process of removing dead, damaged, or infected tissue from a wound to promote healing and prevent infection. This procedure is crucial in managing wounds effectively, as it helps to create a clean environment for healing and reduces the risk of complications.
Xenografts: Xenografts are transplant tissues or organs taken from a donor of a different species than the recipient, commonly used in advanced medical procedures. They are often considered when human organs are not available for transplant, posing unique challenges in terms of compatibility and immune response. Understanding xenografts is crucial for addressing complications that arise from their use and ensuring effective patient care.