The actual fluid infusion rate is then titrated hourly, based on the adequacy of physiological responses, such as the urine output. Additional factors influencing these needs include the presence or absence of inhalation injury, the extent of full-thickness burns, and the time since injury. Volume requirements for resuscitation can be estimated by the total burn size and the patient’s weight (or body surface area).
The edema that forms in the interstitial space forms rapidly in the first 8 h following burn injury, and continues to form more slowly for at least 18 h. Burn shock is characterized by increased capillary permeability, increased hydrostatic pressure across the microvasculature, protein and fluid movement from the intravascular space into the interstitial space, increased systemic vascular resistance, reduced cardiac output, and hypovolemia requiring fluid resuscitation. In addition to local injury at the site of burn, severe thermal injury over a large area of the skin, roughly 20 % total body surface area (TBSA) or greater, results in acute systemic responses collectively known as burn shock. Thermal burns from dry sources (fire or flame) and wet sources (scalds) account for approximately 80 % of all reported burns and can be classified based on the depth of burn.
#2nd degree sunburn healing stages update
This review presents an update on the care of burn patients, with special emphasis on the mechanisms underlying burn wound healing and recent advancements in burn wound care.
Since the first International Congress on Research in Burns over 50 years ago, progress has been made in a host of areas, and vital improvements in early resuscitation, infection management, wound excision and coverage, and fluid management have helped in the fight against burn mortality. This can be largely attributed to national decreases in burn size, improvements in burn critical care, and advancements in burn wound care and treatment that have been driven by research, as reflected in the dramatic increase in burn publications over the last several decades. The survival rate for admitted burn patients has improved consistently over the past four decades and is currently a favorable 97 % for patients admitted to burn centers. This article reviews recent advancements in the care of burn patients with a focus on the pathophysiology and treatment of burn wounds.Īcute thermal injuries requiring medical treatment affect nearly half a million Americans each year, with approximately 40,000 hospitalizations and 3,400 deaths annually. In addition to improvements in patient stabilization and care, research in burn wound care has yielded advancements that will continue to improve functional recovery. Furthermore, burn wounds are complex and can present unique difficulties that require late intervention or life-long rehabilitation. However, for the intensivist, challenges often exist that complicate patient support and stabilization.
Research on burns has generated sustained interest over the past few decades, and several important advancements have resulted in more effective patient stabilization and decreased mortality, especially among young patients and those with burns of intermediate extent. The priorities of specialized facilities focus on stabilizing the patient, preventing infection, and optimizing functional recovery. Burns are a prevalent and burdensome critical care problem.
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