Abstract
Burn injuries are one of the most devastating forms of trauma worldwide. Not only do burn injuries affect almost all organ systems, the long-term sequelae of burns are significant and can be debilitating. Rapid, accurate assessment and prompt response to burns are keys to minimizing morbidity and mortality. The treatment of burn patients requires the presence of a well-organized team of caregivers who understand the complex consequences of burn injuries and who are adept at coordinating care. All of this begins with understanding the types of burns that can occur, being able to classify burns, and applying the principles of ATLS to burn patients. Beyond this, a keen understanding on the evolving physiological changes that result from the injury helps to guide therapy, intraoperative management, and recovery and rehabilitation in these patients.
Key words
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
World Health Organization. The Global Burden of Disease: 2004 Update. Geneva 2008. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf.
Langley K, Sim K. Anaesthesia for patients with burns injuries. Curr Anaesth Crit Care. 2002;13(2):70–5.
National Burn Repository. 2011 Report of National Data from 2001–2010. 2011. http://www.ameriburn.org/2011NBRAnnualReport.pdf.
Edelman LS. Social and economic factors associated with the risk of burn injury. Burns. 2007;33(8):958–65. PubMed PMID: 17869003. Epub 2007/09/18. eng.
WHO. Global Burden of Disease 2004 Summary Tables. Geneva2008. http://www.who.int/healthinfo/global_burden_disease/estimates_regional/en/index.htm.
Peck MD, Kruger GE, van der Merwe AE, Godakumbura W, Ahuja RB. Burns and fires from non-electric domestic appliances in low and middle income countries Part I. The scope of the problem. Burns. 2008;34(3):303–11. PubMed PMID: 18206314. Epub 2008/01/22. eng.
Sawhney CP. Flame burns involving kerosene pressure stoves in India. Burns. 1989;15(6):362–4. PubMed PMID: 2624690. Epub 1989/12/01. eng.
Barss P, Baker S, Mohan D. Injury prevention: an international perspective: epidemiology, surveillance, and policy. New York: Oxford University Press; 1998.
Grange AO, Akinsulie AO, Sowemimo GO. Flame burns disasters from kerosene appliance explosions in Lagos, Nigeria. Burns. 1988;14(2):147–50. PubMed PMID: 3390735. Epub 1988/04/01. eng.
Gupta M, Bansal M, Gupta A, Goil P. The kerosene tragedy of 1994, an unusual epidemic of burns: epidemiological aspects and management of patients. Burns. 1996;22(1):3–9. PubMed PMID: 8719308. Epub 1996/02/01. eng.
Marsh D, Sheikh A, Khalil A, Kamil S, Jaffer Z, Qureshi I, et al. Epidemiology of adults hospitalized with burns in Karachi, Pakistan. Burns. 1996;22(3):225–9.
El-Badawy A, Mabrouk AR. Epidemiology of childhood burns in the burn unit of Ain Shams University in Cairo, Egypt. Burns. 1998;24(8):728–32. PubMed PMID: 9915673. Epub 1999/01/23. eng.
Mabrouk A, El Badawy A, Sherif M. Kerosene stove as a cause of burns admitted to the Ain Shams burn unit. Burns. 2000;26(5):474–7. PubMed PMID: 10812271. Epub 2000/05/17. eng.
Orgill DP, Solari MG, Barlow MS, O’Connor NE. A finite-element model predicts thermal damage in cutaneous contact burns. J Burn Care Rehabil. 1998;19(3):203–9. PubMed PMID: 9622462. Epub 1998/06/11. eng.
Hettiaratchy S, Dziewulski P. ABC of burns: pathophysiology and types of burns. BMJ. 2004;328(7453):1427–9. PubMed PMID: 15191982. Pubmed Central PMCID: PMC421790. Epub 2004/06/12. eng.
Petrone P, Kuncir EJ, Asensio JA. Surgical management and strategies in the treatment of hypothermia and cold injury. Emerg Med Clin North Am. 2003;21(4):1165–78. PubMed PMID: 14708823. Epub 2004/01/08. eng.
Murphy JV, Banwell PE, Roberts AH, McGrouther DA. Frostbite: pathogenesis and treatment. J Trauma. 2000;48(1):171–8. PubMed PMID: 10647591. Epub 2000/01/27. eng.
Cartotto RC, Peters WJ, Neligan PC, Douglas LG, Beeston J. Chemical burns. Can J Surg. 1996;39(3):205–11. PubMed PMID: 8640619. Epub 1996/06/01. eng.
Cooper MA. Electrical and lightning injuries. Emerg Med Clin North Am. 1984;2(3):489–501. PubMed PMID: 6534739. Epub 1984/08/01. eng.
Browne BJ, Gaasch WR. Electrical injuries and lightning. Emerg Med Clin North Am. 1992;10(2):211–29. PubMed PMID: 1559466. Epub 1992/05/01. eng.
Ritenour AE, Morton MJ, McManus JG, Barillo DJ, Cancio LC. Lightning injury: a review. Burns. 2008;34(5):585–94. PubMed PMID: 18395987. Epub 2008/04/09. eng.
Duclos PJ, Sanderson LM. An epidemiological description of lightning-related deaths in the United States. Int J Epidemiol. 1990;19(3):673–9. PubMed PMID: 2262263. Epub 1990/09/01. eng.
Weiss SM, Lakshminarayan S. Acute inhalation injury. Clin Chest Med. 1994;15(1):103–16. PubMed PMID: 8200187. Epub 1994/03/01. eng.
Mertens DM, Jenkins ME, Warden GD. Outpatient burn management. Nurs Clin North Am. 1997;32(2):343–64. PubMed PMID: 9115481. Epub 1997/06/01. eng.
Paper ABAW. Surgical management of the burn wound and use of skin substitutes 2009. http://www.ameriburn.org.
Collis N, Smith G, Fenton OM. Accuracy of burn size estimation and subsequent fluid resuscitation prior to arrival at the Yorkshire Regional Burns Unit. A three year retrospective study. Burns. 1999;25(4):345–51. PubMed PMID: 10431984. Epub 1999/08/04. eng.
Freiburg C, Igneri P, Sartorelli K, Rogers F. Effects of differences in percent total body surface area estimation on fluid resuscitation of transferred burn patients. J Burn Care Res. 2007;28(1):42–8. PubMed PMID: 17211199. Epub 2007/01/11. eng.
Minimas D. A critical evaluation of the Lund-Browder chart. Wounds UK. 2007;3(3):58–68.
Hidvegi N, Nduka C, Myers S, Dziewulski P. Estimation of breast burn size. Plast Reconstr Surg. 2004;113(6):1591–7. PubMed PMID: 15114118. Epub 2004/04/29. eng.
Lund C, Browder N. The estimation of areas of burns. Surg Gynecol Obstet. 1944;79:352–8.
Monafo WW. Initial management of burns. N Engl J Med. 1996;335(21):1581–6. PubMed PMID: 8900093. Epub 1996/11/21. eng.
Wachtel TL, Berry CC, Wachtel EE, Frank HA. The inter-rater reliability of estimating the size of burns from various burn area chart drawings. Burns. 2000;26(2):156–70. PubMed PMID: 10716359. Epub 2000/03/15. eng.
Amirsheybani HR, Crecelius GM, Timothy NH, Pfeiffer M, Saggers GC, Manders EK. The natural history of the growth of the hand: I. Hand area as a percentage of body surface area. Plast Reconstr Surg. 2001;107(3):726–33. PubMed PMID: 11304598. Epub 2001/04/17. eng.
Jose RM, Roy DK, Vidyadharan R, Erdmann M. Burns area estimation-an error perpetuated. Burns. 2004;30(5):481–2. PubMed PMID: 15225916. Epub 2004/07/01. eng.
Perry RJ, Moore CA, Morgan BD, Plummer DL. Determining the approximate area of a burn: an inconsistency investigated and re-evaluated. BMJ. 1996;312(7042):1338. PubMed PMID: 8646048. Pubmed Central PMCID: PMC2350999. Epub 1996/05/25. eng.
Sheridan RL, Petras L, Basha G, Salvo P, Cifrino C, Hinson M, et al. Planimetry study of the percent of body surface represented by the hand and palm: sizing irregular burns is more accurately done with the palm. J Burn Care Rehabil. 1995;16(6):605–6. PubMed PMID: 8582938. Epub 1995/11/01. eng.
Ichiki Y, Kato Y, Kitajima Y. Assessment of burn area: most objective method. Burns. 2008;34(3):425–6. PubMed PMID: 17920774. Epub 2007/10/09. eng.
Neuwalder JM, Sampson C, Breuing KH, Orgill DP. A review of computer-aided body surface area determination: SAGE II and EPRI’s 3D Burn Vision. J Burn Care Rehabil. 2002;23(1):55–9. PubMed PMID: 11803314. discussion 4; Epub 2002/01/23. eng.
Hartford CE. Care of outpatient burns. 3rd ed. Philadelphia, PA: Elsevier; 2007.
Harrison HN, Moncrief JA, Duckett Jr JW, Mason Jr AD. The relationship between energy metabolism and water loss from vaporization in severely burned patients. Surgery. 1964;56:203–11. PubMed PMID: 14174738. Epub 1964/07/01. eng.
Schultz AM, Werba A, Wolrab C. Early cardiorespiratory patterns in severely burned patients with concomitant inhalation injury. Burns. 1997;23(5):421–5. PubMed PMID: 9426912. Epub 1997/08/01. eng.
Ansermino M, Hemsley C. Intensive care management and control of infection. BMJ. 2004;329(7459):220–3. PubMed PMID: 15271835. Pubmed Central PMCID: PMC487741. Epub 2004/07/24. eng.
Sheridan RL, Ryan CM, Yin LM, Hurley J, Tompkins RG. Death in the burn unit: sterile multiple organ failure. Burns. 1998;24(4):307–11. PubMed PMID: 9688194. Epub 1998/08/04. eng.
Kraft R, Herndon DN, Branski LK, Finnerty CC, Leonard KR, Jeschke MG. Optimized fluid management improves outcomes of pediatric burn patients. J Surg Res. 2013;181(1):121–8. PubMed PMID: 22703982. Pubmed Central PMCID: PMC3465500. Epub 2012/06/19. eng.
Lin CY, Wu CK, Yeong EK, Lin HH, Huang YT, Lee JK, et al. Prognostic significance of left ventricular diastolic function in burn patients. Shock. 2012;37(5):457–62. PubMed PMID: 22508290. Epub 2012/04/18. eng.
Kallinen O, Maisniemi K, Bohling T, Tukiainen E, Koljonen V. Multiple organ failure as a cause of death in patients with severe burns. J Burn Care Res. 2012;33(2):206–11. PubMed PMID: 21979843. Epub 2011/10/08. eng.
Abu-Sittah GS, Sarhane KA, Dibo SA, Ibrahim A. Cardiovascular dysfunction in burns: review of the literature. Ann Burns Fire disasters. 2012;25(1):26–37. PubMed PMID: 23012613. Pubmed Central PMCID: PMC3431724. Epub 2012/09/27. eng.
Cakir B, Yegen BC. Systemic responses to burn injury. Turk J Med Sci. 2004;34:215–26.
Porter JM, Shakespeare PG. Cardiac output after burn injury. Ann R Coll Surg Engl. 1984;66(1):33–5. PubMed PMID: 6691694. Pubmed Central PMCID: PMC2493656. Epub 1984/01/01. eng.
de Campo T, Aldrete JA. The anesthetic management of the severely burned patient. Intensive Care Med. 1981;7(2):55–62. PubMed PMID: 7009689. Epub 1981/01/01. eng.
Black R, Kinsella J. Anaesthetic management for burns patients. Br J Anaesth. 2001;1(6):177–80.
Rehberg S, Maybauer MO, Enkhbaatar P, Maybauer DM, Yamamoto Y, Traber DL. Pathophysiology, management and treatment of smoke inhalation injury. Exp Rev Resp Med. 2009;3(3):283–97. PubMed PMID: 20161170. Pubmed Central PMCID: PMC2722076. Epub 2010/02/18. Eng.
Barasch P, Cullen BF, Stoelting RK. Clinical anesthesia. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2006.
Hampson NB, Zmaeff JL. Outcome of patients experiencing cardiac arrest with carbon monoxide poisoning treated with hyperbaric oxygen. Ann Emerg Med. 2001;38(1):36–41. PubMed PMID: 11423810. Epub 2001/06/26. eng.
Vegfors M, Lennmarken C. Carboxyhaemoglobinaemia and pulse oximetry. Br J Anaesth. 1991;66(5):625–6. PubMed PMID: 2031826. Epub 1991/05/01. eng.
Haney M, Tait AR, Tremper KK. Effect of carboxyhemoglobin on the accuracy of mixed venous oximetry monitors in dogs. Crit Care Med. 1994;22(7):1181–5. PubMed PMID: 8026210. Epub 1994/07/01. eng.
Alarie Y. Toxicity of fire smoke. Crit Rev Toxicol. 2002;32(4):259–89. PubMed PMID: 12184505. Epub 2002/08/20. eng.
Mizock BA. Lactic acidosis. Disease-a-month: DM. 1989;35(4):233–300. PubMed PMID: 2656163. Epub 1989/04/01. eng.
Tursky T, Sajter V. The influence of potassium cyanide poisoning on the gamma-aminobutyric acid level in rat brain. J Neurochem. 1962;9:519–23. PubMed PMID: 13994947. Epub 1962/09/01. eng.
Morocco AP. Cyanides is the. Crit Care Clin. 2005;21(4):691–705. vi. PubMed PMID: 16168309. Epub 2005/09/20. eng.
Planas M, Wachtel T, Frank H, Henderson LW. Characterization of acute renal failure in the burned patient. Archiv Intern Med. 1982;142(12):2087–91. PubMed PMID: 7138158. Epub 1982/11/01. eng.
Schneider DF, Dobrowolsky A, Shakir IA, Sinacore JM, Mosier MJ, Gamelli RL. Predicting acute kidney injury among burn patients in the 21st century: a classification and regression tree analysis. J Burn Care Res. 2012;33(2):242–351. PubMed PMID: 22370901. Pubmed Central PMCID: PMC3310938. Epub 2012/03/01. eng.
Stoelting R, Dierdorf SF. Anesthesia and co-existing disease. 4th ed. Philadelphia, PA: Churchill Livingstone; 2002.
Davies MP, Evans J, McGonigle RJ. The dialysis debate: acute renal failure in burns patients. Burns. 1994;20(1):71–3. PubMed PMID: 8148082. Epub 1994/02/01. eng.
Xiao SC, Zhu SH, Xia ZF, Lu W, Wang GQ, Ben DF, et al. Prevention and treatment of gastrointestinal dysfunction following severe burns: a summary of recent 30-year clinical experience. World J Gastroenterol. 2008;14(20):3231–5. PubMed PMID: 18506931. Pubmed Central PMCID: PMC2712858. Epub 2008/05/29. eng.
Deitch EA. The management of burns. N Engl J Med. 1990;323(18):1249–53. PubMed PMID: 2120587. Epub 1990/11/01. eng.
Rodriguez NA, Jeschke MG, Williams FN, Kamolz LP, Herndon DN. Nutrition in burns: Galveston contributions. J Parenter Enteral Nutr. 2011;35(6):704–14. PubMed PMID: 21975669. Epub 2011/10/07. eng.
Kasten KR, Makley AT, Kagan RJ. Update on the critical care management of severe burns. J Intens Care Med. 2011;26(4):223–336. PubMed PMID: 21764766. Epub 2011/07/19. eng.
Gregory G. Gregory’s pediatric anesthesia. 5th ed. Oxford: Blackwell Publishing; 2012.
Demling RH. Burns. N Engl J Med. 1985;313(22):1389–98. PubMed PMID: 3903505. Epub 1985/11/28. eng.
Alexander JW, Ogle CK, Stinnett JD, Macmillan BG. A sequential, prospective analysis of immunologic abnormalities and infection following severe thermal injury. Ann Surg. 1978;188(6):809–16. PubMed PMID: 736659. Pubmed Central PMCID: PMC1397007. Epub 1978/12/01. eng.
Davis JM, Dineen P, Gallin JI. Neutrophil degranulation and abnormal chemotaxis after thermal injury. J Immunol. 1980;124(3):1467–71. PubMed PMID: 7358988. Epub 1980/03/01. eng.
Flierl MA, Stahel PF, Touban BM, Beauchamp KM, Morgan SJ, Smith WR, et al. Bench-to-bedside review: burn-induced cerebral inflammation—a neglected entity? Crit Care. 2009;13(3):215. PubMed PMID: 19638180. Pubmed Central PMCID: PMC2717412. Epub 2009/07/30. eng.
Hettiaratchy S, Papini R. Initial management of a major burn: II—assessment and resuscitation. BMJ. 2004;329(7457):101–3. PubMed PMID: 15242917. Pubmed Central PMCID: PMC449823. Epub 2004/07/10. eng.
DeSanti L. Pathophysiology and current management of burn injury. Adv Skin Wound Care. 2005;18(6):333–4.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer Science+Business Media New York
About this chapter
Cite this chapter
Wang, C. (2014). Assessment and Physiology of Burns. In: Scher, C. (eds) Anesthesia for Trauma. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0909-4_13
Download citation
DOI: https://doi.org/10.1007/978-1-4939-0909-4_13
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4939-0908-7
Online ISBN: 978-1-4939-0909-4
eBook Packages: MedicineMedicine (R0)