Burn Injuries Research Paper

Introduction
Burn injuries are major causes of morbidity and mortality. The patho-physiological and hemodynamic changes to these injuries are unique. Adequate timely fluid resuscitation can minimize their impact and improve patient survival.

Pathophysiology:
Primary goal of fluid management in burn patients is to restore plasma volume. There is a shift of extracellular fluid (ECF) into the burned from viable tissue. There is increased loss also due to loss of the barrier of skin. Burn produces tissue injury which causes disruption of the capillary beds. This is manifested by local vasodilatation, increased permeability and decreased reflection coefficient to proteins. This leads to transfer of fluid from normal healthy tissue to the injured

This state of normovolemic hypopoerfusion is also known as burn shock. If adequate fluid resuscitation is done, cardiac function is normalized within 48 hours of the injury.

Types of burn:
Burns are classified into first, second and third degree according to their depth.
1. First degree burns: In these injuries, epidermis remains intact. These are characterized by erythema, pain and absence of blisters. Fluid resuscitation is not necessary for such type of burns as these are not life threatening injuries.
2. Second degree burns (partial thickness burns): These injuries penetrate epidermis and extend into dermis for some distance. They usually have a red or mottled appearance with swelling and blister formation and are very painful. Fluid replacement is required in such injuries if more than 20% of total body surface area is involved.
3. Third degree burns (Full thickness burns): These injuries penetrate the entire dermis. The burned area appears dark, dry and leathery. They are usually painless with little swelling of the burned tissues. Second and third degree burns which involve more than 20% of TBSA are also known as “Major Burns”

Total body surface area

At times , these patients may get more fluids than the calculated volume in response to various hemodynamic changes. This phenomenon is known as “fluid creep”5. It may cause abdominal compartment syndrome6 and pulmonary complications.
1. Abdominal compartment syndrome : At risk population: Patients with circumferential abdominal burns Pediatric patients Patients receiving more than 6 ml/kg/%TBSA of resuscitation fluids
Urgent decompression is required in patients with intraabdominal pressure more than 20 mm of hg. This pressure is usually measured with intraluminal bladder pressure using foley’s catheter.
2. Pulmonary complications: Over hydrated burn patients are at risk of developing pneumonia. These patients have decreased mucociliary clearance, are immunocompromised and may require tracheal intubation which predisposes them to develop