Burn Injury Assessment Resuscitation and Complications
Key Points
- Burn severity is driven by depth, etiology, and total body surface area (TBSA).
- Early priorities include hazard removal/decontamination, airway protection, and fluid resuscitation.
- The Rule of Nines and palmar method support rapid TBSA estimation.
- High-risk complications include inhalation injury, hypovolemic shock, infection/sepsis, thermoregulation failure, contractures, and psychological trauma.
Pathophysiology
Burn injury disrupts skin barrier, microvascular integrity, and systemic inflammatory balance. With larger burns, capillary leak and fluid shifts reduce effective intravascular volume and can rapidly cause tissue hypoperfusion.
Depth and etiology alter local tissue destruction and downstream complications. Thermal, chemical, electrical, and radiation injuries require distinct safety and treatment considerations.
Classification
- Depth class: Superficial, partial-thickness, full-thickness, and (in some systems) fourth-degree injury.
- Cause class: Thermal, chemical, electrical, and radiation burns.
- Burden class: TBSA involvement using Rule of Nines or palmar estimate.
- Physiologic risk class: Airway/inhalation risk, shock risk, infection risk, and functional recovery risk.
Nursing Assessment
NCLEX Focus
Prioritize ABCs, exposure context, and early hemodynamic compromise signs before detailed local care.
- Assess burn depth and pattern, including entry/exit evidence in suspected electrical injury.
- Estimate TBSA promptly and repeat as edema and demarcation evolve.
- Screen for inhalation injury (head/neck/chest burns, smoke exposure, airway irritation signs).
- Monitor perfusion and volume status: urine output, vital trends, mentation, and shock indicators.
Nursing Interventions
- Remove exposure source and complete decontamination first for chemical/radiation cases.
- Protect airway early when inhalation injury is suspected; anticipate rapid deterioration.
- Begin fluid resuscitation per protocol and titrate to urine output and perfusion goals.
- Coordinate multidisciplinary burn care, including rehabilitation, scar prevention, and psychosocial support.
Burn Shock Window
Delayed recognition of fluid shift and airway compromise can cause rapid multisystem decline.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| iv-fluids | Lactated Ringer’s | Use burn-resuscitation protocols and monitor urine output/perfusion endpoints. |
| analgesics | Opioid and nonopioid regimens | Titrate to severe procedural/background pain while monitoring respiratory risk. |
Clinical Judgment Application
Clinical Scenario
A patient presents after a house fire with partial- and full-thickness burns over the torso and upper extremity, hoarse voice, and progressive tachycardia.
Recognize Cues: High TBSA burden plus airway and perfusion warning signs. Analyze Cues: Combined inhalation risk and capillary-leak fluid loss increase decompensation risk. Prioritize Hypotheses: Airway compromise and evolving burn shock are immediate threats. Generate Solutions: Activate burn pathway, secure airway strategy, initiate resuscitation, and transfer coordination. Take Action: Implement protocolized monitoring and interdisciplinary escalation. Evaluate Outcomes: Urine output and perfusion stabilize, and respiratory status remains controlled.
Related Concepts
- wound-classification-framework - Burn injury is a wound mechanism with distinct severity implications.
- wound-healing-phases-and-closure-intentions - Burn depth affects healing trajectory and closure planning.
- delayed-wound-healing-factors-and-complications - Large burns have elevated infection and delayed-healing risks.
- fluid-volume-deficit-signs-causes-and-nursing-care - Burn-related capillary leak can produce severe hypovolemia.
- chronic-pain-neuropathic-vs-nociceptive - Burn recovery often requires layered pain management strategies.
Self-Check
- How do depth and TBSA jointly determine burn acuity?
- Which cues should trigger aggressive airway planning in burn patients?
- Why is urine output a key early endpoint during burn resuscitation?