Burn Injury 4

Chapter 28
CARE OF PATIENTS WITH

BURNS
Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Burns
Occur when there is injury to tissues of the body caused by heat, chemicals,
electrical current, or radiation
Should be viewed as preventable
Burns can cause: fluid and protein loss, sepsis, changes in metabolic, endocrine,
respiratory, cardiac, hematologic, and immune functioning.
A lack of or delay in wound healing is a key factor for all systemic problems and a major
cause of disability and death among patients who are burned.
Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Burns: skin changes

Epidermis (outer layer of the skin)
0.15 mm thick but thinner in older adults

layer can grow back after a burn injury
no blood vessels nutrients are diffused from the dermis
Dermis
Thicker than epidermis
made up of collagen, fibrous connective tissue, and elastic fibers
contains blood vessels, sensory nerves, hair follicles, lymph vessels, sebaceous
glands and sweat glands
skin cannot restore itself when entire layer of dermis is burned
Subcutaneous tissue lies beneath the dermis
with deep burns, the subcutaneous tissue may be damaged, leaving bones,
tendons, and muscles exposed

Causes and Types of Burn Injury

Dry heat (flame): caused by open flame. Common in house fires and
explosions. Ignited clothing from open flame accounts for the most injuries.
Explosions usually result in flash burns because they produce a brief exposure
to very high temperatures
Moist heat (scald): contact with hot liquid or steam
more common among older adults
Hot liquid spills usually burn the upper, front areas of the body
Immersion scald injuries usually involve the lower body
Contact:
Chemical
Electrical burns: entry and exit site
Types of Burn Injury

Electrical Burns
Severity of injury depends on
Amount of voltage
Tissue resistance
Current pathways
Surface area
Duration of the flow


Electrical Burns
Current that passes through vital organs will produce more life-threatening
sequelae than current that passes through other tissue
Electrical sparks may ignite patients clothing, causing a combination of
thermal flash injury


Electrical Burns
Severity of injury can be difficult to assess, as most damage occurs beneath skin
Iceberg effect
Electrical current may cause muscle spasms strong enough to fracture bones

Functional Changes
Skin is a protective barrier and any break can increase the risk for infection
May also cause fluid and electrolyte imbalance evaporation through
burned skin occurs 4x rapidly compared to intact skin
the rate of evaporation is in proportion to total body surface area burned and
depth of injury
burns reduces excretory ability full thickness burns destroys sweat glands
pain
partial thickness burns: nerve endings are exposed, increasing sensitivity
and pain
full thickness burns: nerve endings are completely destroyed, wounds
may not transmit sensation except when sharp stimulus is applied,
patients often have a dull or pressure type pain
Vit D activation:
Partial thickness burns: reduces the activation of Vit D
Full thickness burns: function is completely lost
Temperature: heat source that exceeds the skins capacity to dissipate
causes cell destruction and results in burns
Psychosocial problems: reduced self image due to change in appearance
Classification of Burn Injury

Severity of injury is determined by
Depth of burn: how deep into the skin the burn goes
how much body surface area is involved
Degree of tissue damage is related to the agent causing the burn and to the
temperature of the heat source, and how long the skin is exposed to it
Watch location, thin areas like eyelids, ears, tops of the hands and feet
older adults have thinner skin which increases their burn severity even at low
temperatures and short duration
Superficial: Epidermis
superficial thickness wounds have the least damage because only the
epidermis is injured
Extent of burn in percent of TBSA( total body surface area)
Location of burn
Patient risk factors
Identify the Burn Depth

Superficial/Partial Burns
Superficial
involves the epidermis, blistering, healing
is rapid
Superficial burns damage only the top layer of the skin- the epidermis
*the area heals rapidly in 3 - 6 days

without a scar or other complication
No scar formation
Caused by prolonged exposure to low intensity heat (sunburn) or short flash
exposure to high intensity heat.
Redness with mild edema, pain, and increased sensitivity to heat occurs
Desquamation (peeling of dead skin) occurs for 2 or 3 days after the burn
Table 28-1

Deep Partial Burn
Partial Thickness
involves the entire epidermis and varying depths of dermis
Superficial Partial Thickness
injury to the upper third of the

dermis, leaving good blood
supply
Red, moist, blanch when
pressure is applied
Blisters: small blisters are left
intact unless its on a joint and
large blisters are debrided
Increase pain sensation: nerve
endings are exposed and any
stimulation (touch or
temperature) cause intense pain
Heal 10-21 days
no scar
some minor pigment changes
can occur
Deep Partial Thickness
Extend deeper in the skin dermis,

fewer healthy cells remain
Blisters do not usually form
Wound surface is red and dry
with white areas in deeper parts
(dry because fewer blood vessels
are patent)
Blanches slowly or not at all
Edema is moderate
Pain is less than superficial
because more nerve endings
have been destroyed
See next slide
Deep Partial Burn

Deep Partial: Involves the epidermis and dermis, redness or white to skin, moderate
edema
*Takes 3-6 weeks to heal
*Scar formation does occur
A few healthy cells remain
These wounds can progress to full thickness wounds when tissue damage
increases with infection, hypoxia, or ischemia
Surgical intervention with skin grafting can reduce healing time

Full Thickness
Full Thickness Burns

Full Thickness: Involves the epidermis, dermis, and fat
wound may be waxy white, deep red, yellow, brown, black
hard, dry, leathery eschar that forms from coagulated particles of destroyed
dermis
Thrombosed vessels may be visible beneath the surface of the burn
These dermal blood vessels are heat coagulated, causing the burned tissue to be
avascular (without blood supply)
Sensation is reduced or absent because of nerve ending destruction
Healing time depends on establishing good blood supply in the injured areas.
This can take weeks to months.
Fatty tissue and blackened skin (eschar?) can be seen
Eschar: dead tissue; it must be slough off or be removed from the wound before healing can occur
Edema is severe under the eschar
When the injury is circumferential (completely surrounds an extremity or the chest), blood flow and
chest movement for breathing may be reduced by tight eschar.
May see muscle or bone involved
The deeper it is, the less pain is felt: the nerve endings are destroyed
Will not heal on its own, skin and blood vessels are destroyed
Escharotomies (incision through the eschar) or fasciotomies (incision through eschar and fascia) may
be needed to relieve pressure and allow normal blood flow and breathing
Patient will require a skin graft
Sample Question # 1
The nurse assesses the wound of a client burned as a result of stepping into a bathtub filled
with very hot water. Which assessment finding of the burned areas on the tops of both feet
does the nurse use as a basis to document a probable full-thickness injury?
A
Most of the wounded area is red.
The client reports that the area hurts when touched.
The area does not blanch when firm pressure is applied.
Thrombosed blood vessels are visible beneath the skin surface.
Vascular Changes from initial injury until 24 hrs
Disruption occurs at the burn site immediately after injury, vessels are occluded and
blood flow is reduced or stopped
blood vessel thrombosis occurs, causing necrosis and can lead to deeper injuries
Fluid shift: also known as third spacing or capillary leak syndrome
a continuous leak of plasma from the vascular space into the interstitial space
**the loss of plasma and proteins causes decrease BP and blood volume
**leakage causes extensive edema even in areas that are not burned
Imbalances of fluids, electrolytes, and acid-base occur as a result of fluid shift and
cell damage
Hypovolemia
Metabolic Acidosis
Hyperkalemia: direct cell injury that releases large amounts of cellular potassium
Hyponatremia
Hemoconcentration (elevated blood osmolarity, H&H): develops from vascular
dehydration. This increases blood viscosity, reducing flow through small vessels and increasing tissue
hypoxia
Vascular Changes 24 hours after
Fluid remobilization starts, 24 hours after the capillary leak stops

diuretic phase begins at about 48 - 72 hrs after the burn capillary membrane
integrity returns and edema fluid shifts from interstitial space back into the
intravascular space
Diuresis: due to increased kidney blood flow unless kidney has been damaged
Hyponatremia: increased sodium excretion and the loss of sodium from wounds
Hypokalemia: potassium moves back into the cells and is also excreted in urine
Anemia results from hemodilution, but generally not severe enough to require blood
transfusion
Transfusions are given only if necessary: only if hematocrit is less than 20% to 25%
and patient has manifestations of hypoxia
Metabolic acidosis occurs due to loss of bicarbs
Cardiac Changes
HR increases and Cardiac output decreases because of the initial fluid shifts and
hypovolemia that occur
CO may remain low until 18-36 hours after burn injury
CO increases with fluid resuscitation
Proper fluid resuscitation and oxygen support prevent further complications
Pulmonary Changes
Direct injury to the lung from contact with flames rarely occurs
Respiratory problems are caused by superheated air, steam, toxic fumes, or smoke.
Such problems are a major cause of death in patients with burns and are most likely
to occur when the burn takes place indoors
Respiratory failure: results from airway edema during fluid resuscitation, pulmonary
capillary leak, chest burns restricting chest movements, and carbon monoxide
poisoning
Inhalation injury can occur in the upper and major airways, and lung tissue
upper airway (mouth and throat) is affected when inhaled smoke/irritants cause
edema and obstruct trachea
Chemicals and toxic gases causes more airway injury than heat
Lung tissue injuries result from toxic damage to the alveoli and capillaries. Leaking
capillaries cause alveolar edema which can lead to respiratory distress and pulmonary
failure. This can lead to acute pulmonary insufficiency and infection.
GI Changes
Decreased blood flow to the GI tract

Impaired mucosal integrity
Impaired motility
Peristalsis decreases
Paralytic ileus may develop
Abdominal distension: collection of secretions and gases
Curlings ulcer: acute gastroduodenal ulcer that occurs with the stress of severe injury
due to the reduced GI blood flow and mucosal damage
Mucus lining is destroyed, increasing hydrogen ion production, resulting in ulcers
Give histamine blockers, PPIs, GI protectants, and early enteral feeding
Metabolic and Immunologic Changes

Metabolic Changes
Hypermetabolism: increased secretion of catecholamines, ADH, aldosterone,

cortisol.
Patients oxygen use and caloric needs are high with hypermetabolism
increases core body temperature: low grade fever
Immunologic Changes
Increased risk for infection: the burn injury disrupts or destroys the protective
barrier of the skin
Inflammatory response is activated and often suppresses all types of immune
functions
Immune function is further reduced from topical and steroid antibiotics, general
anesthesia, blood transfusion, and the stress of surgery
Compensatory Changes
any tissue injury can disrupt homeostasis
Inflammatory compensation
GOOD: helps trigger healing in the injured tissue
BAD: it causes fluid shifts
Inflammatory compensation is intended to function on a local and short term basis.
When it is widespread or persistent, they can cause severe tissue damage.
SNS compensation
Stress response that occurs when any physical or psychological stressors are present
SNS compensation is most evident in cardiovascular, respiratory, and GI systems

Extent of Burn - determined by TBSA
Why is it important to know?
Determines the amount of fluids and calories the patient
will need

Extent of Burn
Two commonly used guides for determining the total body surface area
Lund-Browder chart
Considered more accurate: takes age into consideration
Rule of Nines
Used for initial assessment
More general, quicker

Rule of Nines Chart

Know how to determine
percentage of burns


Smoke Inhalation Injuries
From inhalation of hot air or noxious chemicals
Cause damage to respiratory tract
Major predictor of mortality in burn victims
Need to be treated quickly


Location of Burn
Severity of burn injury is determined by location of burn wound
Face, neck, chest respiratory obstruction
from inhalation of chemicals or indirect heat to the area - causes inflammation
which can lead to obstructions
Hands, feet, joints, eyes self-care deficit
Ears, nose, buttocks, perineum infection
There can be contamination from urine and feces: buttocks and perineum
Ear and nose have a poor blood supply


Location of Burn
Eschar formation can cut off blood supply and interfere with
healing
Circumferential burn to the chest area: interfere with
breathing, constrict the chest wall to move
make sure the pt is breathing and doesnt develop
Patients may also develop compartment syndrome


Patient Risk Factors
Pre-existing cardiovascular, respiratory, and renal diseases contribute to poorer
prognosis
Diabetes mellitus and peripheral vascular disease contribute to poor healing
and gangrene
will be more difficult to recover


Patient Risk Factors
Physical debilitation renders patient less able to recover
Alcoholism
Drug abuse
Malnutrition
Concurrent fractures, head injuries, or other trauma leads to a more difficult
time recovering
Difficult time to recover

Resuscitation/Early Phase of Burn Injury

Continues for about 24 to 48 hours
The resuscitation phase is the first phase of a burn injury. It begins at the onset
of injury and continues for about 24 to 48 hours. During this phase, the injury is
evaluated and the immediate problems of fluid loss, edema, and reduced blood
flow are assessed. The priorities for management during this period are to (1)
secure the airway, (2) support circulation by fluid replacement, (3) keep the
patient comfortable with analgesics, (4) prevent infection through careful
wound care, (5) maintain body temperature, and (6) provide emotional support.
Vascular changes that occur:

Fluid shifts from vascular to interstitial space
capillary leak syndrome
concerned with the systemic effects of the burn: ABCs are priority
Goals of management?
General Management for All Types of Burns

Assess for airway patency.
Administer oxygen as needed.
Cover the patient with a blanket.
Keep the patient on NPO status.
Elevate the extremities if no fractures are obvious.
Obtain vital signs.
Initiate an IV line, and begin fluid replacement.
Administer tetanus toxoid for prophylaxis.
Perform a head-to-toe assessment.
Specific Management
Flame Burns
Smother the flames.
Remove smoldering clothing and all metal objects.
Chemical Burns
If dry chemicals are present on skin or clothing, DO NOT WET THEM.
Brush off any dry chemicals present on the skin or clothing.
Remove the patient's clothing.
Ascertain the type of chemical causing the burn.
Do not attempt to neutralize the chemical unless it has been positively identified
and the appropriate neutralizing agent is available.
Electrical Burns
At the scene, separate the patient from the electrical current.
Smother any flames that are present.
Initiate cardiopulmonary resuscitation.
Obtain an electrocardiogram (ECG).
Radiation Burns
Remove the patient from the radiation source.
If the patient has been exposed to radiation from an unsealed source, remove his
or her clothing (using tongs or lead protective gloves).
If the patient has radioactive particles on the skin, send him or her to the nearest
designated radiation decontamination center.
Help the patient bathe or shower.
Concerned with the systemic effects of the burn

ABC is a priority
Airway/respiratory first
Assess for signs of inhalation injuries: facial involvement,
singed hair on face, mouth is black
Breathing
Key signs that your patient is deteriorating for inhalation injury
Hoarseness, brassy cough, difficulty swallowing, drooling, stridor wheezing

Look at respiratory effort (use of accessory muscle)
If patient shows signs of inhalation injury, what will you as the nurse do?
Interventions
Give oxygen
Call Rapid Response! prepare for intubation
Make sure there is intubation equipment at the bedside
Once they are showing signs of inhalation injury, there are at risk for
respiratory arrest/failure, the airways getting more narrow
Suction
HOB elevated: Sit patient up, turning pt frequently
Encourage patient to use incentive spirometer
Monitor ABGs labs
Factors Determining Airway Obstruction or Inhalation Injury
Patients who were injured in a closed space
Patients with extensive burns or with burns of the face
Intra-oral charcoal, especially on teeth and gums
Patients who were unconscious at the time of injury
Patients with singed scalp hair, nasal hairs, eyelids, or eyelashes
Patients who are coughing up carbonaceous sputum
Changes in voice such as hoarseness or brassy cough
Use of accessory muscles or stridor
Poor oxygenation or ventilation
Edema, erythema, and ulceration of airway mucosa
Wheezing, bronchospasm
Factors Determining Airway Obstruction or Inhalation Injury
A change in respiratory pattern may indicate a pulmonary injury. The patient may:
Become progressively hoarse
Develop a brassy cough
Drool or have difficulty swallowing
Produce sounds on exhalation that include audible wheezes, crowing, and stridor
Any of these changes may mean the patient is about to lose his or her airway.
Immediately apply oxygen and call Dr
Circulation
C - Patient is at risk for hypovolemic shock: big cause of death in this phase
Fluid resuscitation must be started immediately!
Monitor edema, urine output, vital signs (BP, pulse)
To determine how much fluid infusion the pt needs we use Parkland formula
Fluid Resuscitation of the Burn Patient
Initiate and maintain at least one large-bore IV in an area of intact skin (if
possible).
Coordinate with physicians to determine the appropriate fluid type and total
volume to be infused during the first 24 hours postburn.
Administer one half of the total 24-hour prescribed volume within the first 8
hours postburn and the remaining volume over the next 16 hours.
Assess IV access site, infusion rate, and infused volume at least hourly.

Monitor these vital signs at least hourly:
Blood pressure
Pulse rate
Respiratory rate
Breath sounds
Voice quality (if not intubated)
Oxygen saturation
End-tidal carbon dioxide levels

Assess urine output at least hourly:
Volume
Specific gravity
Color
Character
Presence of protein
Assess for fluid overload:
Formation of dependent edema
Engorged neck veins
Rapid, thready pulse
Presence of lung crackles or wheezes on auscultation
Measure additional body fluid output hourly

Application of Parkland Formula

A Patient weighing 154 lbs has a burn with a TBSA of 50%. The patient was
found at home at 8am and arrived to the hospital at 10am.
How much fluid should be administer in the first 8 hours? Calculate the
rate.
4 x patient weight in kg x TBSA : this will give you the total volume of fluid
First 8 hours administer half of the total volume
Must infuse within the first 8 hours: time starts from when the burn injury
occurred, not the time they arrived at the hospital.
Rate divided by 6 instead of 8
EX. A Patient weighing 154 lbs has a burn with a TBSA of 50%. The patient
was found at home at 8am and arrived to the hospital at 10am.
Application of Parkland Formula

How much fluid should be administer in the first 8
hours? Calculate the rate.
154 lbs= 70kg
4ml x 70kg x 50% = 14,000
14,000 : 2 = 7,000 ml
7,000ml : 6h = 1,167 ml/h
Evaluation after Giving Fluids
Monitor their response: Urine output is a key indicator, Vital

signs (BP, HR)
Patient will have a foley catheter to measure UOP accurately
Facial Edema Before and After Fluid Resuscitation
Treat pain: Morphine, Dilaudid
Monitor closely
PCA pump
P - Pain
Strong pain meds: if pt will have a respiratory depression he
has to be intubated
Facial Edema Before and After Fluid Resuscitation

Surgical Management of Burns

Escharotomy
Fasciotomy

Escharotomy
Incision made through tight eschar to

relieve pressure and allow normal
blood flow and breathing.
Fasciotomy
A surgical procedure in which an incision

is made through the skin and
subcutaneous tissues into the fascia of the
affected compartment to relieve the
pressure in and restore circulation to the
affected area in the patient with acute
compartment syndrome.
Escharotomy - eschar can cut off blood supply and interfere with healing, can be
done at the bedside
Fasciotomy - under anesthesia
**Although a patient may come in with a horrific burn injury, were more worried about
systemic effects that are acutally more detrimental
Acute Phase of Burn Injury

Begins about 36 to 48 hr after injury; lasts until wound
closure is completed
Fluid starts to shift back from interstitial into the
vascular space
Urine output will increase even more
Concern about infection
Wound care
Nutrition
Mobility

Infection prevention
Sterile technique
No flowers in the room
At risk for pseudomonas
Minimize visitors: children and those with illness should not be allowed
Immunization: Depends on pt immunization status, tetanus ( burn wound
is breeding ground for the organism)
Only give systemic antibiotics and only if patient is showing signs of
infections
Signs of infection: look at the wound, temperature
Hyperinflammatory response: high temperature - give nsaids, tylenol,

Wound care:
Debriding: remove dead tissue, ensure viable tissue to
promote healing
Risk for hypothermia - because skin is removed
Premedicate with pain medication before wound care
Once debrided, a topical ointment is applied Silvedine

Nutrition
Requires a lot of calories hypermetabolic state
burns more calories
Can exceed 5,000 calories/day
High protein, high protein supplements
Can request food at any time, consider the patients
preferences
Promotes healing

Mobility:
Prevent contractures: ROM to the affected extremity
Scar formation can limit the range of motion ability
Out of bed as soon as possible
Rehabilitative Phase of
Burn Injury
Begins with wound closure, ends when patient returns
to highest possible level of functioning
Emphasis on psychosocial adjustment, prevention of
scars and contractures, resumption of preburn activity
Social work, referrals
Rehabilitative Phase of Burn Injury (contd)

This phase may last years or even a lifetime if patient needs to adjust to
permanent limitations
A patient arrives to the ED with superficial facial burns from an explosion

in his apartment building. He has productive carbonaceous sputum with
labored respirations and singed hair.
Based on these findings what is the highest priority of care for this patient?
Airway!
Patient is showing signs of inhalation injury: carbonaceous sputum,
singed hair, labored respirations
(contd)
Which symptoms may indicate a pulmonary injury from the inhalation?
(Select all that apply.)
A.
B.
C.
D.
E.
Development of a brassy cough

Drooling
Clear speech
Audible wheeze
Clear breath sounds
(contd)
Twenty minutes later, assessment of the patient reveals loud wheezing on
exhalation. What is the nurses best action at this time?
A.
B.
C.
D.
Check the patients SaO2 with pulse oximetry.

Apply oxygen and call the Rapid Response Team.
Call a CODE and bring the crash cart to the room.
Call respiratory therapy for a treatment with a bronchodilator.
Chapter 28
AUDIENCE RESPONSE SYSTEM

QUESTIONS
Question 1
A patient is admitted to the ED with burns to his lower legs and hands after
a gas can exploded. What is the initial nursing priority on admission?
A.
B.
C.
D.
Assess and treat his pain. step 4

Use the rule of nines to estimate his percent of body surface area
burned. step 2
Evaluate his airway and circulation. step 1
Place two IV catheters and initiate fluid resuscitation. step 3
Question 2
It has been 12 hours since a patient has been admitted for burns to his face
and neck and for inhalation injuries. He had been wheezing audibly, but at
this time the nurse notes that his wheezing has stopped. What should the
nurse do?
Document this improvement in the patients condition.
Re-assess his breathing in an hour.
Check the patients SPO2 level.
Notify the physician immediately.
Question 3
A patient has been receiving dressing changes with silver sulfadiazine
(Silvadene) for burn injuries over both lower arms. The nurse notices that
the patients white blood cell count has dropped significantly over the past
4 days. What may this change indicate?
A.
B.
C.
D.
The patients infection is improving.

The patient is having an allergic reaction to the silver sulfadiazine.
The patient has kidney disease.
The patient has an electrolyte imbalance.

Burn Injury 4

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Chapter 28

CARE OF PATIENTS WITH

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Burns: skin changes

0.15 mm thick but thinner in older adults

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Causes and Types of Burn Injury

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Types of Burn Injury

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Types of Burn Injury

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Types of Burn Injury

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Classification of Burn Injury

Identify the Burn Depth

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

*the area heals rapidly in 3 - 6 days

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Identify the Burn Depth

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Superficial Partial Thickness

injury to the upper third of the

Deep Partial Thickness

Extend deeper in the skin dermis,

See next slide

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Deep Partial Burn

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Identify the Burn Depth

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Full Thickness Burns

Most of the wounded area is red.

The client reports that the area hurts when touched.

The area does not blanch when firm pressure is applied.

Thrombosed blood vessels are visible beneath the skin surface.

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Vascular Changes from initial injury until 24 hrs

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Vascular Changes 24 hours after

Fluid remobilization starts, 24 hours after the capillary leak stops

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Decreased blood flow to the GI tract

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Metabolic and Immunologic Changes

Hypermetabolism: increased secretion of catecholamines, ADH, aldosterone,

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

any tissue injury can disrupt homeostasis

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Classification of Burn Injury

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Classification of Burn Injury

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Rule of Nines Chart

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Types of Burn Injury

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Classification of Burn Injury

Copyright 2014 by Mosby, an imprint of Elsevier Inc.