PATHOPHYSIOLOGY OF BURN INJURY

Major Burns Loss of skin

Cell lysis 45% BSA barrier
Inhalation injury
(singed eyebrows, eyelashes
Hemolysis ↑ Hyperkalemia & hair; soot in nares & mouth Inflammatory
(6.0 mEq/L) ↑ Capillary response
N: 3.5 – 4.5 permeability
mEq/L
Skin of face
↑ Hemoglobin is pink moist Impaired
(20g/dl) Na,H2O & immune
CHON shift & blister
N: 13.5 – 17.5g/dl ↑Concentration response
from IVS to ITS (20- 30 pus
of blood cells
(Hgb:20g/dl) cells/hpf)
Hyponatremia
(126mEq/L) Respi. Alkalosis
↓ Circulating (pH:7.49,
blood volume pCO2:32mmHg) Hypoxemia

↑ Blood
viscosity Hypovolemic shock
(PR:142 bpm; RR: 36, inspiratory
BP:98/60mmHg) wheeze, sooty
sputum, Po2:60
↑ Myocardial mmHg
depressant factor Massive stress response, sympathetic
nervous system activation
↓ Blood
pressure
Adrenal corticoid hormones & (98/60mmHg)
catecholamine release

Peripheral Tachycardia Hyperglycemia (168mg/dl)

vasoconstriction (142 bpm)
 Afterload

↓Cardiac
output

↓Tissue perfusion

↓ Renal ↓GI blood Anaerobic Tissue Cellular

blood flow flow metabolism damage dysfunction

Risk of acute Risk of Metabolic Thick, white Cell

renal failure paralutic acidosis leathery eschar; swelling
(BUN= ileus (pH=7.30, pain)
27mg/dl) (absent HCO3=18
bowel mEq/L
sounds)

*MAJOR BURN = THICK, WHITE LEATHERY ESCHAR ON CHEST, NECK, WHOLE BACK & MOUTH