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440 ACUTE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Bum Injury

+

Rot .... of Y1ISOaC1MIsubstancea

+

Increased vascular penneabliity

Cell membrane des1ruction

+

Edema IormatIon

EIectroly1e changes

Hematologic changes

RIsk 01 compartment

Decreased IeYefs of K+

Increased Hct

syndrome

Increased levels 01 Na-, cr

(plasma volume loss)

Increased body weight

Increased levels 01 BUN

DecnIased """"'"" of

Low protein confllnt

(protein cataI>ollom)

RBCs (hemolyzed cotls)

Increased numbers 0'

I

wacs (hemoconcentration)

DecnIased numbers of

thrombocytes (platelet

destruction)

+

IJecf8ased ln1mascutar volume

_ blood viscosity

+

IJecf8ased urine output

(hypowlemla)

Myogloblnll1a

(muscle damage)

Increased peripheral resistance

+

IJecf8ased canliac output

+

Ilecreased 0, dotNery to vital orvans and tissues

In the setting of decroased body temperature and Increased heart mt.

Figure 7-3. The physiologic sequelae of major burn injury. (BUN blood

=

urea nitrogen; Ct-

chlorine; Hct hematocrit; K+ potassium; Na·

=

=

=

=

sodium; 0, oxyge/l; RBC red blood cell; IVBC while blood cell.) (Mod

=

=

=

ified from J Maruin. Therma/lnjuries. In VD Caradona. PD Hum, PJ Baslnagel Mason, et al. {eds}, Trauma Nursing from Resuscitation through Rehabilitation [2nd ed]. Philadelphia: Saunders, 1994;740; and RH Demling, C

LaLonde. Bum Trauma. New York: Thieme, 1989;99.)

BURNS AND WOUNDS 441

Table 7·2. Systemic Complications of Burn Injury

Body System

Complications

Respiratory

Inhalation injury, restrictive pulmonary pattern

(which may OCCur with a burn on the trunk),

atelectasis, pneumonia, microthrombi, and adult

respiratory distress syndrome

Cardiovascular

Hypovolemiaihypotension, pulmonary hypertension,

subendocardial ischemia, anemia, and disseminated

intravascular coagulopathy

GastroinrestinaV

Stress ulceration, hemorrhage, ileus, ischemic co\iris,

genitourinary

cholesrasis, liver failure, and urinary rract infection

Renal

Edema, hemorrhage, acute tubular necrosis, acure

renal failure

Source: Data from HA Linares. The Burn Problem: A Parhologist's Perspective. In DN

Herdon (ed), Total Burn Care. London: Saunders, 1996.

summary of the most common complications of burns is listed In

Table 7-2.

Types of 8ums

Thermal Burns

Thermal burns can be the result of conduction or convection, as in

contact with a hot object, hot liquid, chemicals, flame, or steam. In

order of frequency, the most common 'Ypes of thermal burns are

scalds, flame burns, flash burns, and cOntact burns (Table 7-3)4 The

severity of burn depends on the location of the burn, the temperature

of the burn source, and the duration of contact.s

Electrical Burns

An electrical burn is caused by exposure to a low- or high-voltage

current and results in superficial burns, as well as less-visible but

massive damage of muscle, nerves, and bone. Tissue necrosis of

these deeper structures occurs from the high heat intensity of the

current and the electrical disruption of cell membranes.' Tissue

damage occurs along the path of the current, with smaller distal

areas of the body damaged most severely. This pattern of tissue

442 AClITE CARE HANDBOOK FOR PHYSICAL n IERAPISTS

Table 7-3. Thermal Burns: Types and Characteristics

Burn Type

Description

Characterisrics

Scald burn

Spill of or immer

Often causes deep partial- or fullsion in a hot