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INTRODUCTION

CHAPTER OBJECTIVES

At the end of this chapter, the learner will be able to:

  1. Classify burn wounds according to the depth of tissue injury using the American Burn Association terminology.

  2. Estimate the percentage of total body surface area of a burn using the “Rule of Nines.”

  3. Appreciate the different mechanisms of burn injuries.

  4. Recognize the critical aspects of the initial evaluation and assessment of a burn injury.

  5. Estimate the fluid and caloric requirements of a burn patient.

  6. Understand the different nonsurgical and surgical treatment modalities for burns and identify when surgical treatment is required.

  7. Distinguish the discrete complications that can occur after a burn injury and discuss how they are managed.

  8. Address the major physical and psychological objectives of rehabilitation in a burn patient.

Epidemiology

The World Health Organization estimates that almost 200,000 deaths annually are attributed to burns, and the vast majority of burn morbidity worldwide is related to nonfatal burn injuries.1 In the United States alone over 45,000 patients each year require hospitalization for burns,2 creating a significant burden for the health care system. Over 90% of the burn injuries are deemed preventable occurrences. Mortality has significantly decreased with the development of regional burn units, establishment of multidisciplinary treatment teams, and improved critical care strategies focused on optimizing resuscitation, early surgical interventions, infection control, and nutrition. The American Burn Association reports the current survival rates are greater than 96%.2 With increasing survival of this patient population, greater emphasis has been placed on long-term rehabilitation geared at restoration of function and activities of daily living, correction of esthetic deformities, and improvement of the psychosocial well-being. With this paradigm shift in burn care toward emphasis on optimizing post-burn quality of life, newer interventions are being developed and applied even during the acute phase of burn care to facilitate such improvements for burn survivors.

Pathophysiology

The term burn injury is often employed as an umbrella term that encompasses a vast array of unique mechanistic etiologies which eventually result in injury to skin and underlying structures. These mechanisms are classically separated into four main categories: thermal, chemical, radiation, and electrical. Thermal etiologies include flame, contact, scald, and frostbite. Thermal injury to the skin is the result of the direct energy transfer to the tissue in relation to temperature and contact time. Temperature is in actuality a derivative of the average kinetic energy of the molecules within a system, or in the case of burn injury, a substance (ie, boiling water), such that the temperature of any substance represents a potentially transferable molecular kinetic energy (KEavg = 3/2 κT; κ = Boltzmann's constant, T = Kelvin) to some other substance (ie, skin). Transfer of this stored kinetic energy to cellular structures of the skin results in denaturation of proteins, vaporization of water, and thrombosis of cutaneous blood vessels, thus resulting in tissue and cell death. The rapid ...

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