Burns - Resuscitation and Initial Management
Burns range from trivial superficial injuries to life‑threatening multisystem problems. Early assessment and resuscitation determine outcome. Immediate priorities are to secure the airway, limit ongoing injury, restore and maintain perfusion, prevent hypothermia, and identify patients who need specialist burn‑centre care.
This section summarises pathophysiology, practical classification and TBSA estimation, ABCDE priorities with burn‑specific caveats, fluid‑resuscitation principles (Parkland approach), key investigations, special scenarios, indications for urgent surgery, referral criteria and common exam‑relevant pitfalls.
Why burns can be life‑threatening
- Large surface‑area skin loss produces massive insensible fluid losses and a systemic inflammatory response that increases capillary permeability, leading to third spacing, oedema and hypovolaemic “burn shock” (most marked in the first 24-48 hours).
- Cardiac depression and reduced preload can contribute to circulatory failure.
- Inhalation injury, carbon monoxide (CO) and cyanide exposure (especially from enclosed‑space fires) cause respiratory compromise and impair oxygen delivery and utilisation.
- Electrical injuries may cause deep tissue necrosis, rhabdomyolysis and arrhythmias even when surface burns appear minor.
Classification and extent
Depth (clinical categories)
- Epidermal (first‑degree): epidermis only; erythema and soreness; no blistering.
- Superficial partial‑thickness: epidermis plus papillary dermis; pink, blistered, painful; brisk capillary refill.