Burns
What is a burn
burns are a injury to the skin or tissue caused by
heat, electricity or other sources. Burns vary in
severity.
Local response:
Zone of coagulation: irreversible tissue loss
due to coagulation (the royal childrens hospital melbourne, 2024)
Zone of stasis: decreased tissue perfusion,
tissue is potentially salvageable (the royal childrens hospital melbourne, 2024)
Additional impacts:
- prolonged hypotension
- infection risk
- oedema
Zone of hyperaemia: outermost zone tissue perfusion increased (the royal childrens hospital melbourne, 2024)
Systematic Response:
Cardiovascular changes:
capillary permeability increased, loss of fluids in intestinal compartment. Myocardial contractibility is decreased. Results in hypotension (the royal children's hospital Melbourne, 2024)
Respiratory changes: cause bronchoconstricton occurs (the royal childrens hospital melbourne, 2024)
Metabolic changes: metabolic rate increases up to three times its orignial rate (the royal childrens hospital melbourne, 2024)
burns falls under the shock category. Shock is a complex life threatening condition that comes from circulatory failure. As a result of severe burns, the body falls into a state where it is unable to deliver sufficient oxygen to the cells and tissues (Blumlein & Griffins, 2022)
Results in hypoxia: as a result of poor oxygen supply via circulation
severe burns can damage blood vessels
large burns can lead to hypovolemia, impairing oxygen delivery to tissues
burns can cause a build up of fluid in the burn area which can restrict oxygen delivery
tissue hypoperfusion:
severe burns causes a significant loss of fluid
fluid loss leads to decrease in intravascular volume
burn injuries lead to increased capillary permermibility
lead to decrease in BP, and impaired tissue perfusion
multi-organ failure: (Jeschke et al, 2020)
severe burns can lead to infection (feng et,al, 2028)
increase risk of sepsis
bodys reaction to infection is damges its own tissues and organs
imbalances in fluid
loss of fluid increases capillary permability
can lead to hypovalemia
overall damages kidney and heart
immune suppression (uptodate, 2025)
leads to patients being more susceptible to causing infections
increases risk of sepsis
Types of burns (nationwide children's, 2022)
Superficial epidermal burns:
Pathology: expidermis only
Appearnace: dry and red, no blisters
Sensation: might be painful
circulation: normal
colour: red and warm
superficial dermal thickness burns:
Pathology: involves dermis and epidermis
Appearance: pale pink, smaller blisters, wound base blaches with pressure
Sensation: tender and painful, increased sensation
circulation: hypomanic, rapid capillary refill
colour: pink
deep dermal burns:
pathology: involves epidermis and significant part of dermis
Appearance: blotchy red or pale deeper dermis
Sensations: decreased sensations
circulation: sluggish capillary refill
colour: white/pale pink/ blotchy red
Full thickness burns:
pathology: involves epidermis, dermis destroyed
appearance: white waxy charred, no blisters, no cappliary refill
sensation: no sensation
sensation: no sensation
colour: white/charred/black
blisters: epidermis & dermis destroyed no blisters
Inhalation injuries
difficualty breathing
coughing
stridor
Other
dehydration
shock
infection
Management
immediate management: first aid provided at the scene. By conducting first aid on the scene can prevent burns from getting severly worse, howver depends on the extent of the injury to what first aid is completed. (McCann et al, 2022)
Running under cool water: to be completed for 20 mins even up to 4 hours after injury. this way the tissue damage is arrested and wounds wouldnt be as deep as it could of been (McCann et al, 2022)
Cover the burn with non-adhernt dressing such as cling wrap. (McCann et al, 2022)
Warm the patient: by warming the patinet is can prevent the possibility of hypothermia (McCann et al, 2022)
Chemical burns: patient to be removed from contaminated clothing, irrigated with running water to remove chemical from burn. Irrigated fro 45 mins- 1 hr (McCann et al, 2022)
Pharmacological interventions (uptodate, 2025)
Analgestics: combination of pain relief
Antibitotics and antimicrbiols to prvent and treat wound infections
Fluid resuscitation: required IV to prevent dehydration and organ failure
might require high flow oxygen
hyperglyceamia can occur after a burn
check BGL
may require medications like metformin
State wide interventions: (Alfred Health, 2025)
The Alfred Health Victoria Adult Burns service provides statewide burns care, offers clinical practice guidelines, long term follow up and rehabilitation
provides resources and guidelines for burns assessment and management
minor burn care can be completed without being in hospital and clinics with the appropriate wound management
Burn prevention: education and awareness
Nursing Inteverventions (Zwierello et al, 2023)
Prority assessments:
Airway: check for soot in air way, strider present
Circulation: monitor bp, hr and capillary refill
fluid balance: assess urine output
Overall nursing interventions:
Becuase the extent of the burns can cause a severity of fluid loss
fluid: administer IV fluids
wound:
remove necotric tissues to prevent any infections
apply cling wrap on the new burn after cleaning it
Assess pain:
after reciving a burn, patient is going to be in alot of pain, if patient is consious ask patient to rate thier pain out of 10 and document it
administer pain relief
What causes burns
Thermal burns
causes redness, blistering and swelling
ranges from superficial to fullthickness burns
inhalation injuries
chemical burns
cause more severe tissue damage
pain, redness, tissue necrosis
electrical burns
deep tissue damage
potnetial for internal organ damage
lead to cardiac arrest or arrythmias
Acute presentations in a deteriorating patient
clincial manifestions on each presentations *
reduced conscious state
inhalation, facial or mouth burns
singed faical hairs
strior
sore throat
cough
hoarse voice
mid-deep dermal or full thickness burns
burns with trauma
Changes in perfusion
capillary refill increased
pulse pressure:
skin: warm, red and tender with little to no sensation
Nursing Asessments: (treatment, 2023)
Postion:
comfot for the patient. patients with head and neck burns should be head up to reduce swelling
Airway
Patency: maintain the airway patency
evidence of airway burn: give humidified oxygen via non-rebreather. Be quick with oxygen as airway injuries can worsen overtime. Consider and prepare for intubation
Breathing
respiratory rate: assist ventilation if required
Auscultate chest: listen for chest sounds like stridor to see if their is anything inhaled
maintain O2 sats
severe burns: apply oxygen through non-rebreather mask
Circulation:
perfusion and capillary refill
colour and warth of skin, ensure patient stays warm due to risk of hypoxia
check blood pressure and pulse and cardiac rhythm
Look out for signs of shock
tachycardia
abnormal skin colour
hypotension
Disability:
Conducte a GCS score, pupillary response and limb strength
if reduced level of consciouness, consider shock or hypoxaemia
Assess pain
if indicated, provide analgesia
Exposure
temperature: if less than 35.5 provide blacnkets and warm the patinet
skin inspection
remove all non-adhered clothes and jewelry
apply cling wrap to burn