Burns

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

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

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

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

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

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

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