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Review
. 2022 Mar;22(3):94-103.
doi: 10.1016/j.bjae.2021.10.001. Epub 2021 Dec 21.

Major burns: Part 1. Epidemiology, pathophysiology and initial management

C McCann  1 , A Watson  1 , D Barnes  1
Affiliations
Review

Major burns: Part 1. Epidemiology, pathophysiology and initial management

C McCann et al. BJA Educ. 2022 Mar.
No abstract available

Keywords: burns; epidemiology; pathophysiology; surgical management.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig 1
Fig 1
Functions of the skin.
Fig 2
Fig 2
Depth of burn injuries are described by how much of the dermis has been destroyed. Adapted with permission from the Nederlandse Brandwonden Stichting, Dutch Burns Foundation.
Fig 3
Fig 3
Clinical characteristics of burn injuries (written consent obtained from patient to publish images). (A) Superficial partial thickness burns are pale, pink and moist. Blisters form from fluid leak because of blood vessel damage. They are very painful because the nerve endings are exposed. (B) Deep partial thickness burns are drier, red and non-blanching as the dermal plexus is coagulated by heat. They are less sensate. (C) Full-thickness burns are waxy and white; they may look charred and are not painful.
Fig 4
Fig 4
Pathophysiology of burns. IL, interleukin; TNF-α, tumour necrosis factor-alpha.
Fig 5
Fig 5
Systemic effects of major burns. ADH, anti-diuretic hormone; AKI, acute kidney injury; ARDS acute respiratory distress syndrome; GI, gastrointestinal; HPA, hypothalamic–pituitary–adrenal; NS, nervous system; RAA, renin–angiotensin–aldosterone.
Fig 6
Fig 6
Example of escharotomies performed to facilitate ventilation in a major chest burn (published with written consent from the patient).
Fig 7
Fig 7
Example admission room protocol in use at our institution. ED, emergency department; EMSB, emergency management of severe burns course; HEMS, helicopter emergency medical service; MRSA, methicillin-resistant Staphylococcus aureus; ODA, operating department assitant; PPE, personal protective equipment.
Fig 7
Fig 7
Example admission room protocol in use at our institution. ED, emergency department; EMSB, emergency management of severe burns course; HEMS, helicopter emergency medical service; MRSA, methicillin-resistant Staphylococcus aureus; ODA, operating department assitant; PPE, personal protective equipment.
See this image and copyright information in PMC

References

    1. Suman A., Owen J. Update on the management of burns in paediatrics. BJA Educ. 2020;20:103–110. - PMC - PubMed
    1. James S.L., Lucchesi L.R., Bisignano C., et al. Epidemiology of injuries from fire, heat and hot substances: global, regional and national morbidity and mortality estimates from the Global Burden of Disease 2017 study. Inj Prev. 2020;26:i36–45. - PMC - PubMed
    1. World Health Organisation. Burns factsheets 2018. https://www.who.int/news-room/fact-sheets/detail/burns Available from:
    1. National Health Service. Hospital episode statistics 2004 to 2009. England and Wales.
    1. British Burn Association . National Burn Care Review Committee Report; 2001. Standards and strategy for burn care: a review of burn care in the British isles.