Introduction

One of the major advances in acute burn care of this century is the appreciation of the importance and adoption of the practice of prompt and aggressive fluid resuscitation of the burn victim. Thirty years ago, the majority of patients with extensive burns died from burn shock within the first week following their injuries. Today, however, early death can usually be prevented in previously healthy individuals and is seen only in those with near total body surface burns or in those of advanced age or with major concurrent chronic disease.

There have been advances in a variety of other areas which have also contributed to improved outcome from major burns. These include improved emergency medical services and the general availability of adequately trained teams to provide life-saving treatment both at the scene and during rapid ground or air transport; the prompt referral of patients with major burn injuries to specialized burn centres where teams of experienced and knowledgeable professionals direct management; major advances in cardiopulmonary, respiratory and metabolic monitoring and supportive care and in nutrition; and finally, improved wound management techniques.

After a brief historical perspective, the major local and systemic pathophysiological phenomena which will follow burn injury will be reviewed.

Historical perspective

To appreciate the impact fluid resuscitation has had on burn victims, it is useful to review the natural history of a major burn without treatment.