Incidence: 250 000 people per annum sustain burn injuries in the UK. Of these, 15 000 require admission to a specialist burns unit. There are 300 deaths per annum from burns.

Types:Flame injuries (55%) account for the majority of the burns. Scald burns (40%) are the second most common type. Electrical and chemical burns are less common (5%).

Pathophysiology

Local response – three zones of burn:

1. Coagulation zone – central area composed of non-viable tissue due to coagulation of constituent proteins.

2. Stasis zone – initially blood supply is present but over the ensuing 24 hours hypoperfusion and ischaemia can prevail, resulting in irreversible damage. The aim of burn resuscitation is to increase tissue perfusion and prevent this tissue damage. Hypotension, infection and oedema can render this zone non-viable.

3. Hyperaemia zone – contains viable tissue; unless associated with severe sepsis and/or prolonged hypoperfusion this zone tends to recover.

Systemic response: large burns > 30% total body surface area (TBSA) can have a profound systemic effect on major organs through the release of cytokines and other inflammatory mediators.

1. Cardiovascular system: systemic hypotension and end organ hypoperfusion can occur from (a) fluid loss from the burn wound, (b) sequestration of intravascular fluid and proteins into the interstitial space due to increase in capillary permeability, and (c) decrease in myocardial contractility due to release of cytokines such as tumour necrosis factor α.

2. Respiratory system: bronchospasm is caused by circulating inflammatory mediators, and adult respiratory distress syndrome can occur in severe burns.

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