Question

Develop a concept map of the responses of the assigned system to burn injury. identify aspects important to patient survival during the resuscitation and acute phase of the burn injury , Include lab values that may be impacted one of the following body systems:  Respiratory  Cardiovascular  Neurological  Gastrointestinal  Renal  Psychosocial

Answer 1

• The acute phase of burns lasts about 48hrs and is followed by a hypermetabolic phase characterised by increased blood flow to the tissues and organs and increases internal core temperature.
• During hypermetabolic phase rapid edema formation occurs causing hypoproteinemia .
• Secondly, an increase in the water permeability of the interstitial space becomes evident. Which further increases edema formation.j
• Patient with acute burn injury develop a hypermetabolic state with associated catecholamine production and release.
• Increased adregenic stimulation is one of the triggers of myocardial infraction and cardiac arrhythmias.
• Cardiac instability in burned patients is associated with hypivolemia, increased afterload and direct myocardial depression.
• The hyperaggregability, hypercoagulablity and impaired fibrinolysis resulting from any acute injury may predispose to myocardial infraction.

The first 48 hrs following injury are focused on acute resuscitation with patient assessment, airway protection, and fluid replacement.

• Optimal resuscitation aims to minimize rather than treat burn shock by maintenance of organ perfusion with the least amount of fluid necessary.
• Most patients with burn shock can be resuscitated successfully using various fluid regimine as demonstrated by multiple different resuscitation guidelines, based on body weight and burn size.
• Radioisotope experiments by Baxter and Pruitt have shown that plasma expansion during early resuscitation was independent of the type of fluid given.
• Under resuscitation leads to decreased perfusion, acute kidney injury and ultimately death. Over resuscitation is associated with complications such as edema formation, abdominal compartment syndrome and multiple organ dysfunction.

Lab values impacting body systems:

1. Full blood count : the hematocrit can increase to 55-60% an indicator of profound intravascular depletion.
2. Urea and electrolyte concentration: electrolyte abnormalities.
3. Clotting screen: evaluation for the depletion of coagulation factors.
4. 12 lead electrocardiography to rule our arrhythmias.
5. Cardiac enzymes to evaluate for myocardial injury with high voltage injuries.
6. Chest x-ray evaluation of secondary injuries such as aspiration or trauma.
7. Arterial blood gas analysis: evaluation for carbon monoxide exposure, and base deficit and lactate may be predictive of volume of resuscitation required.