Burn Shock
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Introduction[edit | edit source]
Shock is a medical emergency and it occurs when the body's tissues and organs are deprived of adequate oxygenated blood. Burn shock is a term used to describe certain signs such as: decreased cardiac output, increased vascular resistance, hypovolemia and hypoperfusion that occur after severe burn injuries have been sustained[1]. This incident leads to the release of inflammatory substances such as histamines and prostaglandins into the circulation resulting in large movements of fluid from the capillary space. Burn shock mostly occurs within the first 24hrs after sustaining burn injuries with its peak levels at 6 to 8 hours after the injury[1]. It may extend up to 2 to 3 days and last longer in the elderly population[2].
Pathophysiology of Burn Shock[edit | edit source]
Clinical Features of Burn Shock[edit | edit source]
- Hypovolaemia
Prevention of Burn Shock[edit | edit source]
Burn shock is better prevented than treated. The administration of fluid resuscitation promptly, within the first 24hrs of the occurence of burn injuries is crucial especially when burns are extensive and above 20% of the total burn surface area in both adults and children[1]. Fluid resuscitation is primarily aimed at the maintenance of vital organ function while also avoiding the complications that may stem from over and under resuscitation[3]. The Parkland formula is mostly used to determine the amount of fluid to infuse. It is given as:
Four mL lactated ringers solution × percentage total body surface area (%TBSA) burned × patient's weight in kilograms = total amount of fluid given in the first 24 hours.
It is advised that one-half of the quantity of the fluid obtained from the formula be administered over the first 8hrs post thermal injury while the second half should be given over the next 16hrs[4]. The formula only serves to determine the initial fluid rate which is thereafter adjusted to achieve an hourly urine output between 30 and 50 mL in a 70-kg adult with urine output being an important factor that guides fluid management [4][5].
Contraindications to Fluid Resuscitation[edit | edit source]
Haemodynamically stable patients may not benefit from fluid resuscitation as this may lead to oedema[1].
Complications of Burn Shock[edit | edit source]
Multiple organ failure such as
- Acute renal failure
- Decreased perfusion
- Death
Role of the Physiotherapist[edit | edit source]
Resources[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 Schaefer TJ, Nunez Lopez O. Burn Resuscitation And Management. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020
- ↑ Dean S. Management of burns and plastic surgery. In: Porter S editor. Tidy's Physiotherapy (14th Edition). Churchill Livingstone: Elsevier, 2009. p95-112.
- ↑ Dries DJ. Burn care: before the burn centre. Scand J Trauma Resusc Emerg Med. 2020; 28(97)
- ↑ 4.0 4.1 Jeng JC, Bowyer MW. Burns. In: Parsons PE, Wiener-Kronish JP. Critical Care Secrets (Fourth edition) Mosby: Elsevier, 2007.
- ↑ Tsarouhas N, Agosto P. Burns. In: Baren JM, Brennan JA, Rothrock SG, Brown L. Paediatric Emergency Medicine. Saunders: Elsevier, 2008. p1285-1320.
