Burn Injury, Flame

Flame injuries accounted for 43% of all burn cases from 2003 to 2012.

70,000 flame injuries requiring treatment over same 10-y period.

Approximately 70% of injuries are accidental and nonwork related.

Approximately 70% of injuries occur at home.

Major predictors of mortality include BSA >40%, age >60, and presence of inhalation injury.

Predicted mortality is 0.3%, 3%, 33%, or 90%, depending on presence of zero, one, two, or three of the above-mentioned risk factors.

Up to one-third of pts with inhalation injury will develop acute airway obstruction.

Other incidental traumatic injuries may be present.

Airway protection and ventilation

Hypovolemia with early goal-directed volume resuscitation as the single most important therapeutic intervention

Hypothermia

Direct thermal energy produces direct cellular destruction and coagulative necrosis.

Systemic microvascular integrity is lost in massive inflammatory response; proteins are lost into interstitial space.

Significant shift of fluids, electrolytes, and proteins into the interstitium occurs with rapid equilibrium of intravascular and interstitial compartments.

Changes reflected by massive edema formation and loss of circulating plasma volume, hemoconcentration, decreased urine output, and depressed CV function.

Cardiac output is reduced due to hypovolemia, decreased contractility, and increased afterload.

Most edema occurs at the burn site and is maximal at 24 h after the injury. Edema results in tissue hypoxia and increased tissue pressure with circumferential injuries.