Burns: Classification, TBSA, and Critical Care

A major burn is a whole-body illness that happens to start at the skin. The visible wound is the least of it: large burns trigger a systemic inflammatory response that causes massive capillary leak, profound fluid shifts, hypermetabolism, immune suppression and a sustained risk of infection lasting weeks. Understanding that is what separates competent burn nursing from wound care. Care divides into three phases, and each has a different dominant threat. Emergent phase, roughly the first 24 to 48 hours, is dominated by airway compromise and hypovolemic shock from capillary leak. This is where fluid resuscitation happens and where patients die if it is done badly. Acute phase, from the end of fluid shifts until wound closure, is dominated by infection, nutrition and wound management in a hypermetabolic, immunosuppressed patient. Rehabilitative phase is dominated by contracture prevention, scar management, function and psychological recovery — and it begins on day one, not after discharge, because a contracture prevented is far easier than a contracture released. Two priorities sit above everything else and are worth stating at the outset. Airway first —...