Shock is categorized as a medical emergency and occurs when the tissues and organs fail to receive adequate oxygenated blood. Therefore, burn shock is used to describe specific signs such as “decreased cardiac output, increased vascular resistance, hypovolaemia and hypoperfusion” caused by severe burn injuries (Curtis et al., 2019). Such injuries are associated with the release of histamines (inflammatory substances) into the blood circulation. This results in a large movement of fluids from the capillary space. It is important to note that burn shock occurs within the first 24 hours following severe burn injuries.
Burn shock is triggered by the interaction between hypovolaemia and anti-inflammatory substances within the body. After experiencing a burn, hydrostatic pressure in the vessel allows fluid to move to tissues already damaged by injuries. The same movement is experienced in tissues that have not yet been damaged. An increase in capillary permeability triggers the formation of oedema. If the burn injuries are left untreated for 24 hours, oedema eventually reaches the maximum levels (Jeschke, 2021). Extravasation of proteins and electrolytes causes fluid loss from the blood. This eventually leads to low levels of protein within the body. A decrease in cardiac output follows suit as a result of persistent interaction between hypovolaemia and the reduction of contractility of the myocardium (the middle layer of the wall of the heart).
Fluid resuscitation’s main aim is to restore and maintain an adequate supply of oxygen to all tissues within the body. According to Kao et al. (2018), fluid management is critical in patients with mild to severe burn injuries. From a clinical point of view, an adequate volume of IV fluids is essential to preventing burn shocks in severe injuries. Proper fluid replacement during the first 12 to 24 hours is essential to preventing/ reducing cardiac output. It is important to note that severe burn injuries cause great loss of plasma within the first 12 hours following the incident.
Fluids resuscitation is used to restore fluids.
Parkland formula is one of the most commonly used resuscitation formulas. According to Ete et al. (2019), the parkland formula is used specifically for patients with large deep or full-thickness burns of more than 20 percent of total surface area in adults. In children, the formula applies to those with a severe burn of greater than 10 percent of the total surface area. It is calculated using 4ml x TBSA (%) x body weight (kg). The first 50 percent is administered within the first eight hours while remaining in the next 16 hours after sustaining severe burns.
Muir and Barclay’s formula uses a colloid resuscitation with plasma and should be left to run for 36 hours. The 36 hours are divided into six different periods of varying length. This formula applies mainly to those patients who have lost plasma through fluid circulation. The main advantage of colloid resuscitation is that it requires less volume and the blood pressure is well supported. The only disadvantage of this formula is that both colloid and plasma are expensive. As explicated further, plasma and colloid may leak out of circulation and, in the process, damage oedema of the lungs.
The treatment methods for burns are based on the nature and severity of the injuries. Minor burns can be treated at home: they usually heal within a few weeks. However, for serious burns, first aid and wound assessment are the key components. This is then followed by the treatment, which may involve medications, wound dressings, therapy and surgery. The aims of these treatment options include controlling pain, removing dead tissue, preventing infection, reducing scarring risk and regaining function. Some severe burns would require a skin graft to help cover large wounds.
Medical care, which includes medication, is critical as it encourages healing. The care provider may recommend several medical treatment options to speed up the recovery process. First, water-based treatments such as ultrasound mist therapy help clean the wound. It is also important to receive fluids such as intravenous (IV) in order to prevent dehydration and organ failure. Pain and anxiety medication may be administered because healing burns can be incredibly painful. Lastly, burn creams and ointments such as bacitracin help prevent infection as well as prepare the wound to close.
The three elements of survival of a major burn include burn depths, the presence of inhalation injury, and age. First, burn depths can be described either as partial thickness involving the epidermis and portions of the dermis, full-thickness burns that destroy all layers of the dermis, and deeper/fourth degree burns that reach soft tissues such as fascia. Secondly, the presence of inhalation injury can be described as pulmonary damage associated with inhaling smoke. Lastly, age is an element that determines the survivability of an individual: the aged show slow recovery after injury.
References
Curtis, B. J., Boe, D. M., Shults, J. A., Ramirez, L., & Kovacs, E. J. (2019). Effects of multi-day ethanol intoxication on post-burn inflammation, lung function, and alveolar macrophage phenotype. Shock (Augusta, Ga.), 51(5), 625.
Ete, G., Chaturvedi, G., & Barreto, E. (2019). Effectiveness of Parkland formula in the estimation of resuscitation fluid volume in adult thermal burns. Chinese Journal of Traumatology, 22(2), 113-116.
Jeschke, M. G. (2021). Pathophysiology of burn injury. In Burn Care and Treatment (pp. 13-25). Springer, Cham.
Kao, Y., Loh, E. W., Hsu, C. C., Lin, H. J., Huang, C. C., Chou, Y. Y.,. & Tam, K. W. (2018). Fluid Resuscitation in patients with severe burns: A meta‐analysis of randomized controlled trials. Academic Emergency Medicine, 25(3), 320-329.