Hypertrophic scarring can be considered a systemic inflammatory illness regulated by local wound healing factors. Stiffness is common in burn patients both in joints effected by a burn injury and in other joints when immobilised for periods of time. , touch). Family support for the burn patient is wrought with unpreparedness, sudden entry and varied emotional responses. Demographic data, comorbidities, burn lesions characteristics, surgical interventions, anticoagulant medication, the need for transfusions, the presence of a central venous catheter, length of stay, complications, and mortality were Sep 9, 2021 · In burn patients, in particular, the leading cause of mortality is an infection, with 75% of all deaths from burns resulting from infection 1. The most deleterious impact of this dysfunction is the loss of the skin’s natural protective barrier. Feb 1, 2019 · These injury specific reference values may be beneficial to clinically determine whether the change in CBC measurements for a burn patient is following an expected course. Aug 13, 2022 · Learn how to treat minor burns at home and when to seek medical attention for serious burns. Dec 5, 2023 · Pain may last for two or three days and then subside. Splinting should be accompanied by regular exercise regimes as contractures can occur, as well, in desirable positions if a patient is persistently splinted and restricted to that position. , 2017; Romanowski et al. Citation 78 A similar study in burn patients with septic shock has not yet been performed. The repair process of the damage caused by the burn is impaired due to the enhanced loss of fluids and minerals through the burn wound, the onset of hypermetabolism with the concomitant disruption of nutrient supply For burns that encompass over 50% TBSA, there is a 40% decrease in metabolic rate for patients totally excised and covered within 3 days of injury compared to those patients, with like size burns, excised and covered one week after injury . Find out the prevalence, causes, and complications of burns and associated injuries. Alternative Names. Dec 15, 2021 · Burn injuries can be very traumatic. These patients present with their own unique set of nutritional challenges. Twenty of the selected studies indicate that patients aged 60 and above make up less than 5% of the all the admissions. 77 and 0. Background: The prevalence of neuropathic pain (NP) in burn patients is reported in the literature to be as high as 80% 1. Treatment requires hospital care to stabilize the patient and prevent infection. Dec 12, 2020 · Accounting for 0. 44 Critical illness polyneuropathy in burn patients is an underreported condition in burn patients. Burn patients need the highly specialized services of medical professionals who work together on a multidisciplinary team, including the following: Physiatrists. If you have sustained a burn injury, please seek medical advice from a medical professional. Each year approximately one million people in the United States seek medical care for burns, approximately one-third of these in the emergency department [ 1,4-6 ]. 1 To accomplish this, we review the principles of acute pain management in adult burn patients and present a reasonable approach to the management of the complex pain associated with burn injury based on a review of the literature and expert opinion. Two different types of renal failures develop in these patients. Whilst the inflammatory response is fundamental to the healing process, triggering a cascade of cytokines and growth factors to protect against the risk of infection, it is clear that prolonged inflammation can be detrimental and lead to scarring and fibrosis. Call 911 if you think the burn is serious. Mar 3, 2020 · The major findings are that 1) burn center consultation is strongly recommended for all patients with deep partial-thickness or deeper burns ≥ 10% TBSA burned, for full-thickness burns ≥ 5% TBSA burned, for children and older adults with specific dressing and medical needs, and for special burn circumstances including electrical, chemical Feb 24, 2023 · Every patient who comes to the Burn Center is cared for by a team of experts including the burn rehabilitation occupational and physical therapists. In severe burns, the patient will be physically incapacitated and emotionally traumatized. To date, this course is of great importance like the Advanced Trauma Life Support (ATLS) course, which is provided by the American College of Surgeons and many May 23, 2018 · Patient selection. Jul 9, 2024 · Itching is a common complaint among patients during the initial healing period after minor burns. Most burns are small and are treated at home or by local providers as outpatients. The vast majority of burns and scalds are caused by accidents. , wound debridement) and allodynic components (painful responses to non-painful stimuli, e. , chronic renal failure or congestive heart failure) and an already compromised immune system . Twenty-one non-burned volunteers were 14 ± 3 (standard deviation) years of age, 33% were females and 67% were males. These burns may be very painful but are minor in terms of their short-term health impacts. At Weill Cornell Medicine, our burn care specialists are highly trained to care for patients during the three phases of burn recovery: Burn resuscitation Wound care and surgery for initial management Rehabilitation and burn scar reconstruction Sep 27, 2023 · Burn injury is associated with a high risk of acute kidney injury (AKI) with a prevalence of AKI among patients with burns of 9–50%. Results: The incidence of sepsis in patients with more than 20% total body surface area (TBSA) burns is between 3% and 30% and is the most common cause of death in the burn patient, with pneumonia being the most common Burns commonly occur by direct or indirect contact with heat, electric current, radiation, or chemical agents. Burn wounds are a severely debilitating class of Following discharge, muscle breakdown remains elevated in pediatric burn patients for up to one-year post burn . Jul 3, 2017 · The review authors will extract the following data: care setting (including country), study population, source of funding, design of the trial, baseline data about the wound (e. 3 Oct 7, 2013 · Between 4 and 22% of burn patients presenting to the emergency department are admitted to critical care. To prevent hypothermia and maintain normal body temperature, burn patients with over 20% of burn injuries should be kept in an environment with the temperature at or above 30 degree Celsius. May 14, 2012 · Advanced Burn Life Support (ABLS) Course by American Burn Association provides guidelines in the assessment and management of the burn patient during the first 24 hours post injury. Mar 3, 2013 · Burn care providers are usually challenged by multiple complications during the management of acute burns. Trauma centers that refer burn patients to a designated burn center must have in place written transfer Apr 1, 2016 · Intravenous and intra-arterial catheters provide access to the blood, an essential route for delivery of resuscitative and pharmacologic therapy, which are crucial for treating burn patients. Apply white soft paraffin twice daily after cleaning face Chloramphenicol ointment to eye and ear burns Perineal burns are at risk of contamination – after bowel action, area should be cleaned with soapy solution; consider catheterisation Dec 20, 2017 · Burns are characterised by significant local swelling and redness around the site of injury, indicative of acute inflammation. The elderly burn patient is more likely to have multiple comorbidities including organ dysfunction (i. Location . May 13, 2021 · 1. [1, 2] Proper evaluation and management, coupled with appropriate early referral to a specialist, greatly help in minimizing suffering and optimizing results. Aug 24, 2020 · Learn about the causes, signs and degrees of burns, and how to prevent and treat them. For more serious burns, treatment may be needed to clean the wound, replace the skin, and make sure the patient has enough fluids and nutrition. Oct 2, 2020 · The roles of nonopioid pain medications are as follows: Acetaminophen: Use on all burn patients; monitor maximum daily dose. Acute kidney injury (AKI) is one of the most common serious complications in critically ill patients. The use of antibiotic prophylaxis in burn patients remains controversial. e. During the study period, 3155 adult patients were included (elderly, n = 505). Orthopedic surgeons Aug 21, 2019 · Results. Rehabilitation is an essential component in the management of patients with burns and should be commenced on the day of injury is sustained. Population studies have linked burn injury with increased risk of cancer, cardiovascular disease Jan 1, 2018 · The majority of burn patients in most studies come from the adult population, with young workers aged between 20 and 30 making up at least 20. Mar 3, 2013 · Introduction. The measurement of the initial burn surface area is important in estimating fluid resuscitation requirements, as patients with severe burns will have insensible fluid losses due to loss of the skin barrier. Many of our patients tell us that ongoing pain continues to be a problem after discharge from the hospital. Dec 21, 2023 · Romanowski KS, Carson J, Pape K, et al. (Also see Burns, Evaluation and Management and Burns, Thermal). Topicals such as aloe vera or petroleum based jelly can soothe the discomfort caused by itching. Aug 14, 2020 · Burn damage can lead to a state of immune dysregulation that facilitates the development of infections in patients. PubMed; Griggs C, Goverman J, Bittner EA, et al. There are three levels of burns: Introduction. Facial and perineal burns. 0% and was comparable, but aetiology and pre-hospital care were different between elderly and the younger adult reference group. ) This assessment These advances in burn care have improved burn survival from a near 100% mortality seen with a burn size of 30% in the early 1900s, 2 to survival estimates over 50% in young, healthy patients with burn sizes up to 95%. It is important for the family to know that the patient may need a great deal of support. 4 The mean burn size has been Jun 13, 2023 · Following a burn or scald, make sure that you and the affected person are safe from further burns or danger - then cool a burnt or scalded area immediately with cool running water for at least 20 minutes. Dec 5, 2023 · Question 5: For adult patients with a ≥ 20% TBSA burn injury, does administration of high dose (66 mg/kg/hour) ascorbic acid (vitamin C), compared to not using high dose ascorbic acid, while providing crystalloids alone during acute fluid resuscitation (a) reduce total crystalloid resuscitation volume at 24 or 48 hours post burn, (b) increase Burn patients were on average 8 ± 5 (standard deviation) years of age, 40% were females and 60% were males. 87 . Aug 5, 2019 · A Canadian study with the evocative title “what the dietitian prescribes is not what the burn patient gets” confirmed in 90 patients (mean burns 28% BSA) how difficult it is to cover the needs by the enteral route . 1. 1-4 In burn patients, AKI is a growing health concern as it is associated with both short and with the senior burn surgeon. May 18, 2021 · Critically ill burn patients. Dressing . Apr 1, 2022 · Burn wound after-care is an essential part of a complication-free recovery. Patient-controlled analgesia (PCA) with IV opioids is a safe and efficient method of achieving flexible analgesia in burn injured patients (Patterson 2004). In other words, oedema control, respiratory care, positioning, functional movements which are pertinent in burn cases must begin without delay [1] . Skin may be red and tender or swollen. Early excision and grafting prevents further net protein loss and catabolism. Also, determining trends and developing reference values for survivors and non-survivors may help clinicians determine the current clinical trajectory for burn patients. If the burn is more severe, and pain does not settle after a couple of days, a doctor Special Considerations Based on the offending mechanism of injury for the burn patient, the prehospital caregiver needs to take specific actions to reduce the risk of secondary injury to the Feb 13, 2023 · Burns and their treatment are a significant medical problem. 1 Hypertrophic burn scars remain a problematic challenge for both patients and health care providers and are a very frequent problem of burn survivors who have delayed healing or skin-grafted areas. We give every patient a personalized care plan based on the severity of their injury, their loss of function and their personal, professional, and social goals. This chapter will focus on the initial resuscitation and management of severe burns. Many hospitals have a specialized burn unit or center and some facilities are designated solely for the rehabilitation of burn patients. This retrospective multicenter study included data for all severe burns patients admitted to the burn units at eight public hospitals (six academic teaching hospitals and two non-academic general hospitals) in China, from June 2011 to September 2015. After the primary and secondary surveys are completed, early and aggressive Download Guidelines for Burn Patient Referral These guidelines are designed to be used to aid in clinical decision-making. Sep 4, 2020 · PURPOSE. Furthermore, the risk of Jan 31, 2022 · Patients > 18 years who were admitted within 24 h post trauma to burn intensive care unit and presented with a burn injury covering > 10% of the total body surface area (TBSA) at primary survey Jan 12, 2023 · Patients may develop airway obstruction, bronchospasm, atelectasis, shunt, or acute respiratory distress syndrome leading to decreased compliance. In the absence of other injuries, the condition of burn patients usually is easily stabilized, and patients can withstand early long-distance transport with resuscitation en route. An inpatient rehabilitation facility is a specially designed medical rehabilitation facility. Regardless of aseptic technique practice, rates of catheter-associated infection and septic thrombophlebitis in the burn patient are as high as 57% . Given the complexity of NP in burn patients and the wide range of treatments available, a systematic review of the literature is warranted to summarize our current understanding of management and treatment of NP in this population. 65 respectively, with an area under receiver operating characteristic curve of 0. Some studies have attempted to identify factors that explain a burn patient’s LOS. NIH: National Institute of General Medical Oct 22, 2020 · Results. The adult Burn Center at Johns Hopkins Bayview treats burn patients 15 years of age and over. Nov 15, 2022 · A meta-analysis on the use of PCT for identifying sepsis in burn patients showed that a cut-off of 1. 3 Nonetheless, the acute phase of resuscitation still generates significant controversy and is not a standardized process. Burn care has seen renewed interest in colloid resuscitation, a change in transfusion practice and the development of anti-catabolic therapies. [1][2] Burn injuries are highly variable, as is their severity. The concerns of family members vary just as the needs of burn patients differ along the care continuum. Finally, few studies to date have evaluated the effect of a restrictive strategy on infection or wound healing, which are major considerations in burn patients. Jan 23, 2023 · Go to: Introduction. American Burn Association guidelines on the management of acute pain in the adult burn patient: A review of the literature, a compilation of expert opinion, and next steps. Pain of burns has hyperalgesic (increased response to painful stimuli, e. Internists. Plastic surgeons. Apr 18, 2016 · Treatment for burns depends on the cause of the burn, how deep it is, and how much of the body it covers. Burn patients need the highly specialized services of medical specialists who work together on a multidisciplinary team, including any of the following: Physiatrists; Plastic surgeons; Internists; Orthopaedic Feb 13, 2020 · Burn depth is an important factor in assessing patient care needs and, in particular, surgical needs; in general, the deeper the burn the more challenges there are to achieve good scar outcomes. 2 When compared to outcomes in adult burn patients, burns in pediatric patients carry a disproportionately higher morbidity. This article reviews the various aspects of renal failure management in burn patients. Sepsis is a comorbid disease commonly observed in patients with severe burns and is the leading cause of death [ 57 ]. Complications and associated problems include hypovolemic shock, inhalation injury, infection, scarring, and contractures. The patient's comorbidities can influence the burn's clinical outcome. Whether you’re at home healing from a burn […] Apr 18, 2020 · Burden of the burn unit: Hard patient Hard work Unpleasant environment Shortage of expert personnel High expectations: The toil of the burn unit as a deal with God: Working in a burn unit as a valuable effortCaring for burned patients as a connection to God Caring burn patients as a sacred duty: Need for continuing education program: Need for Feb 2, 2024 · Materials and Methods: We conducted a five-year retrospective study on burn patients admitted to our burn center. Additionally, morbidity and mortality tend to increase as the surface area of the burn increases. One Second, burn patients, due to their hypermetabolic state and prolonged critical illness, are physiologically distinct and excluded or underrepresented in transfusion studies. , 2020; Yang et al. The burn team will also follow the patient long-term, prescribing additional therapy if needed. Oct 29, 2022 · Pain resulting from burn injury has proven to be one of the most challenging issues affecting the safe care of burn patients, and there is wide consensus on the risk of morbidities related to under controlled pain or over-prescribed opioid therapy (Dever, 2017; James & Jowza, 2017; Morgan et al. This type of surgery may involve skin grafts ( Figure 2 ), tissue expansion, and other techniques to repair damaged tissue and minimise scarring [ 53 , 54 ]. 88 Posttraumatic stress disorder has been reported to occur in up to 30% of patients with severe burn injury, often developing in the setting of inadequate treatment of Jan 18, 2021 · With a reduction in the mortality rate of burn patients, length of stay (LOS) has been increasingly adopted as an outcome measure. 4 to 9% of burn patients, the proportion of patients with burns by suicide attempt in Western Europe and the industrialized countries is low, whereas suicidal burns are far more common in Asia and the Middle East. Antibiotic creams can prevent or treat infections. Feb 12, 2024 · The Rule of Nines, also known as the Wallace Rule of Nines, is a tool utilized by medical providers to assess the total body surface area (TBSA) involved in burn patients. Third-degree burns need emergency medical care. It is important to point out that most burn survivors do very well psychologically after surviving a burn injury. At Burn and Reconstructive Centers of America, we work around the clock with our patients to ensure a smooth recovery back to a healthy life. An example is a sunburn that turns red and Dec 22, 2020 · The overarching goals of burn rehabilitation are the restoration of function, independence, and quality of life following burn injury. Tidal volumes ≤6 mL/kg ideal body weight; Plateau airway pressures < 30 cm H 2 O in adults The following estimates were derived from sample and registry statistics compiled by ongoing national health care and fire casualty surveys, selected state health data systems, and the Burn Care Quality Platform (BCQP) of the American Burn Association (ABA). 5. Patients with large burns (> 20% TBSA) require fluid resuscitation May 29, 2016 · Outcomes for burn patients have improved dramatically over the past 20 years, yet burns still cause substantial morbidity and mortality. Aug 29, 2017 · A recent randomized clinical trial in severely burn patients showed that low-dose hydrocortisone decreases norepinephrine requirements during initial resuscitation following burns. Epidermal or superficial dermal . This includes the whole patient experience from the time of injury through rehabilitation. Find out when to seek medical care for burns and what complications they can cause. Sep 26, 2023 · Burns can occur when the skin is exposed to heat sources, such as flames, flash burns, hot objects, grease, scald, chemicals, and electricity. Approximately 1% of all annual United States ED visits are due to burns, 1 and burns in patients aged < 14 years are consistently among the top causes of injury-induced mortality. Despite an improvement in burn injury survival in the past Nov 15, 2023 · Learn about the initial care and subsequent management of patients with severe burns, including criteria for intensive care, triage, and transfer. , 2013). 5 ng/ml had a pooled sensitivity and specificity of 0. However, few have investigated the association between LOS and a patient’s mental and socioeconomic status. May 9, 2024 · For minor burns, follow these first-aid guidelines: Cool the burn. Burn providers measure the depth of burns in degrees. (See Supporting the patient with burns. Reaching this goal requires a detailed understanding of burn injury and wound care, interventions to manage short- and long-term complications such as contracture and scar hypertrophy, and the ability to translate care plans through phases of care including Jan 18, 2024 · Caucasian (59%) is the ethnicity with most burn cases followed by African-Americans (20%). [24] X Expert Source Mohiba Tareen, MD Dec 12, 2013 · Introduction. One of the most common complications worldwide is renal failure. Burns can lead to cell death, which can require hospitalization and can be fatal. In such cases, if the trauma poses the greater risk, patients should be stabilized in a trauma center prior to transferring to a burn center. By analyzing the data, 7 main categories were obtained from 932 primary codes: the necessity to provide optimal physiotherapy, the necessity of the patient’s overall physical assessment, the necessity of monitoring and coordination in care, healthy nutrition for burn patients, the need for pharmacotherapy, the need for pain reliefs, and finally the theme for comprehensive physical Jun 13, 2018 · The American Burn Association (ABA) has identified patients who are best served at a burn center. Burns represent one of the most severe forms of trauma and also are a major public health problem [1,2]. 2 According to the World Health Organization’s Global Burn Registry of 8,640 burn patients, children comprised of 42% of the burn patient registry, and the most common type of burn among children was scald burn (80%). [3] Therefore, it is Dec 2, 2007 · Profound tissue oedema occurs both at the burn site and throughout the body tissues. Intensive care management should not be seen as rescue for failed initial treatment but as a preventive measure in patients at high risk of organ failure. 1% and at most 36. Introduction. Patients stay at the facility full-time after discharge from the burn center and must be able to do at least 3 hours of therapy per day. Find out about the types of medications, dressings, procedures and therapies for burn care. Pain and discomfort are an unfortunate part of burn injury and recovery. The goal in management of an acute burn is to limit the extent of the systemic insult. g. The post-burn pruritus is a common and serious complication of burn injury, which severely lowers the quality of life of the patient. This includes burns that are deep or cause fast swelling. Severe AKI occurs in more than one of every twenty patients requiring intensive care unit (ICU) care, 1 and has been associated with mortality rates ranging from 50% to more than 70%. It typically takes two to three weeks or more for a second-degree burn to heal, and the skin may become lighter or darker. 1; Lung-protective ventilation is the standard of care for burn patients with inhalation injury. Physical and occupational therapists play essential roles in the acute treatment of all burn patients, including critically ill patients and even during the resuscitation of patients with large injuries. Sedation and pain management in burn patients. May 29, 2020 · Post-burn pruritus is the pruritus that occurs after burn during the rehabilitation and healing process of burn wounds. Moreover, an Oct 5, 2017 · Any patient with burns and concomitant trauma (such as fracture) in which the burn injury poses the greatest risk to the patient. 2020:41(6):1129-51. Burn patients may be hospitalized for prolonged periods and may require multiple surgeries. Jul 7, 2004 · Intensive care management. Jun 12, 2019 · The ABA reports that 40,000 patients were hospitalized with burns in 2016, and 30,000 of those patients were admitted to the 128 burn centers in the United States. Depth . To attain the objective of optimal long-term function, rehabilitation efforts must begin at the outset of burn care. 46, 47 There is a strong link to sepsis Opioid requirements are increased in burn patients and may far exceed standard dosing recommendations; therefore, tolerance is a challenge throughout burn care (Bittner 2016). However, even when doing everything right, something can still go wrong. Jan 25, 2022 · To meet the demand for diagnostic criteria specific to burn patients, the American Burn Association (ABA) developed a burn-specific sepsis definition in 2007 . You should seek care right away for large burns or ones that cover your Feb 20, 2024 · Burns are a leading cause of accidental injury and death in the United States and worldwide [ 1-5 ]. [better source needed] Jan 1, 2017 · It was reported that 71% of extensively burned victims suffer from abnormal sensation and 36% from chronic pain. The purpose of this fact sheet is to describe some of the emotional recovery challenges that patients may face after sustaining a major burn injury. First degree burn; Second degree burn; Third degree burn. The purpose of this guideline is to update the previous guideline by Drs Faucher and Furukawa. Secondary assessment. Considerations. Annually, about 300 million patients are affected by burns, the fourth most frequent kind of trauma after traffic accidents, violent incidents, and falls []. May 1, 2021 · The occurrence of burns affects the entire membership of one's family. Burn severity, reflected by the median TBSA, varied between 3. depth and size of burn wound, burn type), unit of analysis if more than one burn per patient, type and duration of treatment, outcomes and length of follow‐up. Respiratory failure, sepsis, and multi-organ system failure are common in hospitalized burn patients. 4% of all burn patients [7], [8], [13], [17], [20], [33], [37]. The localised tissue swelling around the site of the burn is usually at its worst within 12 hours of resuscitation, but after 24 hours generalised oedema in unburned tissue is often encountered in patients with more than 30% TBSA burns. . Additionally, the most current management of sepsis was reviewed and described in caring for burn patients with sepsis. This leaflet also gives further advice. NSAIDs: Consider use, owing to safety profile and efficacy; factors to consider include patient clinical picture (comorbidities) and surgeon preference. Patients with large burns (> 20% TBSA) require fluid resuscitation Oct 29, 2012 · As an adult burn centre it regularly admits elderly burn patients. The main reason for the discrepancy between prescription and delivery was the long duration of EN interruption of 9±3 hours The American Burn Association and the American College of Surgeons designed a rigorous review program that ensures verified centers offer the best care for their patients. A literature search was conducted with Mar 21, 2024 · First Aid for Burns. Feb 13, 2023 · Reconstructive burn surgery has greatly improved the quality of life for burn patients by restoring function and appearance to the affected areas. [ 6 ] Many hospitals have a specialized burn unit or center and some facilities are designated solely for the rehabilitation of burn patients. Its highly specialized team consists of experts in plastic and reconstructive surgery, physical and occupational therapy, nursing, psychology, nutrition, social work and case management. If this isn't possible or if the burn is on the face, apply a cool, wet cloth until the pain eases. There should be no raised scar. Hold the area under cool running water for about 10 minutes. 45 It is associated with high mortality rates and prolonged hospital stay and rehabilitation. Multidisciplinary Burn Care Focused on Recovery and Well-Being. Aug 20, 2018 · Following a major burn injury the patient is in a hypermetabolic state resulting in protein loss, reduction in lean body mass and hyperglycemia. J Burn Care Res. Chang and colleagues suggest that a 10% loss of LBM may impair immune function, a 20% LBM loss may impair wound healing and a 30% LBM loss increases mortality. Patients suffered from a severe burn injury encompassing 60% TBSA, and third-degree burns of over 47% TBSA. 39 Many authors have focused on psychiatric history, depression and factors predisposing to suicidal burn, while Jun 15, 2020 · A person may require treatment If blisters burst on a mild-first degree burn, such as on a hand or sunburn. [1] All severely burned patients are trauma patients first, thus should always be handled systematically with an initial focus on the ABCs (airway, breathing, and circulation). Therefore, hydrocortisone can be used in patients with refractory Sep 16, 2019 · While treatment for burn injury has improved significantly over the past few decades, reducing mortality and improving patient outcomes, recent evidence has revealed that burn injury is associated with a number of secondary pathologies, many of which arise long after the initial injury has healed. The secondary assessment shouldn’t begin until the primary assessment is complete; resuscitative efforts are underway; and lines, tubes, and catheters are placed. It occurs more frequently in women and patients of younger age groups. Hyperglycemia, particularly in the paediatric population, is associated with catabolism, bacterial and fungal infections and graft loss [ 22 ]. Jun 19, 2023 · Extensive burns can cause considerable local damage, tissue injury, and a widespread inflammatory response affecting multiple organ systems. The loss of the physical barrier function of the skin opens the door to microbial invasion and can lead to infection. Burn injury is characterised by a hypermetabolic response with physiologic, catabolic and immune effects. There are three levels of injury: First-degree burns affect the top layer of skin only, the epidermis (ep-i-DUR-mis). 2–4. Burns are classified by depth (superficial and deep partial-thickness, and full-thickness) and percentage of total body surface area (TBSA) involved. tu yc xr ll xb nu qd ps ok df