Burns: Classification, TBSA, and Critical Care Management

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 capillary leak, profound fluid shifts, hypermetabolism, immune suppression and sustained infection risk. 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, during the initial resuscitation period, 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 admission, 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 — inhalation injury kills faster than any skin wound,...