Burn Assessment and Management

Burns are tissue injuries caused by thermal, chemical, electrical, or radiation energy that produce cellular damage ranging from reversible injury to complete tissue destruction. Thermal burns are the most common type, caused by contact with flames, hot liquids (scalds), hot surfaces, or steam. Understanding burn pathophysiology requires knowledge of Jackson's burn wound model, which describes three concentric zones of tissue injury. The zone of coagulation is the central area of the burn wound where temperatures were highest, causing irreversible protein denaturation and coagulative necrosis of all cells. This tissue is non-viable and cannot recover regardless of treatment. The zone of stasis surrounds the zone of coagulation and represents tissue with decreased perfusion and potentially salvageable cells. Cells in this zone have sustained thermal injury but are not yet irreversibly damaged -- they exist in a precarious state where adequate resuscitation and wound care can preserve viability, but inadequate resuscitation, infection, edema, or vasoconstriction can convert this zone to coagulative necrosis (wound deepening). Preventing zone of stasis conversion is a primary goal of burn management. The zone of hyperemia is the...