General data about burn

>> GENERAL COMPLICATIONS AFTER BURN INJURIES

WHAT KIND OF PROBLEMS YOUR BODY MAY SUFFER AFTER A BURN INJURY?

Most burns heal without major complications. Extensive burn injuries may affect all your body, require complex treatment and complications are common.


The more severe the burns are, the higher the possibility of complications.
When we consider burn severity, the size of injury is not the only thing that matters.
Other important factors are:
- The depth of your burn (link to depth of burn)
- The part of the body where the skin was burned
- Your Age
- Presence of Smoke inhalation / Burns of the airways and lungs
- Your previous health

Complications may affect one or more body systems and might appear while you are still in the hospital (early complications) or after your discharge from the hospital (late complications).

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BREATHING SYSTEM - ACUTE RESPIRATORY DISTRESS SYMPTOM (ARDS)


If you have significant smoke inhalation, a possible complication may be Acute Respiratory Distress Syndrome. This can be a serious problem and is the result of a number of direct / indirect injuries to the lungs. Any direct damage to your lungs (inhaled smoke, hot air) will impair your breathing. The lungs will rapidly swell and produce secretions in order to eliminate the toxic substances. The lining of the lungs may have sustained significant injury and oxygen transport into the body will be affected.


Your breathing can be severely affected, the oxygen will be low in your body and your chest and lungs will get stiffer. Other organs such as the heart and kidneys may be affected due to lack of oxygen. If you have developed this respiratory complication, you may require breathing assistance and intensive chest physiotherapy. A chest infection may also develop because the defence barrier of the lungs has been breached and bacteria may find their way into the body. Antibiotic treatment will be started. Any problem with your lungs prior to your burn will affect your recovery, and your lungs may not be as efficient as before injury. Depending on the severity, you may feel short of breath at rest or on effort for a long time after the injury.

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Breathing system

 

 

CIRCULATORY AND HEART PROBLEMS


If you have sustained burns big enough to require fluid supplement, it is important that adequate amount of fluids are given.
Tissues need food and oxygen which are delivered through the blood vessels.
A healthy body needs an adequate quantity of fluid inside the blood vessels to be able to do this. If you have suffered extensive injuries, the fluid loss through burns is significant. Without rapid and effective resuscitation, your body can loose large amounts of fluids, making the circulation in your blood vessels sluggish. Important organs (brain, kidneys, heart, and lungs) will not get enough oxygen and can damage them. Your blood pressure will be low (hypovolaemic shock) and you may feel weak, clammy, sweaty or may be shivering.
This acute complication needs to be treated rapidly.
The heart is the main pump that sends the blood around the body and any previous heart problems (heart attack, high blood pressure) can seriously affect recovery from shock. Even if you are not aware of problems with your heart or blood vessels, the physical stress of burns can unmask them. Drugs may be given to support the heart and blood pressure and you will be monitored very closely. With adequate treatment you will pass the shock phase.

 

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The heart and the blood vessels

COMPARTMENT SYNDROME

 

If a deep burn is all around an arm or leg, the muscle, nerves and blood vessels inside will be squeezed because the burned skin is stiff. The limb swells beneath the rigid deep burn and the circulation can be cut off.
You may feel pain out of proportion in the affected arm or leg, the feeling may be altered (pins and needles) and the hand or foot may look pale or blue, cold and clammy.


The treatment consists of cuts carefully placed through the burned skin in order to take the pressure off the tissues underneath (escharotomy). In some cases, surgical release of the tissues underneath the burned skin is not enough and deeper cut down to muscles is needed (fasciotomy). If the arm or leg is not decompressed, the function of that area will be severely compromised. If you have burns almost all around your arm or leg, close monitoring will give us the opportunity to diagnose and treat the compartment syndrome as soon as possible, if it occurs.


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Escharotomy forearm

Fasciotomy forearm

KIDNEY PROBLEMS

The kidneys have an important function to clear your body of excess water, salts (sodium, potassium, phosphates) and other substances (metabolic waste products) that we produce daily. The kidneys will form urine which collects in your bladder. When the bladder is full, you feel the urge to pass urine. Kidneys may be affected because of fluid loss, muscle damage and when infection is present in your body.


A) FLUID LOSS
If you have sustained an extensive burn, large amounts of fluid are lost and if no fluid resuscitation is commenced, less blood will arrive in the kidneys. As a consequence, less urine will be formed and blood will be loaded with salts and other substances that kidneys normally remove. You will feel unwell and you will pass small amounts or no urine. In first instance, you will need plenty of fluids given through a drip. If the kidneys are still struggling to recover, you may need to be attached to a machine (haemodialysis, haemofiltration) that cleans the blood of salts and other substances. Kidneys will normally recover with time. In some cases the kidney may not recover at all.

B) MUSCLE DAMAGE
If the burns are very deep and cover a large area, the muscle tissue breaks down and the substances produced are very toxic for the kidney. Urine will turn red or brown and you may require a considerable amount of fluids through a drip to prevent damage to the kidneys. Treatment will involve close monitoring (regular urine measurement, blood tests) and in severe cases, artificial cleaning of the blood (haemodialysis, haemofiltration).


C) INFECTION
If there is a generalized infection in your body, the kidneys will also be affected by toxic substances produced by bacteria or by the body's reaction to generalized infection.

 

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Kidneys

 

 

ABDOMINAL PROBLEMS (GASTRO-INTESTINAL SYSTEM)


When you have sustained a moderate or serious burn injury, your body enters an emergency state. The stomach and duodenum are more likely to develop ulcers because more acid is produced. Sometimes despite medication to increase gastric protection, erosion of the stomach wall (ulcers) may develop. These ulcers may bleed or perforate, for which surgery may be required. A flexible tube with an attached camera (endoscope) may need to be passed into your stomach if there is a need to stop the bleeding from an ulcer. In the first few days, the gut movement is slower and the food stays inside for longer (stasis). During this period, bacteria inside the gut may migrate from the gut into the circulation. The small gut and colon can twist and may cause partial (pseudo-obstruction) or complete occlusion (total obstruction) of the lumen. It will present as swelling of your tummy and increased pain. Surgeons will assess you and they will decide if you require an operation or you can be treated with conservative methods such as: fasting, evacuation of the stomach contents, fluid through a drip. To avoid these complications, doctors will prescribe measures to protect your stomach and gut. If you require breathing assistance, a fine plastic tube (naso-gastric tube) will also be placed into your stomach through your nose and feeding will start immediately. In this way, the gut will continue to absorb food and will reduce the chances of stand-still and migration of bacteria through the lining of the bowel. Medications may be required to prevent constipation.

 

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NUTRITIONAL PROBLEMS


The daily energy requirements for an adult vary from 1800 up to 3000 kcal according to their level of activity (office work or hard manual labour). Carbohydrates (sugar) (55%) and fat (20-30%) are the main energy suppliers, whereas proteins are mainly used as building material for the body.
On average, our body is 25% fat which is used as an energy store. The remaining 75% is called lean mass. If lean mass is lost, there is higher risk of infection, poor wound healing and impaired defence system. The aim of treatment is to reduce protein usage from your own lean body mass as an energy supplier.
When you sustain a moderate to severe burn injury, energy demands rise significantly due to heat loss through damaged skin and an increase in body heat production as a response to the injury. All these changes are reflected directly in the main body systems. The work of the heart will be doubled and it will struggle to deliver enough blood to the whole body. More carbon dioxide is produced and the lungs need to work harder in order to clear it from the blood. You may get respiratory fatigue. Glucose for energy has to be produced by breakdown of proteins. This results in additional waste products which places additional strain on the kidneys.
The dietician has an essential role in preventing or reducing nutritional imbalance. High protein and high energy food sources are advised. Dietician may follow you up even after discharge, if it is required.

 

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OTHER PROBLEMS


GENERAL INFECTION (SEPSIS). A burn injury affects the immune system and your body is more susceptible to infections with different bacteria, viruses, toxins and parasites. In severe burns, infection can spread more rapidly to different organs. A chest infection can occur. A generalised infection that affects more than two systems of your body has the potential of being life threatening. Strong antibiotics may be added to your treatment.

BLEEDING PROBLEMS. If you have a cut in your skin, you may bleed for a short period of time before the bleeding stops. The coagulation balance is between substances that stop the bleeding and others that maintain the flow inside the blood vessels. A moderate or severe burn injury may cause an imbalance in the complex system of substances that make blood clot: you may bleed more easily or on the other hand you may develop clots in your legs (deep vein thrombosis) or lungs (pulmonary embolism). Both conditions are preventable and treatable in the early stages. Clots from the legs may travel through blood vessels to other places and can be dangerous.

DEFENSE SYSTEM PROBLEMS. The defense mechanism of your body is called the immune system. It is designed to defend you against bacteria, viruses, toxins and parasites normally present in the environment. When you have sustained a burn injury, the immune system is affected. Burned skin causes the release of substances inside your body that can damage the defense mechanisms. You will be more prone to infections.

 

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Defence system

HOW CAN BURN INJURIES AFFECT YOUR EMOTIONAL LIFE?

Burns leave us not only with physical but also with psychological scarring. You may experience flashbacks from the time of injury which can take a long time to disappear. Each Burns unit should have a psychologist. The psychologist will discuss with you any unresolved emotions linked to the burn itself, or to the mechanism of injury. If the burns were deep or you required surgery, the scars changed your body image and your behaviour might be affected. After your discharge from hospital, regular support will be put in place, if you need. Children that have sustained scalds or other types of burns will be followed up till adulthood.


HOW DO YOU SEE YOURSELF?


If you have sustained burn injuries that left visible scars, your body image will change and your self esteem will be challenged. As a direct result, strains in relationships may appear during the recovery period and can continue for a certain period of time. You need to prioritize your concerns. Firstly, you need to focus on healing and later on you may have the energy to tackle the difficult task of accepting yourself as new you. You have to be patient and your partner has to understand that healing is a long process that may take weeks and months. This period cannot be rushed.
It is difficult to feel “in the mood” when questions about identity and purpose in life are raised in your mind. If any unresolved issues in your relationships were present prior to burn injury, may come back during stressful period of recovery and counselling may be required.

HOW CAN I IMPROVE MY SELF-ESTEEM?


The best advice is: DO NOT USE your past level of achievement as your present ones. Take it step by step with small goals over a short period of time (days, or at the most, a week). Celebrate when you meet the goals. You will re-build your self confidence.
Be patient! Healing and adjustment require TIME!. You will be more prone to infections.

 


HOW CAN I OVERCOME MY DEPRESSION AND ANXIETY?


Burn injuries may change your life but will not themselves cause you depression and anxiety. They will be caused by the changes in your life and your reactions to these forced events. People react differently to new events ranging from total denial to realistic acceptance. Stay active, do the exercises that the physiotherapist showed you! An active person copes better with the stress. Focus on what you can do and find your strengths.
If your feelings of anxiety persist, talk with the psychologist from the Burns Unit. You may need some medications and counselling.

 

HOW CAN I DEAL WITH MY EMOTIONS?


Discharge from hospital is an important event to you and your family. You may discover soon that your feelings will overwhelm you and it may be difficult to control them. It is normal. You may feel angry, frustrated and easily upset.
You have to keep in mind that the burn injury affects the whole family. Everyone needs time for readjustments. You may feel like a burden for your family. Talking to the family members, close relatives and friends and sharing your feelings will help you and also them to understand each other better.
If you feel that you cannot cope with your feelings and the changes in your life, you may want to talk to a counsellor or the psychologist from the Burns Unit.

 

HOW CAN I DEAL WITH MY ANXIETY?


Anxiety is another normal reaction to the changes in your life caused by burn injuries. There are methods that can relieve your stress such as: listening your favourite music, watching video during physiotherapy exercises, etc. Regular exercises and deep breathing exercises will improve the body's stress response. If these methods do not work and anxiety is still a cause of concern, please discuss with your doctor or with the nursing staff from the Burns Unit at the next appointment.

The information regarding the impact of burn injuries on your emotional life is a copyright protected material used with the permission of the authors and the University of Iowa Hospitals and Clinics, USA.

 

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