Most burns heal without
major complications. Extensive burn injuries may affect
all your body, require complex treatment and complications
The more severe the burns are, the higher the possibility
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
- Your previous health
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).
^ top of page
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
^ top of page
If you have sustained burns big enough to require fluid
supplement, it is important that adequate amount of fluids
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
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.
^ top of page
The heart and the blood vessels
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
^ top of page
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.
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).
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.
^ top of page
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
^ top of page
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.
^ top of page
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.
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.
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
^ top of page
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
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.
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
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
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
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.
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.
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.
^ top of page