Physiology of Burns and Management - Desklib

Running Header: PHYSIOLOGY OF BURNS AND THE MANAGEMENT 1
PHYSIOLOGY OF BURNS AND THE MANAGEMENT
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PHYSIOLOGY OF BURNS AND THE MANAGEMENT 2
Question 1. Considering Johnno’s mechanism and pattern of injury, develop a concept
map OR provide a written description, that outlines of the pathophysiological processes
that lead to the physiological signs reported on handover from paramedics.
a. Concept map of the pathophysiology of the burns.
Major Burns >30% TBS
Cell lysis
Possible
inhalation
injury
Loss of skin
barrier
Capillarity
permeability.
Sodium, H2O and proteins
shift from intravascular to
interstitial spaces.
Reduced Circulating
blood volume up to
50%.
Burn shock.
Myocardial depressant
factor
Massive stress response,
sympathetic nervous
system activation.
Blood
pressure
reduces.
Hemolysis Hyperkalemia
Hemoglobin/
myoglobin in
urine
Increased
concentration of
RBCs
Increased
blood
viscosity
Hyponatremia
Thermo-
regulation
problems
Impaired
immune
response
Inflammatory
response

PHYSIOLOGY OF BURNS AND THE MANAGEMENT 3
Adrenal Corticoid
hormones and
catecholamine
release
Peripheral
vasoconstriction
.
Tachycardia Hyperglycemia catabolism Risk of
curling’s
ulcer
Metabolism
(after burn
shock resolves)
Decreased Afterload
Decreased Cardiac
output
Tissue perfusion
Reduced GI
blood flow.
Reduced
renal blood
flow.
Anaerobic
metabolism
Tissue
Damage
Cellular
dysfunction
Risk of
acute renal
failure
Risk of
ileus
Metabolic
acidosis
Potential
tissue
necrosis
Cell
swelli
ng

PHYSIOLOGY OF BURNS AND THE MANAGEMENT 4
b. Pathophysiology and the clinical signs.
Firstly, on chest examination, an expiratory wheeze characterized with a coarse crackle
on both upper lobes with a decrease of the lung sounds on the mid zones bilaterally. In addition
to this, his sputum is carbonaceous which is an indication that the patient has inhalational burns.
Her partial pressure of oxygen (PaO2) is 126mmHg, partial pressure of carbon dioxide (PaCO2)
is 46mmHg, pH 7.31, HCO3 17, BE -2.3, K+ 5.1, Na+ 132, BGL 5.6 mmol/l,
carboxyhaemoglobin > 25% and the Hct 51%. The PaO2 is elevated, the PaCO2 is slightly above
the normal, the pH is acidic, there is a base deficit of -2.3, the potassium levels are elevated
while the sodium levels are normal, and the bicarbonate level is low. This clearly shows that the
patient is having metabolic acidosis as explained in the pathophysiology, there is decreased
tissue perfusion which has led to the anaerobic respiration. In addition to this, there is
bronchoconstriction as a result of the release of the serotonin, histamine, and thromboxane which
are very powerful vasoconstrictors and the patient has a circumferential full-thickness burn on
the chest. This two causes constriction of the chest reducing the lung volumes which reduces
CO2 clearance. An expiratory wheeze with a crackle is as a result of the air trying to get out of
the lung through the constricted pathways (Kreimeier, 2016).
Secondly, his systolic blood pressure is 138mmHg while his diastolic pressure is
72mmhg. His heart rate is 138 beats per minute this is a sinus tachycardia. His capillary refill is
longer than 4 seconds. He has cool peripheries and his esophageal temperature is at 36’ c. This
manifestation results from the pathophysiology of the burn. As explained above, there is
hypovolemia as a result of the burn wound. This reduces the cardiac output which initially causes
a drop in the blood pressure. In response to this, the catecholamine’s are released which causes
vasoconstriction, increasing the peripheral resistance which in turn causes an increase in the