COMPLICATIONS OF BURNS
CHANDRASEKAR.L
LECTURER,
MAJMA’AH UNIVERSITY
PHT 331 – SECTION - 1422
Lecture outline
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
This lecture deals about the complications of burns in the following subcategories;
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1. Cardiorespiratory complications

2. Septic complications
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3. Gastrointestinal complications
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4. Other complications
PHT 331 – SEC 1422
1-Jul-16
Lecture Objective
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At the end of this lecture the students will be able to;

Explain the complications of burn in different systems level.

Compare & contrast the complications of burns between different
systems.
PHT 331 – SEC 1422
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Cardiorespiratory complications:
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Acute Lt ventricular failure
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Congestive cardiac failure

Myocardial infarction

Pneumonia

Pulmonary embolism.
PHT 331 – SEC 1422
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Septic complications
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Burn wound sepsis
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Virus infection

Bacteremia
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Septic shock
PHT 331 – SEC 1422
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Gastrointestinal complications
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Hepatic dysfunction
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Pancreatitis
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Calculus cholecystitis
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Renal complications
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Other complications
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Neurological complications
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Vascular complications
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Skeletal complications
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Amputation
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VASCULAR CHANGES RESULTING FROM BURN INJURIES
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
Circulatory disruption occurs at the burn site immediately after a burn injury

Blood flow decreases or cease due to occluded blood vessels



Damaged macrophages within the tissues release chemicals that cause
constriction of vessel
Blood vessel thrombosis may occur causing necrosis
Macrophage: A type of white blood that ingests (takes in) foreign material. Macrophages are key players in the immune response to
foreign invaders such as infectious microorganisms.
PHT 331 – SEC 1422
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Infectious complications
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 The
most frequent complications of the major burn are due to bacterial, fungal
infection.
 Burn wound sepsis is an imbalance in the equilibrium between bacterial and host
resistances resulting in numerical increase in bacteria.
 As bacteria increase from normal level of 103 organism per gram of tissue to level of
greater than 105 organism per gram of tissue. So
they break out the hair
follicles and the glands and migrate through colonizing a long dermal subcutaneous
interface.
 Level of growth in excess of 105 organism per gram. Of tissue constitute ( burn wound
sepsis).
 Level of 108 to 109 organism per gram may be associated with lethal burn.

In rare cases, an infected burn can cause blood poisoning (sepsis) or toxic shock syndrome (TSS). These are serious conditions that
can be fatal if not treated. Signs of sepsis and toxic shock syndrome include a high temperature, dizziness and vomiting.
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Renal failure:
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 Un
treated hypovolemia leads to acute renal failure.
 Acute
renal failure that may occur if the principles of fluid resuscitation
are not understood
 Following
an acute burn, oliguria or anuria shouldn't be diagnosed as
renal failure but only ( insufficient volume replacement).
 To
be sure that patient takes adequate fluid resuscitation, the amount
of urine output must be ( 30-50 ml per hour).
PHT 331 – SEC 1422
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Inhalation injury:
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 First
group of patients are die at site of fire within moments of
injury because of:
 Asphyxia
( as the o2 will be consumed)
 At concentration of 2%, the death ensues in 45 sec.
 The inspired air contain co that can reach to 3000 ppm, combine with Hb and
decrease availability of tissue to o2 .
 Inhalation of HCN contained in smock, this cause rapid tissue hypoxia plus
hyperventilation.
 Inhalation of sulphur dioxide and hydrochloric acid that cause bronchospasm.
 The edematous response of larynx.
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Inhalation injury: cont……
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 The
next group of patients with pulmonary complications develop
respiratory symptoms several hours after admission.
 These
group of patients develop hypoxia and hypercapnia and high levels of
carboxyhaemoglobin, restlessness, wheezing.
PHT 331 – SEC 1422
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Hepatitis
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
It is a leading cause of death in burn victim.
 Multiple blood transfusions add to risk of infection.
 Several anesthesia may be required during the course of
management, exposing the patient to the dangers of drug induced
hepatitis.
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Musculoskeletal complications :
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 Complications
 Exposed
PERIARTICULAR
CLASCIFICATION
involving bone
bone
 Fractures
 Osteoporosis
 Bone
spurs
 Bone growth retardation
 Heterotopic ossifications: - Formation of new bone in tissue that manually don't
ossify
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Musculoskeletal complications : Cont…..
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 Complications
involving joint
 Septic
arthritis
 Capsular tightness
 Dislocations
 Complications
 Exposed
involving tendon
tendon
 Tendonitis
 Structural
TENDON DESTRUCTION
FOOT DROP CONTRACTURE
deformities subsequent to scarring and scar management.
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Scarring
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


A scar is a patch or line of tissue that remains after a wound has
healed. Most minor burns only leave minimal scarring. You can try to
reduce the risk of scarring after the wound has healed by:
applying an emollient, such as aqueous cream or emulsifying ointment,
two or three times a day
using sunscreen with a high sun protection factor (SPF) to protect
the healing area from the sun when you are outside
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


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Hypertrophic scar = continued
production of collagen
Keloid = ….with extension into
surrounding tissues
Scar contracture
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
The hypertrophic scar is defined as a widened or unsightly
scar that does not extend beyond the original boundaries of
the wound. Unlike keloids, the hypertrophic scar reaches a
certain size and subsequently stabilizes or regresses.

Keloid scars are defined as an abnormal scar that grows
beyond the boundary of the original site of a skin injury. It is a
raised and ill defined growth of skin in the area of damaged
skin.
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Burn Scars - Hypertrophic
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Burn Scars - Keloid
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Burn Scars - Contracture
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Burn Scars - Contracture
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Peripheral neuropathy
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
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Weakness of muscles
Lack of sensations
Types:
Generalized peripheral neuropathy (poly neuropathy) - Patient
complains of fatigue and lack of endurance, distal weakness in upper
and lower extremity.
Local neuropathy: - It is caused by a stretch or compression injury to a
single nerve.
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Shock
After a serious injury, it is possible to go into shock. Shock is a life-threatening
condition that occurs when there is an insufficient supply of oxygen to the body. It's
possible to go into shock after a serious burn.
Signs and symptoms of shock include:
a pale face
cold or clammy skin
a rapid pulse
fast, shallow breathing
yawning
unconsciousness
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PHT 331 – SEC 1422
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COMPLICATIONS OF BURNS
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
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Heart problems
Inhalation injuries
Pneumonia
Adult respiratory distress syndrome - ARDS (shock lung)
Infection of the wound site
Infection of the urinary tract
Septicemia
Renal and liver failure
Joint effusion and periarticular swelling
Calcification of periarticular tissues
Contraction of scar tissue causing joint deformity
Psychological trauma to the patient
PHT 331 – SEC 1422
1-Jul-16