Infection is a major complication of burns. Infection is linked to impaired resistance from disruption of the skin's mechanical integrity and generalized immune suppression. The skin barrier is replaced by eschar. This moist, protein rich avascular environment encourages microbial growth. Migration of immune cells is hampered, and there is a release of intermediaries that impede the immune response. Eschar also restricts distribution of systemically administered antibiotics because of its avascularity.
Risk factors of burn wound infection include:
- Burn > 30% TBSA
- Full-thickness burn
- Extremes in age (very young, very old)
- Preexisting disease e.g. diabetes
- Virulence and antibiotic resistance of colonizing organism
- Failed skin graft
- Improper initial burn wound care
- Prolonged open burn wound
Burn wounds are prone to tetanus. A tetanus booster shot is required if individual has not been immunized within the last 5 years.
Circumferential burns of extremities may compromise circulation. Elevation of limb may help to prevent dependent edema. An Escharotomy may be required.
Acute Tubular Necrosis of the kidneys can be caused by myoglobin and hemoglobin released from damaged muscles and red blood cells. This is common in electrical burns or crush injuries where adequate fluid resuscitation has not been achieved.
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