![]() ![]() These burns will need only local burn wound care and pain control. Most burns are small and classify as minor burns with the primary symptom being pain. Fluid loss locally at the burn site, fluid shifts systemically, plus decreased cardiac output and increased vascular resistance, can all lead to marked hypovolemia and hypoperfusion called “burn shock.” This condition can be managed with aggressive fluid resuscitation, as discussed in the Burn, Resuscitation, and Management chapter. Large burns (>20% body surface area) also cause a systemic response from the release of inflammatory and vasoactive mediators. In clinical practice, burns are dynamic injuries that may progress over hours to days, making it difficult to accurately determine the various zones during the early course of the injury. The outermost area is the zone of hyperemia, representing an area of reversible vasodilation and an area that usually returns to normal. Surrounding this is the zone of ischemia or stasis, representing an area of decreased circulation and an area at increased risk of progression to necrosis due to hypoperfusion or infection. The innermost injury is the zone of coagulation or necrosis, representing the area of irreversible cell death. The local injuries can be roughly separated into three zones of injury analogous to a circular target pattern. Thermal burns cause both local injuries and, if severe (> 20% of body surface area), a systemic response. There are various other structures within the skin like hair follicles, sebaceous glands, sweat glands, capillaries, and nerve endings. Two primary layers comprise the skin, the thinner outer layer called the epidermis, and the deeper, thicker layer called the dermis. The main skin functions are protection (infection, temperature changes, physical forces, chemicals, etc.), body temperature regulation, preventing fluid loss, and cosmetic/identity. ![]() The skin is the largest organ of the body, making up about 16% of a person’s weight. ![]()
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