Clinical
features of burn injuries
Pain
Pain is immediate, acute and intense with superficial burns. It is
likely to persist until strong analgesia is administered. With deep burns there
may be surprisingly little pain.
Acute
anxiety
The patient is often severely distressed at the time of injury. It is
frequent for patients to run about in pain or in an attempt to escape, and
secondary injury may result.
Fluid
loss and dehydration
Fluid loss commences immediately and, if replacement is delayed or
inadequate, the patient may be clinically dehydrated. There may initially be
tachycardia from anxiety and later a tachycardia from fluid loss.
Local
tissue oedema
Superficial burns will blister and deeper burns develop oedema in the
subcutaneous spaces. This may be marked in the head and neck, with severe
swelling which may obstruct the airway. Limb oedema may compromise the
circulation.
Burns of the eyes are uncommon in house fires as the eyes are tightly
shut and relatively protected. The eyes, however, may be involved in explosion
injuries or chemical burns. Burns of the nasal airways, the mouth and upper
airway may occur in inhalation injuries.
Coma
Following house fires, the patient may be unconscious and the reason for
this must be ascertained. Asphyxiation or head injury must be excluded. Burning
furniture is particularly toxic and the patient may suffer from carbon monoxide
or cyanide poisoning.