What is the biggest challenge facing doctors in the first days after a burn injury?  Fluid loss.  

When a victim suffers severe burns, much of his skin may be gone and to put it very simply, his capillaries begin to leak. Instead of sticking together, keeping blood inside of the vessel, the tissue cells separate and become very porous. Huge amounts of fluid pour out into the tissue. In small burns this fluid accumulates only in the burned areas but in very large burns fluid can accumulate everywhere in the body. A burn patient can develop a significant amount of swelling at the expense of blood flow. The blood volume goes down as the patient becomes more swollen.  Because his heart is unable to pump enough blood to the body, he develops shock.  This shock may cause other organs to stop working.  Doctors will combat these effects by providing the patient with fluids, electrolytes, antibiotics, pain medication, tetanus vaccination and often by inserting a catheter.  The catheter is needed to measure urine output and monitor fluid levels. 

Also, with the infusion of fluids the doctors must constantly monitor the patient’s circulation in his arms and legs.  A condition called compartment syndrome can arise in a burn patient when

  • stiff scars wrap around the limb and the tissue in that limb causing fluid loss; and/or,
  • swelling results from all the fluid administered to combat the losses fluid in the blood vessels and tissues. 

Compartment syndrome can even occur in the chest/abdomen if the patient’s trunk is badly burned and the skin cannot handle the swelling.  When necessary doctors will relieve the compartment syndrome by performing an escharotomy or fasciotomy

Approximately 50% of all deaths that occur within first 10 days following burn injury are due to inadequate fluid resuscitation necessitated by the burn.