Physiological Changes

Cardiovascular Fluid shifts from the vascular to the interstitial space occur because of increased permeability related to the inflammatory response. Hypovolemic shock may result, or it may be overcorrected by overzealous fluid replacement, which can lead to hypervolemia. Hypertension occurs in about one-third of all children with burns, possibly caused by stress.

Pulmonary Pulmonary edema brought about by primary cellular damage or circumferential chest burns limiting chest excursion can occur. Byproducts of combustion may lead to carbon monoxide poisoning. Inhalation of noxious gases may cause primary pulmonary damage or airway edema and upper airway obstructions.

Genitourinary Potential for renal shutdown brought about by hypovolemia or acute renal failure exists. Massive diuresis from fluid returning to the vascular space marks the end of the emergent phase. Patients may develop hemomyoglobinuria because of massive full-thickness burns or electric injury. These injuries cause the release of muscle protein (myoglobin) and hemoglobin, which can clog the renal tubules and cause acute renal failure.

Gastrointestinal Paralytic ileus can result from hypovolemia and last 2 or 3 days. Children, in particular, are susceptible to Curling's ulcer, a stress ulcer, because of the overwhelming systemic injury.

Musculoskeletal Potential exists for the development of compartment syndrome because of edema. Echaratomy (cutting of a thick burn) may be needed to improve circulation. Scarring and contractures are a potential problem if prevention is not started on admission.

Neurologic Personality changes are common throughout recovery because of stress, electrolyte disturbance, hypoxemia, or medications. Children, in particular, are at risk for postburn seizures during the acute phase.

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