![]() Loss of intravascular fluid into burned areas and edema formation (in nonburned sites) can quickly result in burn shock with impaired tissue and organ perfusion. After major burn injury, continued loss of plasma into burned tissue can occur up to the first 48 h or even longer. Generalized edema even in noninjured tissues occurs when the injury exceeds 25 to 30% total body surface area (TBSA). Operating room concerns for the burn-injured patient include airway abnormalities, impaired lung function, vascular access, deceptively large and rapid blood loss, hypothermia, and altered pharmacology. Burn injury is associated basal and procedural pain requiring higher than normal opioid and sedative doses. Formulae for fluid resuscitation should serve only as guideline fluids should be titrated to physiologic endpoints. Electrical burns result in morbidity much higher than expected based on burn size alone. Approximately 2 to 5 days after major burn injury, a hyperdynamic and hypermetabolic state develops. Hemodynamics in the early phase of severe burn injury is characterized by a reduction in cardiac output and increased systemic and pulmonary vascular resistance. Massive airway and/or lung edema can occur rapidly and unpredictably after burn and/or inhalation injury. Care of burn-injured patients requires knowledge of the pathophysiologic changes affecting virtually all organs from the onset of injury until wounds are healed. ![]()
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