Introduction

A major burn injury poses a threat to life which necessitates intensive nursing and medical care. Complications may develop and these will be dealt with in respect to their relevant systems in this chapter.

Respiratory

The incidence of pulmonary complications associated with burn injury is approximately 22% but the mortality of this group is of the order of 80%. Early complications result from upper airway obstruction by oedema, which may go on developing for up to 48 hours, bronchospasm and inhalation of toxic vapours.

Intubation to secure the airway must be considered early as it will become more difficult as oedema develops. Tracheostomy is avoided as it is associated with an increased mortality if performed as an emergency. A serious complication of nasal intubation is sinus infection but the security of fixation of the tube, which may be impossible to replace in the first few days, is so important that the nasal route is preferable to oral intubation. If the tube cannot be satisfactorily taped in position, it must be sutured in place. Oral tubes may be sutured to the teeth.

Fluid resuscitation must not be decreased, but rather increased if inhalational injury accompanies a cutaneous burn since it will improve circulatory support without worsening lung oedema. Steroid therapy is no longer advocated as it has been shown to be associated with an increased infection rate and mortality. Prophylactic antibiotics are not recommended as their use results in infection by resistant bacteria. Sputum must be cultured regularly and if infection develops appropriate antibiotic therapy must be instituted.