Burns and inhalation injury

Abstract

The disruption of homeostasis caused by a major burn injury provides one of the greatest challenges in clinical patient care. The loss of integrity of the skin destroys the barrier between the balanced inner environment and that of the external world, leading to loss of body temperature, fluids, proteins, and electrolytes, and at the same time allowing ingress of foreign material and invasion by microbes. However, the local tissue damage and the response to it is only the external sign of what quickly becomes a massive systemic response leading to fluid loss in uninjured tissues and dysfunction of distant tissues and organs. From a teleological perspective, the injured human being has not evolved to survive such a massive insult, and therefore it is only in recent years that advances in resuscitation, infection control, and wound care have allowed survival to the point that the full expression of the body to such an injury can be recognized. Success in caring for these patients has come in a stepwise fashion and provides demonstrable support for the value of continuing investigation and the advantages of integrated multidisciplinary care of seriously ill patients. © 2008 Springer New York.