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  • Updated 03.20.2021
  • Released 10.19.2014
  • Expires For CME 03.20.2024

Neurologic aspects of burn injuries

Introduction

Overview

According to World Health Organization estimates, 180,000 deaths occur annually due to burn injury. Burns are often devastating injuries that affect almost every system of the body. Multiorgan failure and sepsis are important causes of death. Immediate management of burn injury requires airway maintenance, 100% oxygen administration, fluid resuscitation, monitoring and maintenance of circulation, nutrition, and measures for pain relief. Various neurologic and musculoskeletal complications may appear a few weeks to years after injury. The risk of stroke is higher in patients with burn injury than in the general population. Burn and pathologic scars can cause intense pain, even without evidence of underlying nerve damage. Psychiatric complications are common among survivors. Neurologic complications are frequently undiagnosed. Some patients develop critical care polyneuropathy. The factors associated with critical care polyneuropathy in burns were prolonged ventilation, large burns, and sepsis. In the presence of preexisting diabetic neuropathy, the management of lower-extremity burn injuries becomes difficult and many of such patients may require limb amputation. Patients with multiple sclerosis and concurrent burn injuries need longer hospital stay and burn triage and treatment. Correct management requires a skilled multidisciplinary approach that addresses all the problems facing a burn patient. In this article, the author discusses the neurologic aspects of burn injuries.

Key points

• A burn is a devastating form of injury caused by thermal, chemical, electrical, or radiation energy.

• Burns affect almost every system of the body and result in several early and long-term complications.

• Burns are associated with pruritus, encephalopathy, neuropathy, and other neuromuscular complications.

• Psychiatric complications are common among survivors.

• Survival of burn patients has improved considerably over the past several decades.

• Multiorgan failure and sepsis are important causes of death.

• Patients with epilepsy have a higher incidence and severity of burn injury.

Historical note and terminology

A burn is an injury caused by thermal, chemical, electrical, or radiation energy. Burn injury has been known since the discovery of fire from prehistoric times. Written descriptions on burns are available dating back to Hippocrates (460 - 377 BC). Egyptian healers made remedies for burns from plants, animal products, and minerals along with divine methods. The Edwin Smith papyrus (1500 BC) used honey and grease for the treatment of burns; Charak and Sushruta (Ayurveda) used honey in burn dressings. Wilhelm Fabry (1560-1634; also known as Hildanus) was the first surgeon who, in 1607, wrote a specific treatise dealing with burn injury titled “De combustionibus.” He described the widely used system for classifying burns injuries (31; 15). Ambroise Paré (1510-1590), the famous French barber-surgeon, contributed immensely to the surgical care of burns (37). French surgeon Guillaume Dupuytren described wound debridement. The 3 zones of a burn were described by Jackson (19).

Availability of sulfa drugs and antibiotics such as sulfonamide in 1932 and penicillin in 1941, during World War II, brought revolutionary changes to burn management. Need for urgent burn resuscitation was felt after major burn disasters of modern time (eg, the Rialto Theatre House Fire in New Haven, Connecticut in 1921 and the Coconut Grove Nightclub Fire in Boston, Massachusetts in 1942). Evans and co-workers devised the fluid resuscitation methods in 1952 (13).

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