Neurologic aspects of burn injuries

Ravindra Kumar Garg MD (Dr. Garg of King George's Medical University in Lucknow, India, has no relevant financial relationships to disclose.)
Peter J Koehler MD PhD, editor. (

Dr. Koehler of Maastricht University has no relevant financial relationships to disclose.

)
Originally released October 19, 2014; last reviewed March 30, 2020; expires March 30, 2023

This article includes discussion of neurologic aspects of burn injuries, thermal injury, burn trauma, fire-related injuries, heat injury, fluid resuscitation, and septic shock. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

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 (Naylor et al 1996; Hattery et al 2015). Ambroise Paré (1510-1590), the famous French barber-surgeon, contributed immensely to the surgical care of burns (Thomsen 1977). French surgeon Guillaume Dupuytren described wound debridement. The three zones of a burn were described by Jackson (Jackson 1953).

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 (Evans et al 1952).

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