Phases of Burn Injury
One of the primary causes of severe burns often occurs during a major fire in an apartment complex that is unprepared for or unsafe in an emergency evacuation. Often tenants with no warning of this imminent danger are trapped by flames or smoke and cannot easily access escape routes to safety, putting them at high risk of suffering from major burns, including first-, second-, or third-degree burns and death.
Building safety is the responsibility of the landlords, whom many times are found negligent of providing adequate fire exits, smoke detectors, self closing doors, and other safety equipment and instructions for tenants. In NYC alone, fires are a huge problem and are often the result of safety and negligence issues on the part of property owners and managers.
If you are a burn injury victim as a result of a fire, contact the law firm of Ronemus & Vilensky, LLP, attorneys experienced in fighting for the rights of fire and burn injury victims in some of the most devastating cases in the city.
Burn Injury Stages
Victims of severe burn injuries experience extreme pain. The amount of time required to recover from a serious burn depends on the extent of the burn and the steps taken in the healing process. The more severe the burn injury, the more likely treatment will be required by a burn specialist. Burn management is critical in the healing process.
In addition, many factors should be considered during the early phase of assessing and treating a patient. Factors to address include a patient’s vital signs, amount of fluid loss, signs of thermal injury, respiratory failure, blood flow, and possible carbon monoxide poisoning.
Following are the various phases of burn injury, according to the National Institutes of Health (NIH).
The emergent phase begins with the onset of a burn injury and lasts until the fluid resuscitation phase is completed or for approximately 24 hours. During this initial phase, the priority in the care for the burn victim often involves maintaining a sufficient airway for breathing and providing proper care and treatment for burn shock.
As quickly as 20 minutes after the burn occurs, injury to the capillaries can cause significant fluid and electrolyte shifts from the vasculature into the interstitial tissues. The primary concern is hypovolemic shock, as the vascular fluids move into interstitial spaces (second-spacing) and areas generally with no fluid (third-spacing), leading to vascular volume loss. Examples of third-spacing include blisters and edema. Capillary permeability is restored by adequate fluid replacement. As interstitial fluid gradually returns to the vascular space, edema disappears, and diuresis begins.
The emergent phase usually lasts 48-72 hours from when the burn occurred. The beginning of diuresis marks the end of the emergent phase.
Fluid Replacement by IV
Patients with 15% TBSA (total body surface area) or more will require approximately two large bore IV access sites for infusing large volumes of fluid. Once the patient’s fluid needs have been properly calculated, using the Parkland (Braxton) formula, crystalloid solutions (Lactated Ringer’s) or colloidal solutions (albumin) are infused as scheduled.
Colloidal solutions are advisable following the first 12-24 hours post-burn when capillary permeability returns to normal and the fluid stays in the vasculature for circulation. After that, the rate of fluid administration is based on patient response, such as urine output or vital signs, on an hourly basis.
Once the patient reaches the acute phase of burn management, the primary focus should be facilitating wound care, particularly with deep or full-thickness burns. This may last for weeks or months, depending on the body’s response to treatment, and begins with diuresis and concludes with burn wound healing or skin grafting.
The patient may require psychosocial support as the reality of their condition sets in. The patient’s laboratory values, especially sodium, potassium, and glucose, should be closely monitored as capillary permeability normalizes. As with any trauma patient, once the burn wounds begin to heal, the patient should begin to do stretches and movements to prevent the occurrence of painful contractures, as this could become a significant concern.
Diuresis to Near Wound Closure
Fluid mobilization results in diuresis and the patient becomes less swollen. Necrotic tissue around the wound begins to separate as fibroblasts form granulation tissue. Burn wounds will begin healing within 10-21 days, provided they are kept moist and infection-free. However, in severe cases, such wounds will likely require the surgical excision of burn eschar (stiff, dead skin issue) and may also require the application of skin grafts for healing.
In the final stages of burn care management, wounds should have healed, and the patient can now begin the process of self-care and rehabilitation. In addition, they should be provided psychosocial support to help them manage changes to their body image.
Newly-healed areas of the skin may likely be hypersensitive to sun and heat, so the patient should be instructed to avoid direct sunlight for at least the next three months. Furthermore, the patient should be instructed on handling wound care and dressing their wounds in clean bandages. Home care nursing services are advisable for follow-up care following discharge from a hospital or clinic if necessary.
Contact Experienced NYC Fire Accident Attorneys
Attorneys Ronemus & Vilensky work closely with burn injury victims to preserve their rights. Most importantly, we always work hard to help hold those responsible for fire tragedies accountable to the victims. Contact our NYC Burn Injury Attorneys today for a free consultation or call 212-779-7070.