Answers and Discussion

Answers and Discussions to the Questions:

• What physiological effects do burn wounds have on the different organ systems of the body?
  
  At the site of the burn tissue necrosis occurs, leading to the breakdown of capillary enothelial integrity.  This results in the leakage of fluid, electrolytes and protein from the intravascular space.  The most dramatic losses occur within the first 12 hours.  This may result in hypovolemia, leading to decreased cardiac output.   Red blood cells may be hemolyzed by the burns or by passing through the damaged capillaries and DIC may result.  Hypovolemia may lead to decreased renal profusion and oliguria.  This combined with hemoglobinuria and myoglobinuria contribute to the development of acute renal failure.  Reduced albumin and loss of immunoglobulins into the wound can lead to decreased immunity.  Liver dysfunction occurs due to congestion and necrosis, which also predisposes to immunosuppression and septicemia. 

• How would you treat the hypovolemic shock?
  
  During the first 24 hours a balanced electrolyte crystalloid solution is recommended.   You want to avoid pulmonary or burn tissue edema.  After capillary membranes become more stable you can give a colloid like plasma or hetastarch.  Maintain total protein levels between 3.5 and 6.5 gm/dL.
  
• How would you manage the wounds?
  
  Topical antimicrobial agents like silver sulfadiazine are best unless a systemic infection is present, in which case a baytril/ampicillin combination works well.  The wounds need to be debrided daily until no more necrotic tissue is present.  The animal may need heavy sedation or even anesthesia for this.  You can cover the wounds with wet-to-dry bandages.  Smaller wounds can heal by second intention but larger ones may require skin grafts.  Keeping all wounds as clean as possible is important so you should consider a urinary catheter and wear gloves at all times when doing anything to these patients.

• How would you manage the pain?
  
  Although morphine (1 mg/kg SQ, q. 6-8 hrs.) is usually great for pain control, it did not work in this case.  This dog was in a lot of pain.  Fentanyl CRI was tried (2-5 mcg/kg/hr, can go up to 10mcg/kg/hr in severe cases) but also was not enough.   "Abercrombie" finally got an epidural catheter placed and was given a morphine/bupivicaine combination on top of occasional doses of IV fentanyl or SQ morphine.   Acepromazine was also used for sedation.  If you see a patient within 2 hours of being burned, apply cold water to the injured tissue and perform passive range of motion exercises if possible on the burned areas to reduce edema formation and maintain preburn motility and function.
  
• What complications do you need to watch for and how would you treat them?
  
  Sepsis is a big problem.  If it starts to develop, give IV antibiotics (baytril and ampicillin combination is good).  DIC may occur--treat appropriately with heparin.   Keep an eye on renal values and total protein--make sure you're keeping up with fluid losses.

• Follow-Up: "Abercrombie" stayed in the critical care unit for over a week.  He was anesthetized daily and had his wounds debrided.   He was in excruciating pain.  The wounds started to granulate in but he had not started to walk again yet.  The owners took him home for a week.  He had a recheck appointment and seemed OK at that time.  Then we were notified that something went wrong and the owners had him euthanized at home.  

Severe Burn Injury Pearls

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Copyright 2000, Wayne E. Wingfield, Colorado State University   
This page was last edited:  04/14/00