Professional Documents
Culture Documents
Ammon Jensen
Nursing 422
Brother Sanders
In 2006, there were 517,000 visits to emergency departments due to burns (Pitts et al.,
2008). Haynes (2016) reported that 3,280 people died in 2015 in incidents related to fires. Those
that have suffered from fire related incidents often bear the burden of scars which are constant
reminders of a possibly terrible event. This paper will discuss the differences in fluid shift during
Emergent Phase
The emergent phase of a major burn is usually about 72 hours beginning from the time
the incident happened. It is during this time that the burn causes the most threat. With all the
damage done to epidermis, dermis, muscles, and even bone, it increases the permeability of the
blood vessels allowing fluids to leak. Sodium, albumin, and other osmotic agents are able to
move outside the blood vessels and cause the fluid to shift into the interstitial spaces. This is the
initial and most influential cause of hypovolemia with burn victims (Lewis et al., 2014).
Two other causes of fluid shift or hypovolemia in burn victims are third spacing and
evaporation. Third spacing is the loss of fluid into formations such as blisters. It can also form
edema in locations that were not burned but are dependent to the area which was burned. Fluid
loss by evaporation is much more prominent because damage done to the epidermis allows for
The priority during the emergent phase is fluid replacement with electrolytes. Rapid fluid
and electrolyte shift will result in hypovolemia which is one main causes of death with those that
have major burns. It is important to have two large intravenous catheters inserted to administer
fluids and electrolytes quickly for lifesaving measures. One report found that an excess of fluid
BURN VICTIMS 3
resuscitation with colloids reduced mortality with fewer complications such as syndrome, but
Acute Phase
After lifesaving measures restore fluid to the body and prevent death related to
insufficient fluid volume, the body can start to heal. During this phase, which can last weeks to
months, the body is trying to balance electrolytes and fluids. Sodium and potassium play the
largest parts in the electrolyte balance. Both electrolytes need to be carefully monitored as they
can have polarized effects. During fluid resuscitation during the emergent phase, they can use
excess fluids with isotonic solutions or hypertonic solutions. With sodium, you could have water
intoxication or hypernatremia which would result in increased thirst, and dry mucous membranes
As with sodium, potassium will have a large effect if it is at an inappropriate level. Hyper
or hypokalemia can result in cardiac dysrhythmias and different muscle complications such as
weakness or cramping. Since both electrolytes are so important, they will be monitored closely
Conclusion
Although there are many casualties to fires due to major burns, because of the
understanding of the fluid shift during the emergent and acute phases, there are many lives saved.
Interventions can be performed that will allow medical staff to assess where a patient is currently
and make a plan. Current research has proven to be the benefit of all as can be seen with the
knowledge about the fluid shifts during the emergent and acute phases of major burns.
BURN VICTIMS 4
References
Dulhunty, J. M., Boots, R. J., Rudd, M. J., Muller, M. J., & Lipman, J. (2008). Increased fluid
resuscitation can lead to adverse outcomes in major-burn injured patients, but low
Haynes, H. (2016, September). Fire loss in the United States. Retrieved from
http://www.nfpa.org/news-and-research/fire-statistics-and-reports/fire-statistics/fires-in-
the-us/overall-fire-problem/fire-loss-in-the-united-states
Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., Knighton, J. (2014). Medical-Surgical
Pitts, S. R., Niska, R. W., Xu, J., & Burt, C. W. (2008). National hospital ambulatory medical
care survey: 2006 emergency department summary. Natl Health Stat Report, 7(7), 1-38.