What are the clinical manifestations of burns?

Updated: Jan 10, 2018
  • Author: Robert L Sheridan, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Two of these, burn wound cellulitis and invasive burn wound infection, are seen with some regularity by clinicians outside a burn center environment.

Burn wound cellulitis (see the image below) usually manifests with progressive erythema, swelling, and pain in the uninjured skin around a wound. Usually, this is seen in the first few days after the burn occurred and is typically caused by S pyogenes. Infection can progress rapidly, but it is generally sensitive to penicillin. Excision of associated deep eschar can be essential to the successful treatment of cellulitis. Elevation to reduce edema is an important adjunct.

Initial evaluation and management of the burn pati Initial evaluation and management of the burn patient. Burn wound cellulitis manifests with increasing erythema, swelling, and pain in uninjured skin around the periphery of a wound.

Invasive burn wound infection (see the image below) is a rapid proliferation of bacteria in burn eschar that invades underlying viable tissues. A change in color, new drainage, and, occasionally, a foul or sickly sweet odor are clinical findings. Pseudomonal and other gram-negative species are common causes. This infection can be life-threatening and usually requires combined treatment with surgery and antibiotics.

Initial evaluation and management of the burn pati Initial evaluation and management of the burn patient. Invasive burn wound infection implies that bacteria or fungi are proliferating in eschar and invading underlying viable tissues. These wounds display a change in color, new drainage, and often a foul odor. These infections are life-threatening.

Fever and systemic toxicity commonly accompany both infections. Inspect burn wounds frequently to identify infection early. This is an important consideration in outpatient burn care. Someone must inspect the wounds managed in the outpatient environment to promptly detect infections. Errors in initial depth assessment are routine. Infections occur and must be treated in a timely manner. A wound monitoring plan is an essential part of burn care.

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