Unit
- Epidermis: The outermost layer of skin provides a waterproof barrier and contains melanocytes. It is avascular and regenerates from the basal layer. In burns, damage to this layer results in redness and blistering without scarring if the basal layer survives.
- Dermis: Below the epidermis lies the dermis, which contains collagen, elastin, blood vessels, nerve endings, and hair follicles. Burns that penetrate the dermis impair circulation and sensation, leading to longer healing times and increased infection risk.
- Subcutaneous tissue: This layer of fat and connective tissue insulates the body and provides cushioning. Deep burns extending into subcutaneous tissue often require surgical intervention and carry higher morbidity due to fat necrosis and fluid loss.
- Zones of injury: A burn wound has three zones: the zone of coagulation (irreversible damage), the zone of stasis (compromised blood flow but potentially salvageable), and the zone of hyperemia (increased blood flow). Proper wound care aims to prevent the zone of stasis from converting to coagulation.
- Inflammatory phase: Immediately after injury, vasodilation and capillary permeability increase, leading to edema. Neutrophils and macrophages clear debris. Systemic inflammatory response syndrome (SIRS) can occur in large burns, affecting remote organs.
- Proliferative phase: Fibroblasts deposit collagen, and angiogenesis restores blood supply. Epithelial cells migrate from wound edges. This phase requires a moist environment and protection from infection to support healing.
- Maturation phase: Collagen remodeling occurs over months to years, reducing scar thickness and improving pliability. Hypertrophic scarring and contractures can develop without proper management, emphasizing the need for ongoing follow-up.
- Systemic effects: Large burns trigger metabolic stress, hypermetabolism, and catabolism. Increased heart rate and respiratory rate compensate for fluid loss and tissue demands. Understanding these systemic effects helps care teams anticipate complications.
- Loss of barrier function: Burned skin loses its ability to retain moisture and resist microbial invasion. Transepidermal water loss increases dramatically, leading to dehydration and electrolyte imbalances. The compromised barrier also allows pathogens easy entry, making infection a leading cause of morbidity in burn patients.
- Metabolic response to large burns: The hypermetabolic state driven by catecholamines and cortisol increases resting energy expenditure by up to 100 percent. Muscle protein breakdown accelerates to supply amino acids for wound repair, leading to rapid weight loss. Early enteral nutrition is essential to mitigate catabolism and support immune function.
Scope of Practice
Role: Burn Care Coordinator in an Inpatient Burn Unit
Within scope:
- Educating patients and families about skin anatomy and healing phases using approved materials.
- Documenting wound characteristics such as depth, color, and exudate as observed by nursing staff.
- Coordinating interdisciplinary team meetings to discuss wound progression and treatment plans.
- Providing emotional support to patients during dressing changes within established protocols.
- Tracking patient vitals and reporting changes to the medical team.
Outside scope:
- Diagnosing burn depth or classifying injury zones independently.
- Prescribing wound care products or modifying treatment orders.
- Performing debridement or applying topical agents without direct supervision.
- Interpreting laboratory results to guide clinical decisions.
- Assuming responsibility for surgical planning or operative care.
Quick Revision
- Skin consists of epidermis, dermis, and subcutaneous tissue; burn depth determines healing potential.
- The zones of injury guide clinical assessment and treatment priorities.
- Burn wound healing progresses through inflammatory, proliferative, and maturation phases.
- Large burns cause systemic effects including hypermetabolism and SIRS.
- Care coordinators support wound documentation and patient education within scope boundaries.