7 Burn Complications

Timing and immediate priorities

Burn complications may develop within minutes or hours, during resuscitation, or weeks to months later. At every stage, prioritize immediate threats to airway, breathing, circulation, and limb perfusion. Reassess new or worsening changes and promptly involve the burn team when a serious complication is suspected.

Airway injury

After an enclosed-space fire, facial burns, soot around the mouth, and a newly hoarse voice can signal an Evolving airway injury. Airway swelling may progress, so urgently assess the airway and arrange early expert airway management. Do not wait several hours, for oxygen levels to fall, or for airway obstruction to become advanced.

Perfusion and limb ischemia

Resuscitation and circulation

Increasing confusion, falling urine output, and cool extremities during initial treatment can indicate Poor perfusion. These findings may also reflect another evolving problem, so reassess perfusion and the patient's injuries and promptly alert the resuscitation or burn team. Treatment should be adjusted under clinical supervision; neither continuing unchanged without reassessment nor abruptly stopping all intravenous fluids is appropriate.

Limb circulation

Several hours after a circumferential full-thickness limb burn, increasing tightness, worsening pain, numbness, or weaker distal pulses can indicate impaired circulation and ischemia beneath Circumferential eschar. Elevate the limb, urgently notify the burn team, and repeat and document neurovascular assessments. The burn team determines whether decompression, such as escharotomy, is indicated. Do not apply a tight compression dressing or wait for the hand to become pale and pulseless.

Infection and kidney complications

Wound infection and sepsis

New burn-wound discoloration or drainage, especially with increasing lethargy or falling blood pressure, requires prompt notification of the clinical team and urgent assessment for invasive Wound infection and sepsis. The team needs to evaluate both the wound and the patient's overall condition and direct treatment. Do not wait for the next dressing change, avoid examining the wound, or start antibiotics without an order.

Kidney injury after electrical injury

A high-voltage electrical injury can damage deep muscle beyond what the visible skin burns suggest. Dark, reddish-brown urine may indicate Myoglobinuria from Rhabdomyolysis, which can contribute to acute kidney injury. Promptly inform the team and monitor renal function and urine output.

Scarring and contractures

Weeks after a deep burn across a joint, a raised, tightening scar and progressively reduced movement can indicate a Contracture. Arrange burn rehabilitation assessment and follow the prescribed positioning, splinting, and range-of-motion plan, guided by the burn team. Do not treat loss of movement as inevitable, stop range-of-motion activity, wait until the scar has fully matured before reporting the problem, or apply an unprescribed tight bandage across the joint.

Later burn complications can include hypertrophic scarring and contractures. Early rehabilitation planning helps address functional limitations.