Clinical features of burn injuries

1. Pain
   Pain is immediate, acute and intense with superficial burns. It is likely to persist until strong analgesia is administered. With deep burns there may be surprisingly little pain.
2. Acute anxiety
   The patient is often severely distressed at the time of injury. It is frequent for patients to run about in pain or in an attempt to escape, and secondary injury may result.
3. Fluid loss and dehydration
   Fluid loss commences immediately and, if replacement is delayed or inadequate, the patient may be clinically dehydrated. There may initially be tachycardia from anxiety and later a tachycardia from fluid loss.
4. Local tissue oedema
   Superficial burns will blister and deeper burns develop oedema in the subcutaneous spaces. This may be marked in the head and neck, with severe swelling which may obstruct the airway. Limb oedema may compromise the circulation.
5. Special sites
   Burns of the eyes are uncommon in house fires as the eyes are tightly shut and relatively protected. The eyes, however, may be involved in explosion injuries or chemical burns. Burns of the nasal airways, the mouth and upper airway may occur in inhalation injuries.
6. Coma
   Following house fires, the patient may be unconscious and the reason for this must be ascertained. Asphyxiation or head injury must be excluded. Burning furniture is particularly toxic and the patient may suffer from carbon monoxide or cyanide poisoning.
   
   (DAVID J. COLEMAN, Bailey Surgical Textbook)