Burn Complications

A burn patient surviving the first 48 hours doesn't mean the danger is over — the complications that kill often arrive days to weeks later, and nurses catch them first.

Major burn complications extend well beyond the wound itself and follow a timeline. In the first 24-72 hours, the greatest threats are airway compromise from inhalation injury (singed nasal hairs, hoarse voice, carbonaceous sputum, stridor) and compartment syndrome from circumferential burns causing eschar to act as a tourniquet — the intervention is escharotomy, not fasciotomy. Curling's ulcer (stress ulcer) develops within days due to decreased GI perfusion and requires prophylactic proton pump inhibitors or H2 blockers. Sepsis becomes the leading cause of death after the resuscitation phase; watch for altered mental status, fever or hypothermia, tachycardia, and hyperglycemia before wound cultures confirm it. Acute kidney injury results from myoglobin release in electrical and deep burns — dark tea-colored urine signals rhabdomyolysis, and the nursing priority is aggressive IV fluids to maintain urine output of 75-100 mL/hr for myoglobinuria. Contractures develop during rehabilitation when scar tissue shortens across joints; early splinting and ROM exercises are preventive nursing actions, not afterthoughts.

Key Distinctions

Don't confuse escharotomy (cutting through eschar to release pressure, performed bedside, no anesthesia needed because full-thickness burns lack sensation) with fasciotomy (surgical incision into fascia for true compartment syndrome). Students mix up Curling's ulcer (burn-related stress ulcer) with Cushing's ulcer (brain injury-related). Dark urine in burns signals myoglobinuria requiring increased fluids — not decreased fluids for fluid overload.

Clinical Pearl

Think timeline: airway first, compartment syndrome in hours, Curling's ulcer in days, sepsis in weeks, contractures in months. The burn complication clock never stops ticking.