Burns totally destroy homeostasis, or the body's ability to regulate its processes. The worst pain from a burn comes with second degree burns because the nerve endings are left exposed, and this results in throbbing, intense pain. Third degree burns are worse but actually hurt less, since protective sensation has been interrupted by the burn. Patients with severe burns undergo daily debridement (removal of dead tissue and cleansing) and wound care, which also causes extreme pain.
The three major problems confronting burn patients are:
Burns cause a massive immune system response to the trauma. The loss of skin also means that the patient's metabolism skyrockets as the body tries to stay warm. This takes tremendous energy and calories--energy gets generated, but calories and fluids are used beyond a person's ability to take them in. A burn of a little as 6 percent of the total body surface area is enough to be fatal to both children under 6 and older adults.
A person with a larger percentage body burn (referred to by their total body surface area) or severe, combined thermal and inhalation injury often do not retain conscious memory of this early phase.
Burns that will heal by primary intention (without surgery) generally do so within two to three weeks. The longer the wound takes to heal, the more scarring may develop afterward during the collagen formation, remodeling and remolding phase of healing. Also, some cultural/racial groups scar worse than others (genetics is thought to be the culprit). People of African, Celtic and Mediterranean descent scar worse than other groups. They develop more hypertrophic (raised) scarring and keloid scarring. This group may or may not be helped by cosmetic surgery following/during late phases of recovery.
Information courtesy of Ann Burkhardt, OTR/L,
a fellow of the American Occupational Therapy Association