This chapter discusses the diagnosis, evaluation and management of burns. Respiratory insufficiency or failure may result from mechanical or physiological mechanisms following a thermal injury. Thermal injuries can result in a significant impact to the cardiovascular system. The cardiovascular insufficiency observed following thermal injury may result from direct cardiac suppression via inflammatory mediators, alterations in preload, cardiac contractility, or peripheral vascular tone. The secondary assessment of a thermal injured patient should follow a systematic approach similar to that of a trauma patient. The thermal injuries should be evaluated and classified based on degree and extent of injury. A Lund and Browder chart can assist in the establishment of the extent and depth of thermal injury based on the body part affected. Partial thickness burns greater than 10% total body surface area (TBSA) is one of the criteria for patients who would benefit from transfer to a burn center.

Many poisonous substances produce their primary toxic effects by affecting neurotransmission. Recognition of several known toxidromes may narrow the diagnostic focus and aid in management. The various types of toxidromes include: cholinergic syndrome, aticholinergic syndrome, adrenergic syndrome, sedative hypnotic syndrome, opioid syndrome, and withdrawal syndromes. Although many drugs depress the level of consciousness and respiratory drive, the agents most frequently responsible for these effects include opioids or sedative/hypnotics. The toxicity from any of these agents can cause hypotension, hypothermia, pulmonary edema, and hyporeflexia. Electrical injuries can result in numerous immediate and delayed neurological complications. The most common cause of death by either alternating current or direct current (lightning strike) is cardiorespiratory arrest. The most common cause of death in persons with significant thermal injury is multiple organ failure and its complications. Alternating current typically induces ventricular fibrillation and lightning strike (direct current) commonly causes asystole.