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A patient's skin is stretched and meshed to cover a larger area, before being stapled in place |
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Another major concern is the loss of fluid. When deep burns
cover a large area of the body and the skin no longer provides
an effective barrier against infection, the immune system goes
into overdrive to ward off invading germs. It floods the injured
areas with blood and plasma carrying immune cells, which cause
extensive inflammation and swelling. In some cases the swelling
is severe enough to interfere with breathing, and the patient
must be put on a ventilator.
The massive immune response can also cause fluid to leak from blood vessels throughout the body. This leads not only to dehydration and deterioration of vital organs but also to a dangerous drop in blood pressure, which can result in shock. Indeed, many patients admitted to burn units are already in shock and unable to feel the pain that would be overwhelming if they were conscious. Even when a patient is conscious, though, the burn team must focus first not on painkillers but on stabilizing the blood pressure. The New York team accomplishes this by pumping as much as 8 gal. of a salt fluid into his veins in the first 24 hours of treatment, a process that can cause the patient temporarily to gain as much as 60 lbs. "There is clearly a period at least early on where patients are not getting any type of pain relief," explains director Yurt. "It's too risky. You don't want to give them too much morphine. Otherwise they'll drop their blood pressure." Once the blood pressure stabilizes, however, doctors can begin dripping morphine directly into the veins, gradually increasing the dosage if the pain persists. Still, Yurt admits, "we can never relieve the pain completely."
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