Burn injury is characterized by a hypermetabolic response with physiologic, and immune effects. The intensity of damage obtained can be determined by temperature which the skin has been exposed to and an agent causing the burn. Some causes of burns are chemical burns, electrical burns, radiation, and thermal burns. The Jacksons thermal wound theory talks about three zone that is identified at the site of cutaneous injury: zone of coagulation is the center of wound where necrosis happens, zone of stasis surrounds the zone of coagulation where there is moderate tissue damage and causing vascular leak and zone of hyperemia surrounds zone of stasis where there is no damage to tissue but has some inflammation.
Systemic changes that happen during the initial stages of burns are release of vasoactive peptides which cause altered capillary permeability leading to loss of fluid causing severe hypovolemia which further leads to decreased cardiac output, decreased renal blood causing renal failure, altered pulmonary resistance causing pulmonary edema, systemic inflammatory response syndrome (SIRS) and lastly multi-organ failure. Edema is initiated in the first hour following the burn. The primary phase is an increase in the water content of the injured tissues followed by the second phase which is a more gradual increase in fluid flux within 12-24 hours post-burn. After the 24th-hour mark sepsis starts setting in.
Several non-pharmacological and pharmacological strategies have been found to effectively modulate burn-associated metabolism. The initial stages of management are usually fluid resuscitation either to avoid hypovolemia due to fluid loss or treating hypovolemia. Early excision and closure of the burn wounds have shown greater benefit and achievement. Infection in severe burns is always a problem and it leads to mortality thus appropriate measure are usually taken when taking care of burns patient plus the early antibiotic cover is given. Analgesia and nutrition supplements are always an ongoing treatment priority in burns patients in the recovery phase.

To conclude, early recognition of degree and percentage of burns is important and knowing the stages of bodies response to burns helps in early resuscitation. Burn-associated catabolism is very difficult to reverse but through non-pharmacologic and pharmacologic means it can be to some extent. Thus early recognition, early resuscitation and ongoing reduction in sepsis rate in burns patients can decrease mortality.

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