Understanding the pathophysiology of a burn injury is important for effective management. In addition, different causes lead to different injury patterns, which require different management. It is therefore important to understand how a burn was caused and what kind of physiological response it will induce. The body's response to a burn Burn injuries result in both local and systemic responses. Local response The three zones of a burn were described by Jackson in 1947. Zone of coagulation-This occurs at the point of maximum damage. In this zone there is irreversible tissue loss due to coagulation of the constituent proteins. Zone of stasis-The surrounding zone of stasis is characterised by decreased tissue perfusion. The tissue in this zone is potentially salvageable. The main aim of burns resuscitation is to increase tissue perfusion here and prevent any damage becoming irreversible. Additional insults-such as prolonged hypotension, infection, or oedema-can convert this zone into an area of complete tissue loss. Zone of hyperaemia-In this outermost zone tissue perfusion is increased. The tissue here will invariably recover unless there is severe sepsis or prolonged hypoperfusion. These three zones of a burn are three dimensional, and loss of tissue in the zone of stasis will lead to the wound deepening as well as widening. Examples of a scald burn (left) and a contact burn from a hot iron (right) in young children Flash injury True high tension injury Current arcs, causing flash No current goes through patient Current passes through patient Differences between true high tension burn and flash burn Electrocardiogram after electrocution showing atrial fibrillation Chemical burn due to spillage of sulphuric acid Clinical review

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This study demonstrates that a systemised trauma network combined with evidence based practice can lead to improvements in patient care.