What factors decrease the rate of survival of burn injuries? Select all that apply

Question

1. Cardiac disease
2. Renal disease
3. Endocrine diseases
4. History of substance abuse
5. Age

Answer 1

1. Cardiac disease
2. Renal disease
3. Endocrine diseases
4. History of substance abuse
5. Age

Rationale: Cardiac and respiratory diseases. Previous cardiac disease increases the mortality rate because the added insult of burn injury is overwhelming. Stimulation of the sympathetic nervous system causes the release of catecholamines (epinephrine and norepinephrine), increases systemic vascular resistance, and thus increases cardiac workload. Renal disease. The hypovolemia that occurs as a result of fluid shifts causes a decrease in renal blood flow and filtration rates, which increases the risk for renal failure. There is a higher risk for renal failure when any of the following is also present: dehydration, acidosis, massive presence of necrotic tissue after third- and fourth-degree electrical and chemical burns, hypercatabolic state, and/or shock. Renal failure increases the mortality rate of burn injuries. Endocrine diseases. In the presence of endocrine abnormalities such as diabetes, the added insult of a burn injury exacerbates the disease and impacts wound healing and the immune response. These patients tend to die from overwhelming infection. History of substance abuse. Preinjury status is a major factor in an individual's ability to survive a burn injury. Age. The very young and the elderly have higher mortality rates than a young adult with the same percentage of burn injury. In the younger population (usually under 2 years of age), there are two specific reasons for increased mortality. First, infants and young children have an immature immune system with a weak antibody response to infection and tend to die of septicemia. Second, the very young have a greater proportion of body surface area per amount of body mass. As a result, there is a higher risk for fluid-volume loss, requiring greater fluid resuscitation for total percent burn as compared to adults. Therefore, there is an increased risk for the development of hypovolemic shock. In the older population (over 60 years of age), burns tend to exacerbate previous medical problems such as cardiovascular disease, renal insufficiency, diabetes, and chronic obstructive pulmonary disease. This population tends to have decreased physiological reserves, which are needed to respond to the stress of a burn injury; therefore, older adults are at a higher risk for shock and multisystem organ failure. Additionally, the older population tends to heal more slowly, resulting in a greater risk for the development of infection and pneumonia.