[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Critical care](https://durgical.com/en/nursing/areas/critical-care/) › Nursing the patient with major burns: inhalation injury, circulation to the limbs, wounds, infection, temperature, pain and nutrition

# Nursing the patient with major burns: inhalation injury, circulation to the limbs, wounds, infection, temperature, pain and nutrition

- Safe practice

In a major burn the nurse watches the airway, the pulses of burned limbs, temperature and infection, controls pain and supports early feeding and movement.

Updated Nov 13, 2026

## Key points

- Suspect inhalation injury after a fire in a closed space: soot in the mouth, singed nasal hair, hoarseness, stridor, carbonaceous sputum or breathlessness.
- Check pulses, capillary refill and pain in burned limbs every hour during the first 72 hours and report changes: escharotomy may be needed.
- Prevent hypothermia: warm room, covered wounds, warmed fluids and gases as ordered; start rewarming if core temperature falls below 36 °C.
- Give analgesia before dressings and procedures as ordered, and assess pain several times a day with a validated tool.
- Start oral or enteral nutrition early, ideally within about 12 hours, as ordered.

## What it is

After the first hours, the patient with a major burn needs close nursing care for days to weeks. The airway can swell after smoke or heat inhalation; circumferential burns of a limb or the chest can cut off circulation or breathing; the loss of skin makes the patient lose heat and opens the door to infection; pain is intense, above all during dressings; and the body enters a long hypermetabolic state that needs early nutrition. Rehabilitation and psychological support start from admission. This page covers that care; the fluid calculation is on the burn resuscitation page.

## What it requires

- Inhalation injury has three types: poisoning by combustion products (carbon monoxide, cyanide), thermal injury to the upper airway and chemical injury to the lower airway.
- Patients with carbon monoxide poisoning can have normal carboxyhaemoglobin on arrival; high-flow oxygen continues until levels are confirmed low.
- Escharotomy is indicated when circumferential eschar threatens the blood supply of a limb or restricts breathing in the chest, abdomen or neck.
- Burns of 20 % TBSA or more carry a high risk of hypothermia.
- Burn patients are prone to infection, including ventilator-associated pneumonia; sepsis and multiple organ failure are the main causes of death.

## How it is applied (and why)

- Assess the airway and breathing often and keep the head raised 30–45° — lung injury from smoke can take time to show.
- Have intubation equipment ready if there are signs of inhalation injury, and report hoarseness or stridor at once — early airway control prevents obstruction.
- Check pulses, refill, colour, sensation and pain in burned limbs hourly; elevate them — eschar and oedema can cut off the circulation.
- Measure core temperature every 1–2 hours, keep the room warm and uncover only the area in use — open wounds lose heat fast.
- Follow strict hand hygiene, clean technique and the unit's precautions, and teach visitors the rules — the lost skin barrier invites infection.
- Do the dressings ordered after giving analgesia in advance, and add non-drug measures (distraction, music, relaxation) — dressing pain is the most intense.
- Start feeding early by mouth or tube as ordered and record intake — the hypermetabolic state wastes muscle.
- Do range-of-motion exercises and keep positions and splints as planned — they prevent contractures and stiffness.
- Watch the eyes in facial burns and screen for anxiety, low mood and acute stress — the eyes and the mind are also at risk.

## In nursing practice

- Normal oxygen saturation and a normal chest X-ray on arrival do not rule out inhalation injury.
- Report fever or a low temperature, a change in the wound, intolerance of feeds or confusion: they may be early signs of infection or sepsis.
- Facial burns can injure the eyelids and expose the eye to infection and foreign bodies.
- Psychological effects of a burn can last for years; social work and psychology belong in the team.

## Common mistakes

- Waiting for stridor before calling about a hoarse patient after smoke inhalation.
- Checking the pulses of a burned limb only once per shift.
- Leaving the patient uncovered during long procedures.
- Starting a dressing without analgesia given in advance.

## Test yourself

Think of the answer, then tap the question to see it.

## Which findings suggest inhalation injury in a burned patient?

A fire in a closed space, soot in the mouth, singed nasal hair, facial burns, hoarseness, stridor, carbonaceous sputum, wheeze or breathlessness.

## When is an escharotomy needed?

When circumferential eschar threatens the blood supply of a limb or restricts breathing in the chest, abdomen or neck.

## Why does the burned patient lose heat so easily?

Because the lost skin barrier allows evaporative heat loss; the risk is high from about 20 % TBSA.

## When should analgesia be given for a burn dressing?

Before the dressing starts, as ordered, combined with non-drug measures, because dressing pain is the most intense.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/nursing-the-patient-with-major-burns-inhalation-injury-circulation-to-the-limbs/)

## Elsewhere in DurgiPedia

- [Burns in forensic medicine: patterns and antemortem signs](https://durgical.com/en/forensic-medicine/burns-in-forensic-medicine-patterns-and-antemortem-signs/)

## Connections

## Related 4

- [Burns: estimating the burned area (rule of nines, Lund–Browder) and the fluid formula, with worked examples](https://durgical.com/en/nursing/burns-estimating-the-burned-area-and-the-fluid-formula-with-worked-examples/)
- [Wound care and dressings: cleaning and choosing a dressing](https://durgical.com/en/nursing/wound-care-and-dressings-cleaning-and-choosing-a-dressing/)
- [Transmission-based precautions: contact, droplet and airborne](https://durgical.com/en/nursing/transmission-based-precautions-contact-droplet-and-airborne/)
- [Nutrition in the ICU: early enteral feeding, feeding intolerance, parenteral nutrition, glucose and refeeding](https://durgical.com/en/nursing/nutrition-in-the-icu-early-enteral-feeding-feeding-intolerance-parenteral-nutrit/)

## Related conditions 1

- [Burns (thermal, chemical, electrical; inhalation injury)](https://durgical.com/en/conditions/burns/)

[← All of nursing](https://durgical.com/en/nursing/)

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Bridging the evidence–practice gap in early burn injury care: a comprehensive evidence synthesis of global guidelines, consensus, and systematic reviews for resource-limited settings](https://pmc.ncbi.nlm.nih.gov/articles/PMC13298258/) (European Burn Journal, 2026); [Burn injury (Primer)](https://pmc.ncbi.nlm.nih.gov/articles/PMC7224101/) (Nature Reviews Disease Primers (Jeschke et al.), 2020); [The pivotal role of nursing personnel in burn care](https://pmc.ncbi.nlm.nih.gov/articles/PMC3038394/) (Indian Journal of Plastic Surgery, 2010).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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Source: https://durgical.com/en/nursing/nursing-the-patient-with-major-burns-inhalation-injury-circulation-to-the-limbs/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/nursing-the-patient-with-major-burns-inhalation-injury-circulation-to-the-limbs/