Which burn pattern is most associated with the greatest risk of burn-induced hypovolemic shock?

Which burn pattern is most associated with the greatest risk of burn-induced hypovolemic shock?

• A. Patient with burns on the hands and feet only
• B. Patient with upper & lower back burns and a circumferential left leg burn
• C. Patient with a facial burn only
• D. Patient with a circumferential burn on both arms

Answer: (B)

The most important factor is a large total body surface area burned combined with a circumferential burn that can trap swelling and impair circulation. A pattern involving burns across a large portion of the back (upper and lower back) plus a circumferential burn around the left leg means a big amount of skin is damaged, so fluid leaks into the interstitial space (third-spacing) is substantial. The circumferential leg burn adds a constrictive component that can worsen swelling and restrict venous return from the limb, further reducing effective circulating blood volume. Together, these effects drive the greatest risk of burn-induced hypovolemic shock. Burns confined to hands/feet or just the face involve smaller areas and less immediate fluid loss, and a circumferential burn on a single arm, while serious, does not add as much total fluid shift as a large trunk burn plus another circumferential limb burn.

The most important factor is a large total body surface area burned combined with a circumferential burn that can trap swelling and impair circulation. A pattern involving burns across a large portion of the back (upper and lower back) plus a circumferential burn around the left leg means a big amount of skin is damaged, so fluid leaks into the interstitial space (third-spacing) is substantial. The circumferential leg burn adds a constrictive component that can worsen swelling and restrict venous return from the limb, further reducing effective circulating blood volume. Together, these effects drive the greatest risk of burn-induced hypovolemic shock.

Burns confined to hands/feet or just the face involve smaller areas and less immediate fluid loss, and a circumferential burn on a single arm, while serious, does not add as much total fluid shift as a large trunk burn plus another circumferential limb burn.