Begins with the return of fluids to the intravascular space. The acute stage ends when the wounds are healed or covered with grafts. Goals include: wound closure with no infections; minimal scarring; maximal functions; maintenance of comfort; adequate nutrition; maintenance of fluid, electrolyte, and acid base; wounds are cleansed and debrided daily to promote healing, prevent infection, and provide a clean bed for grafting, debridement can be mechanicals. chemical, surgical, or a combination (like hydrotherapy) . Once cleaned, the burn dressing and topical antibiotic treatment are applied. Apply dressing from distal to proximal. Limit bulk. Applying distal to proximal helps venous blood return. Dressings may be open (nothing applied), closed, biological, synthetic, or a combination. Hypovolemic Phase or Burn Shock - 30% or more surface burned. systemic response. Lasts 36-448 hrs after a burn. Fluid shifts from the vascular compartment to the 3rd space (interstisital). First S&S is Edema. Blood becomes heme-concentrated (thicker), incresed levels of HCT, Hbg, skin ability to prevent water loss is dcrsd due to a burn damage to the skin. decresd urine output (strees hormones released - aldosterone, ADH, going into shock. Sympathetic nervous system kicks in and blood is shifted away from everything except the brain and the heart. ADH is released and aldosterone is released and aldosterone is release which tells the body to hold onto what water tyou do have in the body; may have comprosed airway - look for burns of head and neck, signed nasal hairs, soot in mouth or nose, coughing, voice changes, mucosal burns, and stridor (cumferential circle - completely around the neck or toso ) burns and edema of the neck or chest can restrict respirations. swelling may restrict breathing.