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Burns Fluid Resuscitation
The document discusses crucial considerations in managing burn shock, emphasizing the need for accurate assessment and tissue perfusion preservation while avoiding over-resuscitation. It highlights the complexities associated with patients of extreme ages, those with significant inhalation injuries, and extensive burns, along with comorbidities. Early referral and multi-faceted care approaches are advised to improve outcomes and manage complications effectively.
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Burns Fluid Resuscitation
- 1. DON’T BURN YOURBRIDGES (AND DROWN IN FLUID) DR CLAIRE SEIFFERT INTENSIVIST, RNSH, SYDNEY
- 2.
- 3. Restore + preserve tissue perfusion Avoidinitial over resuscitation Accurate Ax Early Colloid Permissive hypotension Urine 0.5- 1ml/kg av over 2 hrs Goals
- 4. Fluid Creep Skin Oedema Compartment Syndrome Pulmonary and cerebral oedema ARDS,MODS Increased cost + mortality
- 5.
- 6.
- 7. THE CHALLENGES Extreme ageDelayed resus Major inhalation, Major electrical injury Extensive burns Underlying comorbidities
- 8. BEYOND THE FLUID Earlyreferral Early ETT Exclude other trauma Warming Lines Opthal Nutrition No prophylactic Abx Psychological
Editor's Notes
- #3 Burn shock = combination of distributive seicondary to release of local and systemic inflammatory mediators and hypovolaemic shock caused by generalized microcirculatory injury and loss of fluid into the interstitial space. CO additionally reduced within the first 4 hrs of injury and recovers gradually over the next 24-48hrs.
- #4 Resoration of preload + CO an resuscitation takes 24-48hrs. In that time allow permissive hypotension, permissive hyperlactataemia
- #6 Begin fluid resuscitation with Hartmann’s Solution for burns >15%TBSA in adults, and for burns >10%TBSA in children <16 years old. Where appropriate, warm IV fluid administration should be considered to help minimise heat loss.
- #8 http://www.anzbaasm.com/3234