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Fluid resuscitation in burn - HARSH AMIN (plastic & cosmetic surgeon)
This document discusses fluid resuscitation for burn injuries. It notes that before 1940s, hypovolemic shock was a leading cause of death from burns but mortality has decreased with fluid resuscitation formulas. However, 50% of burn deaths in the first 10 days are still due to inadequate or inappropriate fluid management. The document then describes the pathophysiology of burn shock, standard resuscitation methods using formulas like Parkland formula, and complications that can arise like over-resuscitation. It emphasizes the importance of monitoring patients closely during resuscitation.
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Fluid resuscitation in burn - HARSH AMIN (plastic & cosmetic surgeon)
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- 2. Introduction Before 1940s hypovolemic shock was the leading cause of death after burn injury Now the mortality due to hypovolemic shock is decreased after use of various fluid resuscitation formulas. But still 50% burn deaths occurring in first 10 days are mainly due to inadequate and inappropriate fluid resuscitation management.
- 3. Phases of managementof burn injury
- 4. Burn Resuscitation Burns shock -patho-physiology Burns shock resuscitation -standard resuscitation methods -problems and complications with resuscitation
- 5. Burn shock Mechanism is still not clear
- 6. Patho-physiology NORMALBLOOD CAPILLARY POSTBURN BLOOD CAPILLARY Water molecule Water is the smallest molecule that can pass through the capillary pores. Protein molecule Permeability is increased, which allows large molecules such as proteins to pass through the capillary pores easily.
- 9. Resuscitation Itbegins with arrival of patient
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- 12. Estimation of Sizeof Burn
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- 14. Secure an IVLine A challenging task in burns patient
- 15. Difficult to SecureIV Line
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- 18. Peripherally inserted centralcatheter
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- 21. Estimation of Sizeof Burn Overestimated in inexperienced hand
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- 24. Fluid Resuscitation Protocol Goal: Restore and Preserve tissue perfusion to avoid ischemia
- 25. Resuscitation Solutions Crystalloids-RL, d5%, NS, Hypertonic Saline Colloids- Albumin, Dextran, Hetastarch
- 26. Most Preferred Solution Most Preferred Fluid → Ringer Lactate( RL ) Na+ conc most free of converted 130mEq/L physiological Glucose to HCO3
- 27. Resuscitation Formulas CRYSTALLOID C O L L O I D H Y P E R T O N I C SALINE DEXTRAN Parkland Evan’s Monafo Demling Modified Brooke Brooke Warden Slater None is absolute — ultimate resuscitation is conditional
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- 29. Fluid Resuscitation in fluid requirements for children averaged 5.8 cc/kg/% burn. Which equals parkland formula + maintenance fluid 4 mL/ kg × % TBSA burn + 1500 cc/m2 BSA for 24 h Pediatric Patient
- 30. Formula For PediatricBurn
- 31. In massiveburns , child and inhalational injury cases combination of fluid is used to “minimize edema” Where- calculate by parkland formula and ---> 1st 8 hr RL + 50 mEq NaHCO3 hypertonic 2nd 8 hr RL - 3rd 8 hr RL+ 5% albumin hyperosmolar
- 32. Monitoring Noresuscitation formula is a license to put the burns patient on AUTO PILOT
- 33. Cardiovascular- B.P./ECG/heartrate Renal- urine output U.O.-Adult- 30-50 ml/hr - child(<30kg)-0.5-1 ml/kg/hr
- 34. When does resuscitation complete ??? When No more accumulation of edema fluid (18 – 30 hrs post burn) Resuscitation fluid require till Volume required to maintain U.O. at 30-50 ml/hr equals Maintenance volume
- 35. “Fluid Creep”-over resuscitation Most common disadvantage with parkland’s formula Sequelae: Skin edema Compartment syndrome Pulmonary & Cerebral edema ARDS / MOD ↑ costs, ↑mortality
- 36. Avoiding “the creep” Avoid early over resuscitation (accurate initial burn estimation) Early institution of colloid ( colloid rescue ) Changing Resuscitation protocols
- 37. Failure of Resuscitation Extreme age Extensive burns Major electrical injury Major inhalational injury Initial delay in initializing fluid Underlying disease that limits metabolic or cardiac reserve
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- 40. Thank you for your attention