Fluid resuscitation is primary care for initial burn injury!
Goal of fluid resuscitation: Maintain end-organ perfusion while avoiding complications of over-reususcitation and underresuscitation
- Parkland (or consensus formula) tell you where to BEGIN resuscitation
- The single best monitor of resuscitation is urine output
- In addition, monitor the following:
- Heart rate
- Blood pressure
- Mental status
- Acid-base balance
- Hematocrit
- Swelling
Who gets “formally” resuscitated?
- Any burn > 10-15% TBSA
- All electrical, chemical, and inhalation injuries
- Multitraumas with burns
- Extremes of age
Increased fluid requirements are common in:
- Very young
- Extremely deep burns
- Electrical injuries (what you see if often the tip of the iceberg)
- Inhalation injuries
- Delay to initiation of resuscitation
Consensus formula for Adult Burn resuscitation:
2-4 mL x Body weight (Kg) x %TBSA
= 24 hour fluid estimates with LR
1/2 in the first 8 hours, 1/2 over the next 16 hours
Caveat: Burn injury estimate is for 2nd and 3rd degree only- superficial, or 1st degree, doesn’t count
Goal urine output is 30-50 mL/ hour for “regular” burns, 50-100 mL/ hour for electrical injury or presence of myoglobinuria
***If the patient isn’t making enough urine, he’s not getting enough fluid***
Link to our current resuscitation protocol