Acute Burn Resuscitation
- Estimate initial fluid requirement using the Parkland formula (4 mL/kg/%TBSA burned).
- Give half of the calculated fluid volume over the first 8 hours from the time of the burn.
- Give remaining half of the fluid volume over the next 16 hours.
- For > 30% TBSA burns, Vitamin C infusion should be considered.
- In patients with burns > 20% TBSA:
- Insert a central venous catheter
- Insert a urinary (Foley) catheter
- Monitor intra-abdominal (bladder) pressure q 4 hours during the initial resuscitation
- Consider invasive hemodynamic monitoring to guide resuscitation
- Resuscitation endpoints in the first 24 hours post-burn injury:
- Monitor arterial lactate q 4 hours until < 2 mMol/L
- Maintain urine output at 30-50 ml/hr (50-100 ml/hr if receiving Vitamin C)
- In electrical injury or rhabdomyolysis patients, serial creatinine kinase levels should be checked daily until < 2500 mcg/L
- Monitor hemoglobin to ensure that it is not trending upward
- If the patient requires > 1.5 times the calculated Parkland formula volume (6 ml/kg/TBSA), consider colloid rescue:
- 5% albumin at 1/3 Parkland rate + 2/3 Parkland rate of Lactated Ringers OR
- 25% albumin at 1/15th the Parkland rate + 2/3 Parkland rate of Lactated Ringers
- Fresh frozen plasma may be used as an efficacious alternative to albumin for colloid rescue
- If the patient has received > 250 mL/kg of fluid resuscitation, intraocular pressure should be measured.
Acute Burn Resuscitation guideline
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