FLUID RESUCITATION IN BURNS FOR TRAUMA.pptx

Urine out put as main monitoring tool

1. FLUID RESUSCITATION in burns GROUP P

2. OVERVIEW Introduction Rationale for resuscitation Indication for resuscitation The Resuscitation Complications

3. INTRODUCTION: O f the various components integrated in managing burns patients, fluid resuscitation plays a vital role. P roper fluid management is critical to the survival of burns patients with extensive burns . It aids in maintaining tissue perfusion and organ function (most notably the kidneys) while avoiding the complications of inadequate or excessive fluid therapy. T he first 24 hours post-burn injury are most crucial for intervention with fluids because it is during this time that the increased capillary permeability and intravascular volume deficits are most severe.

4. WHY? A s earlier discussed, massive tissue injury from burns results into marked fluid shifts from the capillary leakage bringing about tissue edema and resultant intravascular hypovolemia. important to note is that these burn injuries cause a decrease in cardiac output and an increase in peripheral vascular resistance as early manifestations of the systemic response to burn injury. I n summary, it’s evident that burns cause hypovolemic and distributive shock hence the need for fluid resuscitation to prevent organ hypoperfusion and cell death.

5. WHO? I t is essential to appreciate that not all burn patients will require fluid resuscitation and therefore intervention is limited to only those that fulfil certain criteria S econd and third degree chemical and thermal burns T hese burns should be of >20% TBSA in adults and >10% in children E lectrical burns with myoglobinuria(tea colored urine) I nhalational burns*

6. Resuscitation: T he choice of fluids accepted is Ringer’s lactate. It’s widely available and approximates intravascular solute content. N ormal saline is avoided to prevent hyperchloremic acidosis. R oute of administration= IV (peripheral veins but if not accessible, central line may be used too) NB : a urinary catheter should be inserted to before administering fluids. patient’s weight(kg) should be noted too .

7. Initial resuscitation B ased on age; this is done before tbsa has been established using rule of nines or lund and browder chats(more accurate) in peripheral or even early hospital setting. 5 years and younger= 125ml per hour 6- 13 years old= 250ml per hour 14 years and older= 500ml per hour

8. O nce the TBSA has been established, the American Burn Association derived a formula to estimate the required fluid for each burns patient. it was derived from the 2 most commonly used resuscitation formulas i.e. P arkland formula (4 ml x kg x%TBSA x 24 hours) and modified brooke(2) chemical & thermal burns: Adults - 2ml x patient’s weight(kg) x TBSA C hildren(13 years and under) – 3ml x patient’s weight(kg) x TBSA Y oung children( </=30kg) and infants receive an additional maintenance dose with Ringer’s lactate and 5% dextrose electrical burns with evidence of myoglobinuria . Adults- 4ml x patient’s weight(kg) x TBSA

9. How to give : F irst half is given within the first 8 hours starting from the time of the burn. S econd half in the next 16 hours. Example; an adult patient with a 50% TBSA second and third degree burn who weighs 70 kg: 2 ml LR x 70 (kg) x 50 (% TBSA burn) = 7,000 ml LR in the first 24 hours. 3,500 ml (half) is infused over the first 8 hours from the time of injury. A minimum of 437 ml LR / hour should be infused over the first 8 hours .

10. Cont… I f initial resuscitation is delayed, the first half of the volume is given over the number of hours remaining in the first 8 hours post-burn. For example, if the resuscitation is delayed for two hours, the first half is given over 6 hours (3500 ml / 6 hours). A minimum of 583 ml lr per hour should be infused over the remaining 6 hours.

11. Monitoring : A s mentioned earlier, the formulas used are only estimates of what could be needed and therefore it is important to monitor the patient’s physiological response and urinary output for any complications or improvement. U rinary output A dults= 0.5-1ml/kg/hr. children= 1-2ml/kg/hr. (thermal burns) A dults = 1-2ml/kg/hr. children= 2-3ml/kg/hr. (electrical burns) M onitor patient vitals hourly for TBSA >20%

12. GOAL OF RESUSCITATION T he goal of resuscitation is to maintain adequate tissue perfusion and organ function while avoiding the complications of over or under resuscitation. B urn fluid resuscitation must be guided by basic critical care principles and managed on a near-continuous basis to promote optimal outcomes .

13. COMPLICATIONS : F luid resuscitation could be complicated by either over or under resuscitation; O ver resuscitation- extremity, orbital and abdominal compartment syndrome. pulmonary and cerebral edema U nder resuscitation- shock, organ failure(most commonly AKI).

14. DANKE!!!