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.
6. Patho-physiology
NORMAL BLOOD
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.
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
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
31. In massive burns , 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
No resuscitation formula is a license to put the burns
patient on AUTO PILOT
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