Management of Major Burns
Initial patient management
- Intravenous access established & I.V. fluids
- N/G tube; enteral feeding
- Folley‘s catheter
- Analgesia
- Tetanus vaccine
- Patient must be kept warm
- Dressing
IV Fluid Therapy
- Infusion of IV fluids is needed to maintain sufficient blood volume for normal
Cardiac Output
- Clients with burns involving 15% to 20% of the TBSA require IV fluid
- Purpose is to prevent shock by maintaining adequate circulating blood fluid volume
- Severe burn requires large fluid loads in a short time to maintain blood flow to vital
organs
- Fluid replacement formulas are calculated from the time of injury and not from the
time of arrival at the hospital
- Diuretics should not be given to increase urine output.
- Change the amount and rate of fluid administration to improve urine output.
- Diuretics do not increase CO; they actually decrease circulating volume and CO by
pulling fluid from the circulating blood volume to enhance diuresis
Guidelines and Formulas for Fluid Replacement in Burn Patients
- Consensus Formula
- Lactated Ringer's solution (or other balanced saline solution): 2–4 mL × kg body
weight × % total body surface area (TBSA) burned.
- Half to be given in first 8 hours; remaining half to be given over next 16 h.
- Evans Formula
- Colloids: 1 mL × kg body weight × % TBSA burned