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Fluid status and blood transfusion requirements for burns patients (Guided…
Fluid status and blood transfusion requirements for burns patients
Overview
Circulatory effects if>15% TBSA, require fluid therapy
Smaller burns, replace with 150% maintenance therapy
Fluid loss: evaporative loss from wound, radiant heat loss, extravasation into tissues from vascular spaces
Pathophysiology
Local inflammatory response = vasodilation and increased vascular resistance
Extravasation of fluid and plasma protein at site of injury
Extensive oedema within first 24 hours, depends on extent of burn
Principles
Maintenance of tissue oxygenation
Avoid over-resuscitation
Prevent wound dehydration
Guided fluid resuscitation therapy
First 24hrs
Parklands formulae (4 x body wt. (kg) x TBSA (%) in first 24 hrs). Give half in first 8hrs and rest in following 16hrs. Add maintenance in children <30kg
Type of fluid: Isotonic balanced crystalloid, consider albumin replacement post 24hrs (leak of albumin in first 24hrs will worsen oedema
Monitor adequacy: Urine output 0.5-1ml/kg/hr (adult), 1-2 in child, HR and BP normalisation, warm extremities, return of gut peristalsis
May require increased resus if: Mech Vent, associated trauma, dehydration
Subsequent fluid management
Intro of nutrition, reduction total rate of fluid admin
Allow for generous urine output, compensate for losses
Estimate for insensible fluid loss ((25 + TBSA %) x m2 BSA)
Electrolyte monitoring and replacement
Monitor for myoglobin and Hb release from tissues causing RF - may need to increase fluids
Rule of 9s
Anaemia and blood products
Haematocrit monitoring often used on first day to assess IV volume expansion
Haemolysis, sequestration
Bleeding likely with graft excision, usually well tolerated - improved with tourniquet use, adrenaline with LA, compression bandages
Blood replacement
Hct <15-20% if healthy and minor operations
<25% if healthy but extensive operation
<30% if hx of CVS disease
Likely develop coagulopathy
Treat hypotension
Manage as required depending on severity, extent of burn, bleeding and haemodynamic consequences
Occasionally req massive transfusion
