#KYJ - Burns fluid resuscitation The Parkland Formula. Water them or they will die! If you are interested enough to watch the quick video I did on oedema, then this post will offer a bit of pathophysiology to preempt the necessity of fluid replacement ( youtu.be/sdWhUmUuWqc ). If vlog is not your thing, then know this; as tissue is burnt, the inflammatory process inherent in all tissue trauma, causes capillaries to leak plasma and the proteins within. This loss of vascular volume is burn area and depth specific, ie a 25% burn will loose more volume than a 10% burn. Once any partial or full thickness burn covers more than 15% total body surface area, the loss of plasma is so great, that it causes a few separate issues. 1. Hypovolaemia In haemorrhage, whole blood is lost, but in burns, its plasma loss which results in overall hypovolaemia. The greater the area of the burn, the more plasma is lost and the more hypovolaemic and therefore, in shock, the patient becomes. 2. Haemoconcentration A) viscosity Imagine boiling soup in the stove. The longer you simmer it, the more water evaporates off, and the thicker and more concentrated it becomes. Well as capillaries leak and it leaves behind a concentrated cocktail of blood cells. This concentration, called haemoconcentration makes the blood more viscous. Now think about this ... does thick blood perfuse easier or more difficultly through narrow capillaries everywhere else in the body? Sluggish viscous blood causes global poor perfusion. B) electrolyte imbalance As blood becomes more viscous than normal, the balance of electrolytes in blood changes. This alteration can lead to hyperkalaemia occurs, which is also further exacerbated by muscle damage on particularly deep burns. Large burns need fluid volume replacement. Internationally and particularly in Australia fluid replacement for burns injuries follows a formula known as the Parkland formula. This formula is calculated on the weight of the patient, the total-body area burned as a percentage. 3-4ml x Kg x %burn This volume is replaced using Normal saline initially (until potassium levels are established) then often switched to Hartmanns. 50% of the calculated volume is administered in the first 8 hours from the time of the burn. The balance is administered over the next 16 hours. Heres an example Hashim 100 kg man was burned with 50% surface area coverage. The burn happens at 10 PM he doesnt arrive until midnight. By 6 AM he needs to have had the first eight hours (or 50%) of the total calculated volume. 4ml x 100kg x 50% = 4 x 100 x 50 = (400) x 50 = 20000ml 20 Litres!!! This patient needs 10 litres delivered in the first 8hours post burn. Its 12 midnight, so you have just 6 hours to get that fluid up and running. You must warm the IV fluid. Giving this cold or at room temperature will cool the patient rapidly into hypothermia, causing shock and cellular hypoxia to worsen. This was just a snippet of our trauma course (burns session). If you are interested in sharing the love please do. Id love to offer our two day trauma seminar to your location. We have openings in May 2015 to run our two day trauma seminar anywhere. All I need is a group of 10.
Posted on: Wed, 03 Dec 2014 09:09:26 +0000
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