Fluid Resuscitation in the Burn Patient
EMS personnel were called to assist a 50-year-old male involved in an accident while working at a foundry. Upon arrival it was found that the patient had suffered second- and third-degree burns to his entire back, legs and arm after having hot molten spilled and splashed on him.
Thermal burns accounted for nearly half of his body. Primary and secondary assessments were completed, the patient was placed on a 15L nonrebreather mask and 2 large bore IVs were started with Lactated Ringers solution infused.
The initial transport decision was to Med Flight the patient to UW Hospital but due to inclement weather he was ground transferred to the UW Hospital Emergency Department and subsequently admitted to the Burn Unit. For burn victims, fluid resuscitation is critical within the first 24 hours.
The goal of fluid resuscitation is to maintain adequate tissue perfusion while avoiding the dangers of excessive or deficient fluid administration. Excessive hydration of the patient can result in the death of tissue that could have otherwise been saved.
The American Burn Association criteria for prehospital placement of IV lines:
- 20% burn with an EMS transport time of over 60 minutes
- Hypovolemic shock from associated injuries
- Management of life-threatening ventricular dysrhythmias
- Potential exists for lifethreatening airway obstruction or cardiac arrest.
It is extremely important for the prehospital provider to adequately calculate the amount of fluid infused as this may be taken into consideration in regards to the patient’s total fluid resuscitation. Once the patient arrives at the hospital, the Parkland formula for fluid resuscitation is often utilized in the management of burn victims.
The Parkland Formula for Adults is 2-4ml LR X kg body weight X % TBSA burn. One-half of this volume is to be administered in the first 8 hours, the remainder over the next 16 hours post burn.
The Parkland Formula is used only as a starting point for fluid resuscitation as each patient reacts differently to burn injury and resuscitation.
This patient had a 115-day hospital admission and underwent seven surgical procedures due to his extensive burns. He has since returned home to his wife and children, has frequent follow up visits to the UW burn clinic, and has continued to be an avid Minnesota Vikings fan!