fluid resuscitation in burn - harsh amin (plastic & cosmetic surgeon)
DESCRIPTION
Fluid resuscitation in burnTRANSCRIPT
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Fluid resuscitation in Burn
Dr. HARSH AMIN
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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.
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Phases of management of burn injury
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Burns shock -patho-physiology
Burns shock resuscitation -standard resuscitation methods -problems and complications with
resuscitation
Burn Resuscitation
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Burn shock
Mechanism is still not clear
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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.
Patho-physiology
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Resuscitation
It begins with arrival of patient
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Secure I.V. Line
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Weight of Patient
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Estimation of Size of Burn
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Start Resuscitation
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Secure an IV Line
A challenging task in burns patient
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Difficult to Secure IV Line
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Maximal Sterile Barriers
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Peripheral Line
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Peripherally inserted central catheter
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Cental Venous Line
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Venous Cut-Down
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Estimation of Size of Burn
Overestimated in inexperienced hand
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Other Formulas
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Fluid Resuscitation Protocol
Goal: Restore and Preserve tissue perfusion to avoid ischemia
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Resuscitation Solutions
Crystalloids- RL, d5%, NS, Hypertonic Saline
Colloids- Albumin, Dextran, Hetastarch
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Most Preferred Solution
Most Preferred Fluid → Ringer Lactate( RL )
Na+ conc most free of converted
130mEq/L physiological Glucose to HCO3
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CRYSTALLOID
COLLOID HYPERTONIC SALINE
DEXTRAN
Parkland Evan’s Monafo Demling
Modified Brooke Brooke Warden
Slater
Resuscitation Formulas
None is absolute — ultimate resuscitation is conditional
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Most Preferred Formula
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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
Fluid Resuscitation in Pediatric Patient
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Formula For Pediatric Burn
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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
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Monitoring
No resuscitation formula is a license to put the burns patient on AUTO PILOT
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Cardiovascular- B.P./ECG/heart rate
Renal- urine output
U.O.-Adult- 30-50 ml/hr - child(<30kg)-0.5-1 ml/kg/hr
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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
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Most common disadvantage with parkland’s
formula
Sequelae: Skin edema Compartment syndrome Pulmonary & Cerebral edema ARDS / MOD ↑ costs, ↑mortality
“Fluid Creep”-over resuscitation
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Avoid early over resuscitation (accurate initial
burn estimation)
Early institution of colloid ( colloid rescue )
Changing Resuscitation protocols
Avoiding “the creep”
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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
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Innovations
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Innovations
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Thank you
for your attentio
n