Patient (condition)
 
Aliases:
Burns resuscitation

Topic aliases are alternate phrasings for a particular topic.


Assess children in a warm environment using a burns chart if available, or a modified rule of nine if an infant.

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Criteria for transfer to a burns center:
- Any full thickness burn >5% BSA;
- Adult burn >10% BSA;
- Child burn >5% BSA;
- Face, hands, feet, groin, major joints;
- Electrical/chemical burns;
- Inhalational injury. #ref

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When calculating how much intravenous fluid to give each patient in a mass casualty situation, consider whether you have sufficient resources to intubate and ventilate your patient(s).

In the Bali bombings, the Australian army had only sufficient IV fluids for all patients to meet half the requirements based on the Parks formula. They also did not have the resources to ventilate large numbers of patients.

What they found was that once patients were transferred to Perth and given fluids as per the Park's formula their facial oedema accelerated with some of the patients then requiring intubation/ventilation.

The feeling was that giving half the usual intravenous resuscitation volume in this instance delayed the need for ventilation in several of these patients in which they wouldn't have had the resources to ventilate.
#wadem2003

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1. Treat shock (20ml/kg x 3)
2. Resuscitate burns losses
4ml/kg x total body surface area burnt (as percentage) over 24hrs (administer 50% of this over the first 8hrs since the burn) Aim for a urine output of 1ml/kg/hr.
3. Commence maintenance fluid (4ml/kg/hr first 10kg + 2ml/kg/hr next 10kg + 1ml/kg/hr for the remaing kg in weight)

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Burns estimated at under 10% body surface area generally require maintenance fluid only, and do not require resuscitation as per the parkland formula resuscitation.
#ref

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Circulatory shock is usually a late sign in isolated burns injuries.
If shock is present, be suspicious of additional injuries causing shock.
#apls

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Antibiotics as per surgeons. Check medication chart for recently administered.

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