Advanced Trauma Life Support ATLS Student Course Manual 2018

174
CHAPTER 9 n Thermal Injuries
Pitfall
prevention
n FIGURE 9-3 Resuscitation of pediatric burn patients must balance
a higher resuscitation volume requirement due to larger surface
area per unit body mass with the smaller pediatric intravascular
volume, which increases the risk for volume overload.
It is important to understand that under-resuscitation
results in hypoperfusion and end organ injury. Overresuscitation
results in increased edema, which can
lead to complications, such as burn depth progression
or abdominal and extremity compartment syndrome.
The goal of resuscitation is to maintain the fine balance
of adequate perfusion as indicated by urine output.
Cardiac dysrhythmias may be the first sign of hypoxia
and electrolyte or acid-base abnormalities; therefore,
electrocardiography (ECG) should be performed for
cardiac rhythm disturbances. Persistent acidemia in
patients with burn injuries may be multifactorial,
Under- or overresuscitation
of burn
patients.
• Titrate fluid resuscitation
to the patient’s physiologic
response, adjusting the
fluid rate up or down based
on urine output.
• Recognize factors that
affect the volume of
resuscitation and urine
output, such as inhalation
injury, age of patient,
renal failure, diuretics,
and alcohol.
• Tachycardia is a poor
marker for resuscitation
in the burn patient. Use
other parameters to discern
physiologic response.
including under-resuscitation or infusion of large
volumes of saline for resuscitation.
Patient Assessment
In addition to a detailed AMPLE history, it is important
to estimate the size of the body surface area burned
and the depth of the burn injury.
table 9-1 burn resuscitation fluid rates and target urine output by burn
type and age
CATEGORY OF BURN AGE AND WEIGHT ADJUSTED FLUID RATES URINE OUTPUT
Flame or Scald
Adults and older
children (≥14 years old)
2 ml LR x kg x % TBSA 0.5 ml/kg/hr
30–50 ml/hr
Children (