Intake and output is the key measurement to determine whether fluid

Intake and output is the key measurement to determine

This preview shows page 47 - 53 out of 122 pages.

Initial Emergency Burn Management
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4mL x kg x % burned 50% is given in the first 8 hours after injury 25% is given in the second 8 hours 25% is given in the third 8 hours Let’s do some examples! A 45 yo male, weight 220 pounds, burns to 35% TBSA A 23 yo female, weight 155 pounds, burns to 25% TBSA Parkland Formula
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Burn injuries greater than 20% of TBSA can result in burn shock Significant burn injury results in hypovolemic shock; burn shock can occur even when hypovolemia is corrected The burning agent produces dilation of the capillaries and small vessels, increasing capillary permeability Plasma seeps out into the surrounding tissue, producing blisters and edema This progressive fluid loss in extensive burns results in significant intravascular fluid volume deficit Edema occurs locally to the burn wound and systemically in unburned tissues Plasma pressure is decreased due to protein leakage in the extravascular space; plasma is further diluted with fluid resuscitation In addition to leaking capillaries, local and systemic mediators like histamine, prostaglandins, kinins, and oxygen radicals increase vasodilation Pathophysiology of Burn Shock
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Pathophysiology of Burn Shock
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If fluid resuscitation is inadequate, AKI may occur In the ER, an indwelling catheter should be placed for burns greater than 20% of TBSA to monitor urine output and the effectiveness of resuscitation A catheter may be necessary if the burn extends into the perineal area because of the presence or development of edema Urinary catheters with temperature probes should be used whenever possible The nurse measures urine output hourly Adequate urine output for adults is 0.5 to 1mL/kg per hour or 30 to 50 mL/h In children, it is 1 to 2 mL/kg per hour Kidney Management
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Pts with burns greater than 20% of TBSA are prone to gastric dilation as a result of paralytic ileus
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