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Burns
Published in Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal, Plastic Surgery for Trauma, 2022
Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal
Fluid resuscitation in burns is as per the Parkland Formula (4 mL × weight in kg × %TBSA burn). For example, for an adult weighing 80 kg with a 16% TBSA burn the calculation would be 4 × 80 × 16 = 5120 mL. This calculation gives the required resuscitation fluid volume required over 24 hours from time of the burn. Half of the total volume should be given in the first 8 hours from the time of burn with the rest given over the next 16 hours. Crystalloids are the fluids of choice (Hartmanns/Plasmalyte) and should ideally be warmed before giving. Most patients will have already been given some fluid by the time you assess them so factor this into your calculation.
Injuries in Children
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Intravenous access should be obtained early, and fluid resuscitation requirements calculated and started. Urine output calculated through catheterization may facilitate this. Urinary outputs of 2 mL/kg/h for infants, 1 mL/kg/h for children and 0.5 mL/kg/h for adolescents are considered normal. The Parkland formula can also be used for children with greater than 15% body surface area (BSA) burns: The excellent physiological reserve of children means that signs of cardiovascular collapse may occur late; therefore, regular assessment of pulse rate, capillary refill and blood pressure is essential.
Burns
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Brian Brisebois, Joyce McIntyre
Early and adequate fluid resuscitation is critical to prevent hypovolemic shock (Liu), although over-resuscitation, or “fluid creep,” has been associated with increased morbidity (Lundy). The “Rule of Nines” can be used to estimate TBSA burned; each arm 9%, head 9%, anterior trunk 18%, posterior trunk 18%, each leg 18%. Although quick and easy, it is not very accurate. The Lund-Browder chart adjusts for age and is commonly used in burn centers (Greenhalgh). The Parkland formula (4 mL/kg/% TBSA; half over first 8 hours; remaining half over 16 hours) is the most widely used formula to determine initial resuscitation rates, although some centers use the modified Brooke formula (2 mL/kg/% TBSA; half over first 8 hours; remaining half over 16 hours) (Lundy, Greenhalgh). Recent ABA consensus statements suggest these two equations establish appropriate limits for initial resuscitation (Lundy). Children need greater fluid/kg/% TBSA burned than adults. Delayed resuscitation, smoke inhalation, and alcohol intoxication all greatly increase fluid requirements. These equations are useful starting points, but infusion rates should be carefully adjusted based on urine output (UO). A target UO of 1 mL/kg/h for children <30 kg and 0.5 mL/kg/h for adults is ideal. When at or just below target UO, fluids should be gradually decreased until steady state is achieved (Greenhalgh).
Polymerized human placenta haemoglobin attenuates myocardial injury and aortic endothelial dysfunction in a rat model of severe burns
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2018
Zhenyu Zhang, Yingyi Zhang, Yan Deng, Shen Li, Wentao Zhou, Chengmin Yang, Xuewen Xu, Tao Li
Sixty male Sprague-Dawley rats were randomly divided into three groups: Sham group (n = 20), Burn group (n = 20) and Burn + PolyPHb group (n = 20). Animals were anesthetized with intraperitoneal injection of pentobarbital sodium (50 mg/kg) and a 30% TBSA full-thickness burn injury was produced by exposure to 100 °C water for 10 s (Figure 1). Sham rats were exposed to water of room temperature. Immediately after burn injury, PolyPHb at a dose of 0.5 gHb/kg or equal amount of lactated Ringer’s solution was infused via caudal vein. For acute resuscitation, lactated Ringer’s solution calculated from the Parkland formula (4 ml/kg/% burn) was intraperitoneally injected immediately (half of the calculated volume) and 8 h after burn injury (the other half). To reduce the potential pain after severe burn, analgesic drug buprenorphine (0.05 mg/kg) was given subcutaneously before rat fully recovered from anaesthesia. All animals were sacrificed 24 h after burn injury.