This week we dive into some of the initial considerations in the resuscitation of major burn patients.


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Tags: Carbon Monoxide, Cyanide, Major Burns, Trauma





Show Notes
Take Home Points

Be prepared to intubate early, the patency of the airway can decline quickly and without warning. If there is any concern for burns to face/neck or smoke inhalation, consider taking control of the airway early.
Review the rule of 9s and the parkland formula to direct your large volume fluid resus.  Remember the parkland formula directs you to use 4 mL x %TBSA x weight (kg).  Half in the first 8 hours and the second half over the next 16 hours.  Given the large volume here it’s probably best to use LR or another balanced solution.
Do a thorough trauma eval to make sure you don’t miss any other injuries and be sure to watch for developing compartment syndrome
And last, consider the need to treat for CO and/or cyanide poisoning.  Poor cardiac function, cardiac arrest or a high lactate can be clues to cyanide poisoning and just start 100% O2 while you wait for a co-ox, since CO tox is pretty likely.

Rule of 9's
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MD Calc: Parkland Formula for Burns
LITFL: Trauma! Major Burns
LITFL: Releasing the Roman Breast Plate
Parvizi D et al. The potential impact of wrong TBSA estimations on fluid resuscitation in patients suffering from burns: things to keep in mind. Burns 2014; 40: 241-5. PMID: 24050977
Hettiaratchy S, Dziewulski P. ABC of Burns: Introduction. BMJ 2004; 328: 1366-8. PMID: 15178618
Hettiaratchy S, Papini R. ABC of Burns: Initial Management of a Major Burn: I - Overview. BMJ 2004; 328: 1555-7. PMID: 15217876
Hettiaratchy S, Papini R. ABC of Burns: Initial Management of a Major Burn II - Assessment and Resuscitation . BMJ 2004; 329: 101-3. PMID: 15242917

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