Management of severe burns can be challenging and stressful. This page includes useful tips on aspects of severe burn management, and some advice on how to avoid common pitfalls that are seen in cases presenting to Burn Services in Victoria and throughout Australia.
Titrating fluid resuscitation to urine output goals will help to avoid under or over resuscitation.
Fluid resuscitation is required following burn injury to maintain circulating volume and perfuse vital organs. Fluid resuscitation estimations are dependent on %TBSA Burns assessment, when %TBSA Burn assessments are inaccurate it affects the fluid resuscitation calculation. Fluid resuscitation formulas such as Parklands are simply a guide to estimate fluid resuscitation requirements, and are not prescriptive. Rather, use urine output, an easy, low tech measure to assess the adequacy of resuscitation and titrate accordingly. Urine output goals are:
- Adults: 0.5 – 1.0 ml/kg/hr
- Children <30kgs: 1ml/kg/hr
Problems arise when fluid resuscitation volumes are administered only using Parklands formula estimations, and NOT titrated to urine output. If the %TBSA calculation is inaccurate, the patient could be at risk of complications such as kidney injury, a greater need for escharotomy and intubation for example..
With everything else that is happening it is easy to forget to keep the patient warm. Hypothermia is invisible to the naked eye, unlike a burn injury. At least 30% of patients with severe burn injury arrive to the Victorian Adult Burn Service with a temperature less than 35C. This has negative consequences to clotting, contributes to the trauma triad of death, limits early surgical opportunities and is associated with a significant higher mortality, than patients who arrive to the ED normothermic.
Clinicians make great efforts to minimise heat loss and actively keep the patient warm, but this practice is variable. For more information on minimising heat loss visit the Minimising Heat Loss Tab.