Page 311 - Learnwell EVS
P. 311
ns
– A ssess fo r asso ciated injuries (fractures, etc.).
– P ro tect the p atient and k eep him warm : clean/ sterile sheet, survival blank et.
– Insert a urinary catheter if burns invo lve > 1 5 % o f B S A , and in the case o f electrical
burns o r burns o f the p erineum / genitalia.
– Insert a naso gastric tube if burns invo lve > 2 0 % o f B S A (in the o p erating ro o m while
carry ing o ut d ressing p ro ced ure).
– C alculate and initiate fluid and electro ly te requirem ents fo r the first 2 4 ho urs.
– Intensive m o nito ring: level o f co nscio usness, p ulse, blo o d p ressure, p ulse o xy m etry ,
resp irato ry rate (RR) ho urly ; tem p erature and urine o utp ut every 4 ho urs.
– A d d itio nal testing: haem o glo bin, blo o d gro up , urine d ip stick test.
– P rep are the p atient fo r the first d ressing p ro ced ure in the o p erating ro o m .
Notes:
– B urns d o no t bleed in the initial stage: check fo r haem o rrhage if haem o glo bin level is
no rm al o r lo w.
– B urns alo ne d o no t alter the level o f co nscio usness. In the case if altered co nscio usness,
co nsid er head injury , into xicatio n, p o stictal state in ep ilep tic p atients.
– C linical m anifestatio ns o f electrical burns vary significantly acco rd ing to the ty p e o f
current. L o o k fo r co m p licatio ns ( arrh y th m ia, rh abd o m y o ly sis, neuro lo g ical
d iso rd ers).
II. General measures during the first 48 hours
Resuscitative measures
Intraveno us rep lacem ent fluid to co rrect hy p o vo laem ia:
Fluid and electrolyte requirements during the first 48 hours according to age
Children < 12 years Children ≥ 12 years/adults
0 - 8 h 2 m l/ k g x % B S A o f RL 2 m l/ k g x % B S A o f RL
+ m aintenance fluid * p er ho ur x 8 h
8 - 2 4 h 2 m l/ k g x % B S A o f RL 2 m l/ k g x % B S A o f RL
+ m aintenance fluid * p er ho ur x 1 6 h
2 4 - 4 8 h D aily m aintenance IV fluid requirem ents* 4 0 m l/ k g RL m inus o ral fluid s (d o no t
m inus o ral fluid s such as m ilk , bro th , includ e d rink ing water in the calculatio n).
gavage feed s ( d o no t includ e d rink ing
water in the calculatio n).
* m aintenance fluid : alternate RL and 5 % glucose: 4 m l/ k g/ h fo r first 1 0 k g of bo d y weight + 2 m l/ k g/ h
fo r next 1 0 k g + 1 m l/ k g/ h for each ad d itio nal k g (over 2 0 k g, up to 3 0 k g)
Note: increase rep lacem ent vo lum es by 5 0 % (3 m l/ k g x % B S A fo r the first 8 ho urs) in
th e event o f inh alatio n injury o r electrical burn. F o r burns > 5 0 % B S A , lim it th e
calculatio n to 5 0 % B S A .
T h is fo rm ula p ro vid es a guid e o nly and sh o uld be ad justed acco rd ing to sy sto lic
arterial p ressure ( S A P ) and urine o utp ut. A vo id fluid o verlo ad . Red uce rep lacem ent
fluid vo lum es if urine o utp ut exceed s the up p er lim it.
268
– A ssess fo r asso ciated injuries (fractures, etc.).
– P ro tect the p atient and k eep him warm : clean/ sterile sheet, survival blank et.
– Insert a urinary catheter if burns invo lve > 1 5 % o f B S A , and in the case o f electrical
burns o r burns o f the p erineum / genitalia.
– Insert a naso gastric tube if burns invo lve > 2 0 % o f B S A (in the o p erating ro o m while
carry ing o ut d ressing p ro ced ure).
– C alculate and initiate fluid and electro ly te requirem ents fo r the first 2 4 ho urs.
– Intensive m o nito ring: level o f co nscio usness, p ulse, blo o d p ressure, p ulse o xy m etry ,
resp irato ry rate (RR) ho urly ; tem p erature and urine o utp ut every 4 ho urs.
– A d d itio nal testing: haem o glo bin, blo o d gro up , urine d ip stick test.
– P rep are the p atient fo r the first d ressing p ro ced ure in the o p erating ro o m .
Notes:
– B urns d o no t bleed in the initial stage: check fo r haem o rrhage if haem o glo bin level is
no rm al o r lo w.
– B urns alo ne d o no t alter the level o f co nscio usness. In the case if altered co nscio usness,
co nsid er head injury , into xicatio n, p o stictal state in ep ilep tic p atients.
– C linical m anifestatio ns o f electrical burns vary significantly acco rd ing to the ty p e o f
current. L o o k fo r co m p licatio ns ( arrh y th m ia, rh abd o m y o ly sis, neuro lo g ical
d iso rd ers).
II. General measures during the first 48 hours
Resuscitative measures
Intraveno us rep lacem ent fluid to co rrect hy p o vo laem ia:
Fluid and electrolyte requirements during the first 48 hours according to age
Children < 12 years Children ≥ 12 years/adults
0 - 8 h 2 m l/ k g x % B S A o f RL 2 m l/ k g x % B S A o f RL
+ m aintenance fluid * p er ho ur x 8 h
8 - 2 4 h 2 m l/ k g x % B S A o f RL 2 m l/ k g x % B S A o f RL
+ m aintenance fluid * p er ho ur x 1 6 h
2 4 - 4 8 h D aily m aintenance IV fluid requirem ents* 4 0 m l/ k g RL m inus o ral fluid s (d o no t
m inus o ral fluid s such as m ilk , bro th , includ e d rink ing water in the calculatio n).
gavage feed s ( d o no t includ e d rink ing
water in the calculatio n).
* m aintenance fluid : alternate RL and 5 % glucose: 4 m l/ k g/ h fo r first 1 0 k g of bo d y weight + 2 m l/ k g/ h
fo r next 1 0 k g + 1 m l/ k g/ h for each ad d itio nal k g (over 2 0 k g, up to 3 0 k g)
Note: increase rep lacem ent vo lum es by 5 0 % (3 m l/ k g x % B S A fo r the first 8 ho urs) in
th e event o f inh alatio n injury o r electrical burn. F o r burns > 5 0 % B S A , lim it th e
calculatio n to 5 0 % B S A .
T h is fo rm ula p ro vid es a guid e o nly and sh o uld be ad justed acco rd ing to sy sto lic
arterial p ressure ( S A P ) and urine o utp ut. A vo id fluid o verlo ad . Red uce rep lacem ent
fluid vo lum es if urine o utp ut exceed s the up p er lim it.
268
