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10. Medical and minor surgical procedures
Target endpoints for IV replacement fluids
Non-electrical burns Electrical burns
C hild ren < 1 y ear C hild ren 1 -1 2 y Ceahrsild/ ren > 1 2 y ears A ll ages
ad ults
A P (m m H g) SA P ≥60 S A P 7 0 to 9 0 + (2 x age) ASgAe aSPpAp≥ P1ro0p0riate
U rine o utp ut 1 to 2 m l/ k g/ h 1 to 1 .5 m l/ k g/ h 0 .5 to 1 m l/ k g/ h 1 to 2
m l/ k g/ h
dInoppamatiineenItVs w: 5ithto l1igu5riµagd/ ekspg/ itme aindbeyquIaVtepfluimd prep lacem ent:
o r epinephrine I V : 0 .1 to 0 .5 µg/ k g/ m in by I V p um p
S to p the infusio n after 4 8 ho urs, if fluid requirem ents can be m et by the o ral ro ute o r
gavage.
Respiratory care
In all cases: co ntinuo us inhalatio n o f hum id ified o xy gen, chest p hy sio therap y .
E m ergency surgical interventio n if necessary : tracheo to m y , chest escharo to m y .
D o no t ad m inister co rtico stero id s (no effect o n o ed em a; p red isp o sitio n to infectio n).
N o sp ecific treatm ent fo r d irect bro ncho p ulm o nary lesio ns.
Analgesia
S ee Pain management, p age 2 7 1 .
Nutrition
S tart feed ing early , beginning at H 8 :
– D aily need s in ad ults: • calo ries: 2 5 k cal/ k g + 4 0 k cal/ % S C B
• p ro teins: 1 .5 to 2 g/ k g
– H igh energy fo o d s (N RG 5 , P lum p y 'nut, F 1 0 0 m ilk ) are necessary if the B S A is
> 20%
(no rm al fo o d is inad equate).
– N utritio nal requirem ents are ad m inistered acco rd ing to th e fo llo wing d istributio n:
carbo hy d rates 5 0 % , lip id s 3 0 % , p ro teins 2 0 % .
– P ro vid e 5 -1 0 tim es the reco m m end ed d aily intak e o f vitam ins and trace elem ents.
– E nteral feed s are p referred : o ral ro ute o r naso gastric tube (necessary if B S A > 20 e%1d0).
– S tart with sm all quantities o n D 1 , then increase p ro gressively to reach reco m m end
energy requirem ents within 3 d ay s.
– A ssess nutritio nal status regularly (weigh twice week ly ).
– Red uce energy lo ss: o cclusive d ressings, warm enviro nm ent (2 8 -3 3 °C ), early grafting;
m anagem ent o f p ain, inso m nia and d ep ressio n.
Patients at risk of rhabdomyolysis (d eep and extensive burns, electrical burns, crush
injuries to the extrem ities)
M o nito r fo r m y o glo binuria: d ark urine and urine d ip stick tests. I f p resent, ind uce
alk aline d iuresis fo r 4 8 ho urs (2 0 m l o f 8.4% sodium bicarbonate p er litre o f RL ) to o btain
an o utp ut o f 1 to 2 m l/ k g/ h. D o no t ad m inister d o p am ine o r furo sem id e.
269
Target endpoints for IV replacement fluids
Non-electrical burns Electrical burns
C hild ren < 1 y ear C hild ren 1 -1 2 y Ceahrsild/ ren > 1 2 y ears A ll ages
ad ults
A P (m m H g) SA P ≥60 S A P 7 0 to 9 0 + (2 x age) ASgAe aSPpAp≥ P1ro0p0riate
U rine o utp ut 1 to 2 m l/ k g/ h 1 to 1 .5 m l/ k g/ h 0 .5 to 1 m l/ k g/ h 1 to 2
m l/ k g/ h
dInoppamatiineenItVs w: 5ithto l1igu5riµagd/ ekspg/ itme aindbeyquIaVtepfluimd prep lacem ent:
o r epinephrine I V : 0 .1 to 0 .5 µg/ k g/ m in by I V p um p
S to p the infusio n after 4 8 ho urs, if fluid requirem ents can be m et by the o ral ro ute o r
gavage.
Respiratory care
In all cases: co ntinuo us inhalatio n o f hum id ified o xy gen, chest p hy sio therap y .
E m ergency surgical interventio n if necessary : tracheo to m y , chest escharo to m y .
D o no t ad m inister co rtico stero id s (no effect o n o ed em a; p red isp o sitio n to infectio n).
N o sp ecific treatm ent fo r d irect bro ncho p ulm o nary lesio ns.
Analgesia
S ee Pain management, p age 2 7 1 .
Nutrition
S tart feed ing early , beginning at H 8 :
– D aily need s in ad ults: • calo ries: 2 5 k cal/ k g + 4 0 k cal/ % S C B
• p ro teins: 1 .5 to 2 g/ k g
– H igh energy fo o d s (N RG 5 , P lum p y 'nut, F 1 0 0 m ilk ) are necessary if the B S A is
> 20%
(no rm al fo o d is inad equate).
– N utritio nal requirem ents are ad m inistered acco rd ing to th e fo llo wing d istributio n:
carbo hy d rates 5 0 % , lip id s 3 0 % , p ro teins 2 0 % .
– P ro vid e 5 -1 0 tim es the reco m m end ed d aily intak e o f vitam ins and trace elem ents.
– E nteral feed s are p referred : o ral ro ute o r naso gastric tube (necessary if B S A > 20 e%1d0).
– S tart with sm all quantities o n D 1 , then increase p ro gressively to reach reco m m end
energy requirem ents within 3 d ay s.
– A ssess nutritio nal status regularly (weigh twice week ly ).
– Red uce energy lo ss: o cclusive d ressings, warm enviro nm ent (2 8 -3 3 °C ), early grafting;
m anagem ent o f p ain, inso m nia and d ep ressio n.
Patients at risk of rhabdomyolysis (d eep and extensive burns, electrical burns, crush
injuries to the extrem ities)
M o nito r fo r m y o glo binuria: d ark urine and urine d ip stick tests. I f p resent, ind uce
alk aline d iuresis fo r 4 8 ho urs (2 0 m l o f 8.4% sodium bicarbonate p er litre o f RL ) to o btain
an o utp ut o f 1 to 2 m l/ k g/ h. D o no t ad m inister d o p am ine o r furo sem id e.
269
