Page 105 - Journal of Special Operations Medicine - Winter 2016

Figure 2 First-degree burns. (Do not include these wounds in example, if the burn size is 30%: 30 × 10 =
the TBSA estimate!) 300. Starting rate is 300mL/h.
❖ For patients with weight >80kg, add an extra
100mL/h for each 10kg. For example, for a
100kg patient with 30% burns, the starting
rate is 300mL/h + 200mL/h = 500mL/h.
❖ If resuscitation is delayed, DO NOT try
to “catch up” by giving extra fluids.
❖ For children, 3 × TBSA × body weight in
kg gives the volume for the first 24 hours.
One half is given during the first 8 hours.
■ Better: enteral (oral or gastric) intake of electro-
lyte solution
• Sufficient volume replacement will require
“coached” drinking on a schedule using ap-
proximately the same amount of fluids that
would be given IV/IO (see above).
• Oral resuscitation of patients with burns up
(A) Sunburn. to about 30% TBSA is possible (see Hydra-
tion box below).
• If a nasogastric tube (NGT) is available,
it is preferable to resuscitate with infusion
of electrolyte solution via NGT (e.g., 300–
500mL/h. But watch for nausea/vomiting.
■ Minimum: rectal infusion of electrolyte solution
• Rectal infusion of up to 500mL/h can be
supplemented with oral hydration (see Hy-
dration box below)

◆ Monitoring:
➤ Goal: maintain adequate oxygenation and venti-
lation, avoid hypotension, trend response to re-
suscitation. Document blood pressure (BP), heart
rate (HR), urine output (UO), mental status, pain,
pulse oximetry, and temperature, and record data
on a flowsheet (Appendix D).

Hydration
(B) Mostly first-degree burns with small area of superficial second degree.
Plain water is ineffective for shock resuscitation
and can cause hyponatremia. If using oral or rectal
The principles of hypotensive resuscitation fluids, they must be in the form of a premixed or
according to TCCC DO NOT apply in the setting improvised electrolyte solution to reduce this risk.
of burns (without severe bleeding). Examples:
• World Health Organization (WHO) Oral Rehy-
HOWEVER dration Solution (per package instructions or 1L
of potable water with 6 level teaspoons sugar,
In the unusual setting of burns associated with 0.5 level teaspoon salt)
noncompressible (e.g., thoracic, abdominal, pelvic) • Mix 1L of D5W solution with 2L of Plasma-Lyte
hemorrhage, aggressive fluid resuscitation may re- • Per 1L water: add 8tsp sugar, 0.5tsp salt, 0.5tsp
sult in increased hemorrhage. Balancing the risk of baking soda
uncontrolled hemorrhage against the risk of wors- • Per quart of Gatorade (Stokely-Van Camp Inc.,
ening burn shock from under-resuscitation should http://www.gatorade.com/): add 0.25tsp salt,
be guided by expert medical advice (in-person or 0.25tsp baking soda (If no baking soda, double
telemedicine). Be prepared for blood transfusion. the amount of salt in the recipe.)

PFC Guideline: Burn Management 89