Page 112 - Journal of Special Operations Medicine - Winter 2016

Appendix E Fluid and equipment planning considerations

Assumptions: one patient with a 50% total body sur- ■ Better:
face area (TBSA) burn, weighing 80kg, and requir- • Fluids: IV fluid (lactated Ringer’s solution or
ing 4mL/kg/%TBSA for resuscitation the first day Plasma-Lyte) to provide resuscitation for 24
(16L), half that the second day (8L), and half that hours (16L); oral electrolyte replacement
the third day (4L). Note: For planning purposes only, • Equipment: Blood pressure cuff, stethoscope,
the Parlkand formula of 4mL/kg/%TBSA provides pulse oximeter, capnometer, portable ventilator,
an estimate for the first 24-hour fluid requirements; oxygen or oxygen concentrator, airway man-
however, hourly fluid resuscitation should start with agement kit to include endotracheal suction
the rule of 10s. catheter
• Graduated container to monitor urine output
■ Best: • Pain medications
• Fluids: IV fluid (lactated Ringer’s solution or • Nonspecific dressings: roller gauze, torso dress-
Plasma-Lyte) to provide resuscitation for 72 ings, tape or stapler
hours (28L) • Hypothermia prevention: sleeping bag/HPMK/
• Equipment: Portable monitor with capnogra- Blizzard Blanket (Blizzard Protection Systems
phy; lab capability for serum electrolytes, arte- Ltd., http://www.blizzardsurvival.com/)
rial blood gases, and lactate; Foley catheter with • Monitoring: Frequent vital signs, examination,
graduated collection system; portable ventila- fluid input, urine output, flowsheet to document
tor; portable suction; electrocautery or scapel; • Communications: telephone; e-mail digital
oxygen or oxygen concentrator; airway man- photos
agement kit to include endotracheal suction
catheter ■ Minimum:
• Medications: pain medications (refer to Analge- • Fluids: Resuscitation with commercial or impro-
sia, Sedation CPG) vised electrolyte solution (oral, enteral, rectal)
• Burn-specific dressings: Hibiclens to clean • Equipment: Blood pressure cuff, stethoscope,
wounds, Silvadene and/or Sulfamylon cream pulse oximeter, bag-valve mask with positive
(two 400g jars per patient per day), or silver ny- end-expiratory pressure (PEEP) valve, airway
lon (Silverlon) dressings management kit
• Nonspecific dressings: roller gauze, torso dress- • Graduated or improvised graduated container
ings, tape or stapler to monitor urine output
• Hypothermia prevention: sleeping bag or Hypo- • Pain medications
thermia Prevention & Management Kit (HPMK) • Clean sheet, any available trauma dressings
• Monitoring: Portable monitor providing con- • Hypothermia prevention: sleeping bag/emer-
tinuous vital-signs display; capnography, if in- gency blanket/blankets
tubated; document vital-signs trends, intake and • Monitoring: Frequent vital signs, examination,
output, GCS, and pain level on a regular basis; fluid input, urine output documented on pre-
burn-resuscitation flow sheet printed or improvised flowsheet
• Communications: real-time video telemedicine • Communications: telephone
consultation
• Push-pack capability: prepackaged additional
24-hour supplies of fluids, dressings for scenar-
ios >24 hours or >1 patient

96 Journal of Special Operations Medicine Volume 16, Edition 4/Winter 2016