Page 33 - PJ MED OPS Handbook 8th Ed

4) If IV fluids are scarce, also begin slow administration of water at 25mL/hr then increase
by 25mL/hr q4hr to meet goal rate of 100–150mL/hr.
5) If patient becomes nauseated/vomits: D/C feeds, suction NG, and keep NPO.
6) RECALL: Blood is shunted from the GI system to compensate for shock. Do not give PO
fluid for severely injured/unstable patients for the 1st 24 hours.
c. Critical burn (>20% TBSA of 2nd degree or greater burns):
i) Insert Foley catheter.
ii) Continue fluid resuscitation according to “The Rule of Ten”.
1) Initial rate is 10mL per % TBSA per hour for a max casualty weight of 80 kg.
2) Add 100mL per hour to the rate for each 10 kg above 80 kg.
Example: A 90 kg casualty with 50% TBSA burn would receive an initial rate of (10mL
× 50)/hr + 100mL/hr or 600mL/hr.
3) Adjust fluid rate every 1–2 hours to maintain urine output of 30–50mL/hr. Adjust-
ments should not exceed a 20% change from the current rate.
4) Oral fluid administration may be acceptable in burns up to 40% TBSA if crystalloid
supplies are limited. Larger burns are associated with ileus and significantly decreased
bowel absorption. Use WHO oral rehydration packets if available.

PJ PEARLS:
• Bring a collapsible 500mL canteen to be used for collection/measurement of urine output
or chest tube output hourly.
• Empty a Foley collection bag hourly to facilitate measurement.

5. Wound Care Management
a. See Wound Care under Surgical and Medical Procedures for irrigation, debridement, suturing
and delayed closure protocols.
b. Dress wounds using dry sterile dressings, if not available, use clean cloth or other material.
For missions expected to last greater than 24 hours, use silver impregnated dressings to re-
duce frequency of dressing changes. Silver nylon dressings must be changed every 5 days. In
the absence of silver nylon dressings follow Burn Management, Infection under Surgical and
Medical Procedures.
NOTE: Dressing changes can be extremely painful. Consider providing analgesia; for exten-
sive dressing changes, procedural sedation may be indicated.
c. Continue antibiotics. Repeat moxifloxacin 400mg PO or ertapenem 1g IV/IO/IM q24hr for
open wounds or invasive procedures, or suspicion of infection.
d. Monitor for signs of infection (fever, redness, swelling, warm to touch, tenderness, pain,
discharge).
PJ PEARL:
• Rubber dish washing gloves may be used, washed and re-used multiple times with min-
imal risk of tearing in instances where you have limited gloves and need to be selective
about using them (i.e. procedures requiring high levels of dexterity).

Chapter 5. Prolonged Field Care n 31