Page 55 - PJ MED OPS Handbook 8th Ed

Better: Enteral (oral or gastric) intake of electrolyte solution
• Sufficient volume replacement will require “coached” drinking on a schedule using approxi-
mately the same amount of fluids that would be given IV/IO (see page 50).
• Oral resuscitation of patients with burns up to about 30% TBSA is possible.
• If a nasogastric tube (NGT) is available, it is preferable to resuscitate with infusion of electro-
lyte solution via NGT (e.g., 300–500mL/hr). Observe for nausea to avoid vomiting.

Minimum: Rectal infusion of electrolyte solution. Rectal infusion of up to 500mL/hr can be supple-
mented with oral hydration (see Hydration side bar.) Not reliable though, this is a last choice).

HYDRATION NOTE: Plain water is ineffective for shock resuscitation and can cause hypona-
tremia. If using oral or rectal fluids, they must be in the form of a premixed or improvised
electrolyte solution to reduce this risk.
Examples:
World Health Organization (WHO) Oral Rehydration Solution (per package instructions or 1L
of potable water with 6 level teaspoons sugar, 0.5 level teaspoon salt)
Mix 1L of D5W solution with 2L of Plasma-Lyte
Per 1L water: add 8tsp sugar, 0.5tsp salt, 0.5tsp baking soda
Per quart of Gatorade: add 0.25tsp salt, 0.25tsp baking soda (If no baking double the amount
of salt in the recipe.)

Urine Output
Urine output (UO) is the main indicator of resuscitation adequacy in burn shock.
Urine output goal: Adjust IV (oral/rectal intake) rate to UO goals of 30–50mL/hr. For children, titrate
infusion rate for a goal UO 0.5–1mL/kg/hr.
Best: Place Foley catheter
• If UO too low, increase IV rate by 20% q2hr (e.g., if UO = 20mL/hr and IV rate = 300mL/hr,
increase IV rate by 0.20 × 300 = 60mL/hr. New rate is 360mL/hr).
• If UO too high, decrease IV rate by 20% q2hr until the goal of 30–50mL/hr is achieved.
Better: Capture urine in premade or improvised graduated cylinder
• Collect all spontaneously voided urine and carefully measure; >180mL q6hr is adequate for
adults.
• A Nalgene® water bottle is an example of an improvised graduated cylinder.
Minimum: Use other measures
• If unable to measure UO, adjust IV rate to maintain HR less than 140, palpable peripheral
pulses, good capillary refill, intact mental status.
• Measure the BP and consider treating hypotension, but remember: BP does not decrease
until relatively late in burn shock, because of catecholamine release. On the other hand, BP
may be inaccurate (artificially low) in burned extremities.

Chapter 6. Surgical and Medical Procedures n 53