CIRCULATION with haemorrhage control

2. Commence Fluid Resuscitation

Fluid resuscitation is recommended for the following injuries:

Adults (>15%TBSA burn)

Children (>10%TBSA burn):

The goal of fluid resuscitation is to anticipate prevent hypovolaemic shock.

Mechanisms that control protein and fluid loss from the vascular space are severely compromised following severe burns and the subsequent inflammatory response. Hypovolemic shock will develop if fluid is not replaced after burns involving >15 – 20% Total Body Surface Area (TBSA) (13,11)

There is a lack of evidence regarding the best burns fluid resuscitation formula and fluid.

Crystalloid based formulae (eg The Parkland) are simple to administer and effective.

Modified Parkland Formula

The Parkland formula is a guide only to assist in estimation of fluid requirements. Ongoing fluid volume replacement must be determined by clinical indicators of the adequacy of resuscitation.

3 – 4 mls/kg/TBSA% = mls/ given in 24 hours post injury

Rate:
1/2 total in 8 hrs post injury
1/2 total in 16 hrs post injury
Hartmanns is the preferred IV fluid for replacement.

4mls/kg/%TBSA is recommended if the patient has an inhalation injury, presentation is delayed, has associated trauma or has a high voltage electrical injury.

The calculation of fluid requirement is calculated from the time of the burn rather than the time of presentation. If the presentation is delayed, fluid may need to be given more rapidly

Maintenance fluids in children

Maintenance fluids should also be added over and above the Modified Parklands formula for children weighing less than 30kgs. 5% Dextrose and 1/2 Normal Saline should be used for maintenance fluid

Up to 10kgs	100ml/kg/day
10 – 20kgs	1000mls plus 50ml/kg/day for each kg over 10kgs
20 – 30kgs	1500mlsplus 20ml/kg/day for each kg over 20kgs

Oral fluids should be encouraged to supply maintenance fluids if the child is stable and conscious, and no interventions are planned

Adult Fluid Resuscitation for Ambulance Victoria

	Ambulance Victoria use this formula to calculate fluid replacement requirements in the first 2 hours following injury.
%TBSA X Weight in kilograms(kg) = mls in the first 2hrs after injury Normal Saline is the preferred IV fluid for replacement.

Measure urine output to assess effectivness of fluid resuscitation