Monitoring of resuscitation

Monitoring of resuscitation

Although fluid resuscitation has defined guidelines it is critical to understand that the process is dynamic and rigid adherence to protocols should be avoided. The key to monitoring of resuscitation is urine output. Urine output should be between 0.5 and 1.0 /uni00A0 mL/kg body weight per hour. If the urine output drops and the patient is showing signs of hypoperfusion (tachy - car dia, cool peripheries and a high lactate/metabolic acidosis), then a bolus of 10 /uni00A0 mL/kg body weight should be given. It is important that patients are not over-resuscitated; urine output in excess of 2 /uni00A0 mL/kg body weight per hour should warrant a decrease in infusion. Other measures of tissue perfusion such as lactate levels - can be useful, particularly in larger burns. A persistent raised lactate/metabolic acidosis can indicate a missed systemic tox - icity from cyanide or carbon monoxide. Patients with under - lying comorbidities , particularly cardiac or renal, will require further intensive monitoring such as central venous pressure - measurement in an intensive care setting. - Summary box 46.13 Fluids for resuscitation /uni25CF /uni25CF /uni25CF /uni25CF

In children with burns over 10% TBSA and adults with burns over 15% TBSA, consider the need for intravenous /f_l uid resuscitation If oral /f_l uids are to be used, salt must be added Fluids needed can be calculated from a standard formula and start from time of burn The key is to monitor urine output

Monitoring of resuscitation

Although fluid resuscitation has defined guidelines it is critical to understand that the process is dynamic and rigid adherence to protocols should be avoided. The key to monitoring of resuscitation is urine output. Urine output should be between 0.5 and 1.0 /uni00A0 mL/kg body weight per hour. If the urine output drops and the patient is showing signs of hypoperfusion (tachy - car dia, cool peripheries and a high lactate/metabolic acidosis), then a bolus of 10 /uni00A0 mL/kg body weight should be given. It is important that patients are not over-resuscitated; urine output in excess of 2 /uni00A0 mL/kg body weight per hour should warrant a decrease in infusion. Other measures of tissue perfusion such as lactate levels - can be useful, particularly in larger burns. A persistent raised lactate/metabolic acidosis can indicate a missed systemic tox - icity from cyanide or carbon monoxide. Patients with under - lying comorbidities , particularly cardiac or renal, will require further intensive monitoring such as central venous pressure - measurement in an intensive care setting. - Summary box 46.13 Fluids for resuscitation /uni25CF /uni25CF /uni25CF /uni25CF

In children with burns over 10% TBSA and adults with burns over 15% TBSA, consider the need for intravenous /f_l uid resuscitation If oral /f_l uids are to be used, salt must be added Fluids needed can be calculated from a standard formula and start from time of burn The key is to monitor urine output

Monitoring of resuscitation

Although fluid resuscitation has defined guidelines it is critical to understand that the process is dynamic and rigid adherence to protocols should be avoided. The key to monitoring of resuscitation is urine output. Urine output should be between 0.5 and 1.0 /uni00A0 mL/kg body weight per hour. If the urine output drops and the patient is showing signs of hypoperfusion (tachy - car dia, cool peripheries and a high lactate/metabolic acidosis), then a bolus of 10 /uni00A0 mL/kg body weight should be given. It is important that patients are not over-resuscitated; urine output in excess of 2 /uni00A0 mL/kg body weight per hour should warrant a decrease in infusion. Other measures of tissue perfusion such as lactate levels - can be useful, particularly in larger burns. A persistent raised lactate/metabolic acidosis can indicate a missed systemic tox - icity from cyanide or carbon monoxide. Patients with under - lying comorbidities , particularly cardiac or renal, will require further intensive monitoring such as central venous pressure - measurement in an intensive care setting. - Summary box 46.13 Fluids for resuscitation /uni25CF /uni25CF /uni25CF /uni25CF

In children with burns over 10% TBSA and adults with burns over 15% TBSA, consider the need for intravenous /f_l uid resuscitation If oral /f_l uids are to be used, salt must be added Fluids needed can be calculated from a standard formula and start from time of burn The key is to monitor urine output