Burns: Resuscitation in the First 24 Hours

About this course

Burns are traumatic injuries typically to the skin, the body's largest organ that on average, covers a surface area of about 2 m2. A burn can result in the loss of the physical barrier function of the skin, opening the door to fluid loss, renal and circulatory failure, and invasion of harmful microorganisms, which can lead to infection, and ultimately, the development of sepsis. This course examines burn injuries, detailing their types, pathophysiology, and initial interventions. It also discusses the various formulae used in fluid management for both adult and pediatric patients, along with consideration of fluid management of electrical burns, long-term care, and nursing in an emergency setting.

Learning objectives

• Define the several types of burns based on the causative agent and the extent of tissue damage (1st, 2nd, and 3rd degree).
• Review the Rule of Nines and the Lund-Browder Chart for estimating total body surface area burn percentages.
• Review the pathophysiology of burn shock
• Understand the initial management of burn injuries and burn shock based on the American Burn Association practice guidelines and various evidenced based formulae available.
• Analyze the advantages and disadvantages of crystalloid and colloid fluid administration in burns.

Course outline

21 sections · finish in any order across devices

1. 1

   Introduction

   Burns are traumatic injuries typically to the skin, the body's largest organ that on average, covers a surface area of about 2 m2. This vital barrier consists of the epidermis and the dermis, which protects inner structures and promotes wound healing. A burn can result in the loss of the physical ba

   4 min

2. 2

   Defining Burns

   A burn is a traumatic injury to the skin or other tissues triggered by exposure to thermal, chemical, electrical, or radiation sources. Burns are classified based on the causative agent and the extent of tissue damage. Thermal Burns are produced by exposure to heat sources, such as flames, hot objec

   4 min

3. 3

   Burn Degrees

   Burns are divided into three types based on the depth of tissue damage, each with distinct characteristics and underlying damage. These degrees are first-degree, second-degree, and third-degree. First-degree burns, also known as superficial burns, involves damage to the thin outer layer of the skin,

   4 min

4. 4

   Initial Interventions

   In the initial management of burn injuries, several crucial interventions are performed immediately to assess and address potential complications. A thorough airway assessment is done in thermal burns, specifically in cases involving fires where inhalation injury is suspected. Signs of inhalation in

   4 min

5. 5

   Pathophysiology of Burn Shock

   Burn shock is a distributive shock characterized by inadequate tissue perfusion and oxygen delivery despite a normal or increased cardiac output. Initially, there is a brief period of vasoconstriction as a response to the sympathetic nervous system activation. This is accompanied by an increased hea

   4 min

6. 6

   Formulae Used for Fluid Management In Major Burns

   In large deep partial-thickness or full-thickness burns covering more than 20% of TBSA in adults and greater than 10% in children, fluid management is vital. It refers to the administration of intravenous crystalloid solutions to address the profound hypovolemia that occurs in the initial stages of

   4 min

7. 7

   The Parkland Formula

   The Parkland Formula is a well-established formula developed in the 1960s by Charles Baxter at Parkland Hospital at Southwestern University Medical Center. It is the most used formula in US burn centers today. For adults, the formula advises administering 4 ml/kg/% burn (ml per kilogram of body weig

   4 min

8. 8

   Modified Parkland Formula

   The Modified Parkland Formula is a variation that adjusts the fluid rate during the initial 24 hours. It involves administering 2 - 4 ml/kg/% burn of LR solution that is then divided, with half given within the first 8 hours post-burn and the remaining half infused over the subsequent 16 hours. This

   4 min

9. 9

   Brooke Formula

   Developed at the Surgical Research Unit at Brooke Army Hospital in the 1950s, the Brooke Formula recommends a lower fluid rate than the Parkland Formula. In the initial 24 hours post-burn, it advises 1.5 ml/kg/% burn of LR solution + 0.5 ml/kg/% burn colloids + 2000 ml glucose in water. In the next

   4 min

10. 10

    Modified Brooke Formula

    Like the Brooke Formula, the Modified Brooke Formula removes colloids from fluid management in the first 24 hours but increases LR solution to 2 ml/kg/% burn in adult patients and 3 ml/kg/% burn in pediatric patients. In the following 24 hours, crystalloids are stopped, and colloids are introduced a

    4 min

11. 11

    Evans Formula

    The Evans Formula is another approach to fluid resuscitation in burn patients. It was developed by Dr. Everett Evans and co-workers at the Medical College of Virginia in the 1950s following unsatisfactory results from previous guidelines. This formula recommends administrating 1 ml/kg/% burn of crys

    4 min

12. 12

    Monafo Formula

    Monafo's formula was developed in the early 1980s and advocates fluid resuscitation with hypertonic saline solutions that contain 250 mEq of sodium, 150 mEq lactate, and 100 mEq of chloride in the first 24 hours, but amounts can be adjusted according to the urine output. In the following 24 hours, t

    4 min

13. 13

    Formulas Developed for Children

    The resuscitation formulae mentioned above were developed for adult burn patients and were previously used on pediatric burn patients by proportionally reducing quantities. However, this led to complications as children have unique fluid needs following a burn injury, given they have proportionally

    4 min

14. 14

    Fluid Types

    For fluid resuscitation in burn injuries, the ideal fluid restores plasma volume without adverse reactions. Typically, isotonic crystalloid, hypertonic, and colloid solutions are used. Crystalloids are typically used in the early hours of post-burn. They include Lactated Ringers (LR) solution, a bal

    4 min

15. 15

    Considerations: Fluid Management in Electrical Burns

    Fluid management in patients with high-voltage electrical burns ( > 1,000 V) is a far more complex challenge than standard burn management. These burns can cause both superficial and deep injury. Superficial burns are caused by electrical contact, which creates flames capable of igniting the patient

    4 min

16. 16

    Considerations: Acute Renal Failure and Dialytic Support In Severe Burns

    Major burns can significantly impact renal function, resulting in acute kidney injury and renal failure, necessitating dialytic support. The severity of burn injuries, especially in cases of extensive or deep burns, can lead to complications such as rhabdomyolysis and myoglobinuria, causing the rele

    4 min

17. 17

    American Burn Association Practice Guidelines for Burn Shock Resuscitation

    The American Burn Association provides practice guidelines for burn shock resuscitation, emphasizing tailored approaches based on body size, surface area burned, and the severity of the burn injury. For adults and children with burns exceeding 20% TBSA, formal fluid resuscitation is recommended. Com

    4 min

18. 18

    Additional Considerations

    In burn patients, several additional therapy considerations include antimicrobial therapy, attenuating hypermetabolism, nutrition support, pain control, risk for coagulopathy, and thromboprophylaxis. Antimicrobial therapy is crucial to manage infections and prevent sepsis, a significant complication

    4 min

19. 19

    Long-Term Care Considerations

    Long-term care for burn patients encompasses a comprehensive strategy to address the physical, emotional, and psychological aspects of the injury. While individualized interventions, ongoing monitoring, and a multidisciplinary team are essential, several considerations should be considered for most

    4 min

20. 20

    Nursing Considerations

    Nurses play a significant role in managing a burn patient. They must be well versed with the various protocols not only in medical care but also in the psychological assessment of the victim and the family. To ensure the patient receives optimal care, they must also communicate and document every in

    4 min

21. 21

    Conclusion

    The comprehensive management of burns, particularly in the first 24 hours, involves a meticulous understanding of the diverse types and degrees of burns, as well as the pathophysiological underpinnings of burn shock. While guided by well-established formulae, fluid management demands individualized

    4 min

This course satisfies

Requirement summaries come from our state requirement records. Always confirm details with your board before you renew.

References and resources

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