A 7-year-old boy is a patient in your intensive care unit. He was on a camping t

Question

A 7-year-old boy is a patient in your intensive care unit. He was on a camping trip with his family when he accidentally fell on the campfire, causing severe second- and third-degree burns over 60% of his body. The clinical care team tells his parents that it will be critical to maintain their son’s airway and keep his fluid levels high.

The father is confused and asks you why his son’s fluid level is important after a burn. How would you explain this to him?

After your explanation, the father nods that he understands. He then asks how you will measure his son’s fluid levels. How would you respond?

As a clinician with knowledge of physiology, which aspects of this boy’s condition would you be most concerned about?

Explanation / Answer

1. ANS: Severe fluid loss is the greatest problem faced following major burn injuries. Therefore, effective fluid resuscitation is one of the best modern burn treatment.

Appropriate fluid management of major burns directly improves the survival rates of burn patients.

The best type of fluid management in major burns in the first 24 hours after injury.

During this early period after the burning various pathopysiological changes take place, appropriate fluid management plays a fundamental role to maintain the tissue perfusion.

2. ANS: Formulas used for fluid management in major burns:

The most commonly used formulas are the Parkland, modified Parkland, Brooke, modified Brooke, Evans and Monafo’s formulas. These formulas take into account the body weight and the burn surface area.

Ex: Modified Parkland formula

A. Initial 24 hours: RL 4 ml/kg/% burn

B. Next 24 hours: Begin colloid infusion of 5% albumin 0.3–1 ml/kg/% burn/16 per hour

3. ANS: A mild burn usually won't affect the body beyond the original wound, but serious burns can cause additional problems in the body, including dehydration, shock, and chemical imbalances. In the given condition the patient skin is highly damaged because severe second- and third-degree burns over 60% of his body. The skin plays a vital role for keeping the physiological and biochemical conditions of the body in its optimum state. Severe burns can also destroy muscle tissue and damage the kidneys. So the boy was in serious condition.

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