SCCM Resource Library-Pro/Con: Burn Resuscitation: How Much to Pour and With What?

Video Transcription

Video Summary

The video transcript discusses different approaches to burn shock resuscitation and the debate between using more aggressive or more conservative strategies. The speaker explains that burn shock is a complex process of circulatory and microcirculatory dysfunction that requires fluid resuscitation to restore and maintain adequate intravascular volume and organ perfusion. However, there are risks associated with both over-resuscitation and under-resuscitation.<br /><br />The speaker mentions complications of inappropriate resuscitation, including reduced venous return, reduced intravascular volume, reduced cardiac output, increased oxygen demands, compromised perfusion, and end-organ damage. They highlight the importance of individualized therapy, as fluid requirements can vary depending on multiple factors such as burn size, smoke inhalation injury, underlying tissue damage, and associated injuries.<br /><br />The speaker discusses different monitoring options for burn shock resuscitation, including low-tech options like heart rate, blood pressure, and urine output, as well as intermediate and high-tech options such as echocardiography and invasive hemodynamic monitoring. They acknowledge that no single method has proven to be consistently reliable and emphasize the need for individualized therapy based on the patient's condition.<br /><br />The speaker also addresses the issue of fluid creep, where patients receive more fluid than what the formulas predict. They discuss the potential consequences of over-resuscitation, including abdominal compartment syndrome, extremity and orbital compartment syndromes, cerebral edema, pulmonary edema, gastrointestinal dysfunction, wound progression, and delayed healing.<br /><br />Finally, the speaker suggests strategies to reduce fluid resuscitation volumes, such as starting with a lower fluid resuscitation formula, using intraoperative decision support systems, considering early initiation of albumin or plasma, and monitoring other endpoints like lactate, pressor needs, and echocardiographic estimation of volume status. They also mention the potential roles of high-dose vitamin C, hypertonic saline, and colloids in burn shock resuscitation.<br /><br />Overall, the video transcript highlights the need for careful and individualized management of burn shock resuscitation to avoid both under and over-resuscitation and reduce the risk of complications.

Asset Subtitle

Trauma, Integument, 2022

Asset Caption

Fluid resuscitation remains a cornerstone of burn care but there also remains some controversy in how best to resuscitate burn patients. We have seen both underresuscitation and overresuscitation and the complications that come with them. Speakers will discuss traditional burn resuscitation, complication of burn resuscitation, the use of decision support systems in burn resuscitation, and the use of fluids other than lactated Ringer solution in burn patients.

Learning Objectives:
-Review traditional burn resuscitation
-Recognize fluid creep and complications of overresuscitation and describe computerized decision support systems for burn resuscitation
-Describe other modalities of burn resuscitation such as hypertonic saline, fresh frozen plasma, and vitamin C

Meta Tag

Content Type Presentation

Knowledge Area Trauma

Knowledge Area Integument

Knowledge Level Intermediate

Knowledge Level Advanced

Learning Pathway Emergency Medicine and EMS Care

Membership Level Select

Tag Burns

Tag Fluids Resuscitation Management

Tag Abdominal Compartment Syndrome

Year 2022

Keywords

burn shock resuscitation

fluid resuscitation

complications

individualized therapy

monitoring options

over-resuscitation consequences

management

Emergency Medicine and EMS Care

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