Page 316 - Critical Care Nursing Demystified

Chapter 6 CARE OF THE TRAUMATIZED PATIENT 301
Treatment
Remove any source of retained heat or chemicals (like clothing).

Maintain airway patency.
Administer oxygen.
Estimate the amount of fluid loss.
Fluid volume replacement if BSA greater than 15% or critical areas (genitalia).
Possible skin grafting.

Treat for infection.

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How to Do It—Fluid Replacement
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Calculation
Calculation
Estimation of fluid loss during burn injury using the Parkland formula: 2–4 mL ×
Estimation of fluid loss during burn injur y
weight in kg × total body surface area burned
w eight in kg × t otal bod y sur f ac e ar ea bur n
T he f irst hal f o f f luid is g iv en in the f irst 8 h o Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
The first half of fluid is given in the first 8 hours and the rest is given over the next
16 hours T ime b egins a t the time of the e
16 hours. Time begins at the time of the event/injury, NOT the time the patient
arrived at the unit.
Example:
The patient weights 110 lb and has a 50% burned area. The physician orders 4 mL
of LR per kg.
Calculate the weight in kg: 110 divided by 2.2 lb/kg = 50 kg
Calculate the amount of fluid: 50 kg × 4 = 200 mL
Multiply by TBSA% burned: 200 × 50 = 10,000
The patient will receive 5,000 mL in the first 8 hours and the next 5,000 mL in the
next 16 hours.

NURSING ALERT

Calculation of fluid to prevent hypovolemic shock due to large fluid loss is essential in
the burn patient. Always time fluid replacement from the time of injury, NOT the time

of admission to the ECU!