Page 1665 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

1184 PART 10: The Surgical Patient

Pediatric burn patients (<30 kg)
Protocol for fluid resuscitation Bar code label
If burn >25% Step one: Vitals unstable:
Add hetastarch Infuse LR at calculated rate See table below for
at 15 mL/kg/24 h per Galveston protocol (below) pediatric vitals
Start time:________ measure urine output after 1 hour Call physician

Vital signs stable See table below for pediatric vitals

Urine output Urine output Urine output Urine output Urine output
<0.25 mL/kg 0.26-0.5 mL/kg 0.51-1.0 mL/kg 1.1-2.0 mL/kg >2.0 mL/kg
_______ mL _______ mL _______ mL _______ mL _______ mL

Increase IV Increase IV No change- Decrease IV Decrease IV
rate by 20% rate by 10% leave IV rate rate by 10% rate by 20%
initial rate initial rate as is initial rate initial rate

If urine output If urine output
<0.25 mL/kg/h for >2.0 mL/kg/h for
2 consecutive hours: 2 consecutive hours:
Call physician Call physician

Start hetastarch at
15 mL/kg/24 h
(if not started
previously)

Repeat Step one every hour until:

Calculated maintenance rate is reached
_________mL/h (formula in box below)

Do not include
Once at maintenance rate for 2 hours, hetastarch, tube
decrease hourly by 10% of initial rate until off feedings, or
medication fluids as
part of the
Continue hourly UOP recording for 8 hours on burns >20% or resuscitation fluids—
if otherwise indicated (difficult resuscitation, inhalation injury) you should only
titrate the LR during
the resuscitation
If urine output falls below 0.5 mL/kg/h phase
return to Step one & Call physician
For pt <12 months
or <10 kg initiate
D5LR at 5 mL/h for
Obtain ABG, lactate, bladder pressure
glucose source.
Galveston formula Goal maintenance IVF rate Admit weight:______.___kg
2
2
A: _______M x 2000 mL = ________ _____M x 2000 mL = ______mL Admit height: _________cm
(TBSA) (TBSA) Burn size:_____________%
+ (Plus) /24 = ___________ mL (goal rate) Titrate by: ____________mL
(10% of starting IVF rate)
2
B: ___ M x ____ x 50 mL = _____mL
(TBSA) (BSAB) **Normal pediatric vital signs

A + B = __________ mL/1st 24 hours Age RR HR Systolic BP
lower limit
/2 = __________ mL/1st 8 hours Infant (<1 y) 30-60 100-160 >60 (or strong pulse)
/8 = __________ mL/hour IV rate Toddler (1-3 y) 24-40 90-150 >70 (or strong pulse)
Starting IVF rate: _______ mL/h Preschool (4-5 y) 22-34 80-140 Same calc >75
Titrate per protocol until goal School age (6-12 y) 18-30 70-120 >80
Maintenance rate achieved. Adolescent (12-20 y) 12-20 60-100 >90
Place this sheet in nurse manager’s mailbox when resuscitation is complete
FIGURE 123-3. Pediatric burn resuscitation protocol.

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