Case of the Month #46 A Major Burn Injury: Taming the Flames

Circulation: 

• Hypotension should not be attributed to early burn injury 

  • Evaluate for bleeding in concurrent trauma 
  • Also consider comorbid conditions 

• Volume resuscitation 

  • Use the Parkland formula for burns >15% TBSA 
    • 2-4ml/kg/%TBSA burned 
    • Calculated from the time of injury 
    • Give half in the first 8 hours, then half in the subsequent 16 hours 
  • Use balanced crystalloid, delivered through a fluid warmer 

• Cyanide toxicity 

  • Inhalational injury 
  • Cardiovascular instability 
  • Elevated blood lactate levels 
  • If suspected, give high-dose hydroxocobalamin 

IV access is obtained through non-burned skin. You begin volume resuscitation according to the Parkland formula. The initial blood lactate level is 7mmol/L, and you ask for a blood gas to be rechecked in an hour to ensure this is falling. Your colleague will insert an arterial line. You move on in your assessment.