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Monitoring fluid resuscitation

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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The patient with major burns is at risk of inappropriate fluid resuscitation if there is not close monitoring. A urinary catheter is mandatory - see submenu. Other indices required are:

  • pulse
  • blood pressure:
    • spurious readings can be obtained with a sphygmomanometer due to burn oedema
    • an arterial line is the preferred means of monitoring for big burns
  • central venous pressure; very helpful in the following circumstances:
    • pre-existing poor cardiac reserve
    • multiple trauma - allows more accurate fluid challenge
  • blood gases:
    • important to identify acidaemia
    • acidaemia may reflect indequate tissue perfusion, or more rarely the need for escharotomy
  • pulse oximeter:
    • can give constant pulse reading
    • may give spurious readings in carbon monoxide poisoning
  • serum electrolytes; serial values are helpful as:
    • Hartmann infusion can cause hyponatraemia
    • electrical burns can cause hyperkalaemia

For larger burns, a nasogastric tube is warranted to indicate and protect against the effects of gastroparesis. Also, it may provide a route for early enteral feeding in a patient too compromised to eat normally.


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