Navigating the complex world of burn care at first can be intimidating. Fortunately, the nurses and therapists are well-versed in the usual nuances of burn patient management, and an under-appreciated resource. They are friendly and helpful, so a little kindness and consideration on your part will be a worthwhile investment. If you stray from the path of righteousness in your patient care, the attending will happily (not for you) set you right again. Success in acute burn management hinges on diligence and attention to detail.
If you have a question, don't be afraid to ask. You will find our faculty very approachable and helpful. It's more embarrassing to be hammered in the morning than to wake up the faculty at night.
The age of the patient is also essential, as SBH does not accept first time acute patient admissions after their 18th birthday. Older patients can be referred to the Blocker Burn Unit at UTMB. Acute referrals from the UTMB Emergency Room for hemodynamically stable patients meeting SBH admission criteria are sent over for evaluation and treatment without needing to obtain faculty approval prior to transfer.
It is not only courtesy to notify the faculty on-call of all admissions and transfers, but their responsibility to know of such happenings. The mode of transportation and any treatment recommendations should be relayed back to the referring facility.
Calculate Fluid Requirement
Shriners Burns Hospital Resuscitation Formula
Half of this calculated
amount is given over the first eight hours from the time of burn injury,
and the second half of this fluid requirement is given over the next 16
hours. This is only a predicted fluid requirement and actual needs are
titrated to adequate urine output (0.5-1cc/kg/hr for patients older than 2
years of age and 1-2 cc/kg/hr for children under 2 years of age).
Watch serum/urine glucose.
After 24 hours:
3750 ml/m²BSA burned/day
This accounts for total fluid needs, including enteral feedings and IV's. IV solution is chosen to help maintain normal serum electrolyte, e.g. D51/3 NS + 20 mEq K + Phosphate
Blocker Burn Unit Resuscitation Formula
After 24 hours: 1 cc/kg/%TBSA burned. In general, maintenance fluids are estimated to be similar to the above calculations. Mostly, they are determined by the volume of enteral feeds to meet caloric needs and monitored again by urine output.
Hormonal Manipulation (Usually as
part of study protocol - check with Fellow/Attending)
Burn Wound Treatment
Surgical Wound Closure
Next - Acute Burn Management
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