Atlanta Legal Nurse Consultant Listens Up On Fluid Resuscitation: Crystalloids And Beyond
Fluid Resuscitation In Treating Burn Patients
"The primary goal is to restore and preserve tissue perfusion."
Atlanta legal nurse consultant Liz Buddenhagen attended the 2016 J. M. Still Burn Symposium at Chateau Elan in Braselton, Georgia on March 7, 2016. Presenter Kim Linticum, ACNP from the Burn Center at Doctors Hospital in Augusta, Georgia talked about fluid resuscitation of the burn patient.
Understanding the Pathophysiology of Burn Shock:
Linticum began with a history of fluid resuscitation from the original Parkland formula to present day fluid management. She said the primary goal was to restore and preserve tissue perfusion. She reviewed the “vicious circle of shock.”
In burn shock, there is hypovolemic shock with increased vascular permeability at the tissue level with systemic involvement, interstitial edema and evaporation. The end result is reduced circulating volume and insufficient tissue perfusion and shock.
Pitfalls of Over Resuscitation:
1. Over estimation of burn size. This can result in “too much of a good thing” meaning fluid creep which is a term coined in acute burn care for overzealous crystalloid resuscitation of fluid loading.
2. Burn/Wound Conversion. In restoring volume loss, it is important to maintain adequate tissue perfusion by maintaining balance to just enough but not too much.
3. Abdominal Hypertension/Compartment Syndrome. Fluid creep is a significant contributor. Early recognition is key to preventing end organ dysfunction. Should compartment syndrome develop and General Surgery consult is needed and likely a prompt surgical decompression.
4. Ocular Compartment Syndrome. This is a relatively uncommon event and is considered an ophthalmic surgical emergency. Another result of over loading fluid, orbital increased pressure occurs which damages the orbital structures and irreversible blindness can occur. An ophthalmologic consult would be in order to perform a lateral canthotomy and/or an inferior cantholysis.
Potential Complications of Under Resuscitation:
Under resuscitation can result in tissue ischemia, acute renal failure and end organ dysfunction. Isotonic crystalloids are globally accepted as first line burn resuscitation fluid. Colloids use is controversial as to reduction in capillary leak with questionable benefit over crystalloids.
Utilization of Vitamin C in Fluid Resuscitation:
Burn shock is an inflammatory state. The role of free radicals and “pro-inflammation state” led to the use of Vitamin C in burn resuscitation. Benefits include reducing overall fluid volume, it is readily available, naturally occurring, relatively inexpensive and generally well tolerated.
Atlanta Legal Nurse Consultant:
Liz Buddenhagen, RN, assists Atlanta attorneys with the medical aspects of their legal cases. For more information, email Liz@BuddenhagenLNC.com , view Legal-Nurse-Consultant-LNC.com or call 770-725-2997.
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- Contact Information
- Liz Buddenhagen
- Buddenhagen and Associates
- (1) 7707252997
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