Today we are joined by Dennis Djogovic to do Part I on severe burns.
Dennis Djogovic
Dr. Djogovic completed training in Emergency Medicine and Critical Care Medicine from 1999-2005, and is currently employed at the University of Alberta Hospital as an Emergency Physician, and as an Intensivist in the General Systems Intensive Care Unit and in the Firefighters Burn Treatment Unit.
Fluid Management in Burn Patients
Additional Resources
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Scott Weingart
An ED Intensivist from NY.
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[…] http://emcrit.org/racc/critical-burn-patients-in-the-ed/ […]
Could you describe your approach to fluid resuscitation in patients with poor UOP (CKD or even ESRD)? I presume it’s based off other downstream parameters for intravascular volume repletion, but in your experience what is the best approach in this scenario?
Hi Udit, great question, unclear answers. Poor UOP is a surrogate (but not perfect) measurement for renal perfusion, which, along with cardiac ischemia, is our big concern with underresuscitation of the massive burn patient. You are correct in the need for other parameters to assess for volume status, which is very tricky with the big burn (IVC assessment, TTE, passive leg raise, CVP, cardiac outputs, are all challenging when the patient is fully wrapped in heavy dressings and 15L positive). I would consider adding albumin at the 8-12 hr mark, low dose vasopressors if fluid status adequate but MAP low. However, once AKI leads to ATN, or you have established CKD/ESRD, then you are likely on the road to continuous dialysis modalities. Kevin Chung has done some interesting work in this field (with CVVH and burns, and good outcomes), but like all dialysis studies in critical care, the perfect answer has not yet been found. Good luck! — Dennis
[…] podcast from the EMCrit crew on fluid resuscitation in critical burn patients. Don’t bolus fluids, start at 500cc/hr, say goodbye to the parkland formula (Use 2cc/kg for […]