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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Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Chief, Division of Emergency Critical Care
Director, Resuscitation and Acute Critical Care Unit
Stony Brook Medicine
Stony Brook, NY, USA
No conflicts of interest (coi).
Professor
Chief, Division of Emergency Critical Care
Director, Resuscitation and Acute Critical Care Unit
Stony Brook Medicine
Stony Brook, NY, USA
No conflicts of interest (coi).
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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.… Read more »
In need of some more information, in PC 219 it’s mentioned that ABLS calls for a fluid resus of 4ml/kg/BSA in electrocution patients. Which electrocution pts? All? What’s the definition of electrocution? Also how do you calculate BSA of an electrocution? Injuries run a huge spectrum. Thanks!