TBSA% Burned is 31%. The pt weighs 50 kg. The burn injuries occurred at 0300. Fluid resuscitation was started at 0400, and it is now 0900.
Calculate her fluid replacement for the first 24 hours, specify how much will be given, what time intervals will be used, and what the infusion pump should be set for (in mL/hr).
Pt burned at 0300
TBSA Burned = 31% Pt Weight = 50 kg
Started fluid resuscitation at 0400 (1 hr AFTER time of injury)
Time Now = 0900 (fluids going for 5 hrs)
4 mL x 50 kg x 31% = 6200 mL for 24 hrs
6200 mL/2 = 3100 mL
Pt gets 3100 mL in first 8 hrs
Pt gets 3100 mL in next 16 hrs
You have to adjust the formula to reflect initiation of fluids at the time of injury
Fluid resuscitation started at 0400 (1 hr after injury), it is now 0900. So, pt has received fluid resuscitation for 5 hrs. However, you need pt to have received it for 6 hours (time of injury was 0300 and you adjust formula to reflect initiation of fluids at time of injury. Time of injury (0300) to time now (0900) is 6 hours.
Time of Injury = 0300 Fluid Resuscitation Started = 0400 Time Now = 0900
So adjusting formula to reflect initiation of fluids at time of injury means that you adjust the formula to reflect that the fluid started at 0300 (even though it was really started an hour later at 0400)??? Is that correct?
So the time of injury was 0300 and it is not 0900, so the adjusted time of fluid resuscitation would be 6 hrs (0300 to 0900 = 6 hrs)
Started at 0400 (1 hr after burn injury), now 0900 – Received for 5 hrs (need it for 6 hrs because adjust formula to reflect initiation of fluids at time of injury, which was 0300, and 0300 to 0900 = 6 hours).
From here, I know what to do, but I'm not sure I am correct in the reasoning.
To calculate mL/hr for the first 8 hrs, you need to divide by 7 (instead of 8) because the fluid resuscitation should begin at the time of injury (0300) but began an hr later at 0400, so the pt missed an hr. You need to account for that missed hr. You do this by dividing by 7 instead of 8 (b/c pt should receive the first half of the total 24 hours of fluid resuscitation (i.e., 3100 mL) in the first 8 hrs. If the fluids were started an hr after the time of injury, that means the fluids were started an hr late, so instead of running for 8 hrs, they will run for 7 hrs – this is b/c if the starting of fluids is delayed, then the same amount of fluid is given over the remaining time – in this case, the start of fluids was delayed 1 hr (burned at 0300, started fluid resuscitation at 0400), so the remaining time is 7 hrs (8 hrs – 1 hr delayed = 7 hrs).
So, is my reasoning correct?
Do you subtract the missed hr from total hrs? I know that the pt needs to get the first half in the first 8 hrs after the injury, so if they miss an hr, then you need to adjust for that. If an hr was missed, you run the fluids over 7 hours so that the pt gets the required amount of fluid within 8 hrs from the time of injury. Is this because the pt will get more fluid per hr running it over 7 hrs, which makes up for the missed hr?
3100 mL/7 hrs = 442.9 mL/hr for the 7 hrs.
To calculate mL/hr for next 16 hrs, you divide 3100 by 16 hrs.
3100 mL/16 hrs = 193.8 mL/hr for the next 16 hrs.
Okay I know this is long, but I hope you stick with me!!
I just want to know if my reasoning is correct as to why the time is adjusted. If the fluids are started an hr AFTER the time of injury, you adjust the time to receive the first half of fluids to 7 hrs. So I want to know if this is because the pt needs to receive the first half of required fluids within 8 hrs from the time of injury. Also, is it because the pt will get more fluid per hr running it over 7 hrs, which makes up for the missed hr?
As always, your time and responses are appreciated!! Thank you!