burn patient question

LiverpoolJane · Jan 30, 2010

I'm not a burns nurse but to try and answer your question, I would not be looking at any of those answers as being correct in this case.

The nearest I can relate to your patient is one man I helped look after who had acute kidney injury with rhabdomyolysis following an RTA. He had to have fasciotomies to his legs to relieve the pressure and was loosing large amounts of fluid from these incisions. To try and assess fluid loss we had to weigh all bed sheets, pads etc that where liable to become wet with body fluids pre and post, eack KG difference is approx equal to 1 litre. Obviously measure anything that can be measured, urine, vomit etc and use this as a approximate guide as to what is going in and what is coming out.

Bear in mind that alterations in electrolytes and plasma proteins are also going to effect where the fluid sits in the patients body so even though they may be oedematous and appear fluid overloaded they can be intravascularly dry. I hope this goes some way in answering your question, as I said burns is not my speciality but I know a little about fluid balance?

lerabelle · Jan 30, 2010

that is what I was thinking when I was reading my options. Like I said, I do not know the right answer because it was a online test. But one of them was correct. Or maybe the one option I forgot!! But I was wondering how you would be able to calculate the balance of intake vs output in a Burn pt since that was the question. But thanks for your input. We are thinking on the same level.

lera:)

leslie :-D · Jan 30, 2010

i'm going with my original answer of #2, 40ml/hr.

intake will greatly exceed output, so that eliminates #3, and #1 could be eliminated immediately.

i found this link as well.

http://www.burnsurgery.com/Modules/initial/part_two/sec3b.htm

scroll down to intake-output.

leslie:)

LiverpoolJane · Jan 30, 2010

Ok I'm with you now, I thought this was related to your placement, in that case I would go for the make sure his urine output is at least 40mls/hr, in a non burns patient and I would think it would be the same for a burns patient. If the pt is passing urine you would know his kidneys are working and they are not intravascularly dry. Making sure input is equal to output doesn't seem right as you'd want to make sure replacement was more than output to account for insensible loss.

Daily weight would be only be useful if there were no reason to believe there was third spacing, so not applicable in this pt due to electrolyte and plasma protein disturbances.

allnurses Guide · Jan 30, 2010

I worked in burns for quite a few years and agree with Jane, urine output is an excellent way to let you know that the kidney's are perfusing and that you have your fluid input correct

lerabelle · Jan 30, 2010

That is what I put for my answer. UO 40ml/hr. I just don't know if it was right! Thanks for your input!!!

thill67 · Mar 24, 2010

As a Burn ICU, we use several markers to identify fluid balance in our patients. We use the urinary output marker of 30 ml/hr, we also use the CVP( central venous pressure) we use and the mean arterial pressure. Dailey weights are important however in the initial re-sus the dry weight is often unknown and is only a guess, by the hospital. more than likely the pt has recieved as much as 3-4 liters of re-sus fluids in route to a facility if not more due to the parkland formula being used by EMS. They start start large bore IV's and run them wide open.