My patient today...

[soapaddictOH]

Well, last night because I work nights.

He is 94 and came in with a 34.5% flame burn. Fluid recuscitation was pretty much nil pre-hospital. Medical history of HTN, pacer, cataracts and hiatal hernia. Nothing significant,at least for his age, the only med he takes is Cozaar.

By the time I left this AM at 7 he had had 15 liters of fluid. Urine output from 3 pm yesterday was 156cc's. Docs wanted to keep giving him the fluid as long as his O2 sat stayed above 92. Which is did. He had started coughing around 5AM. No crackles, lung sounds dim though.

He is a DNRCC-A.

Thoughts?

This was our chief, the main head honcho, who wanted the fluids given.

[theatredork]

Going by the fluid resuscitation formula, he should have gotten roughly 9.4 Liters of fluid over the first 24 hours. I kind of guessed his weight to be around 150, which might be high for someone that's 94 years old.

Fluid Resuscitation for burns:

4ccs x Pt's weight (in kgs ) x %Burn

4ccs x 68kg x 34.5% burn = 9.4 Liters

I can't really comment on the amount of fluid he got unless I know his weight. Did he get 15 Liters over 12 hours or 24?

[soapaddictOH]

He only weighed 44kg. He got the fluid over 16 hours. He wound up having a weight gain of 26 pounds. I was told the aggressive fluids were because the docs weren't sure of his DNR status and hadn't talked to the family about their wishes for his treatment. His code status was changed to DNR-CC , he was placed on a morphine drip and within 30 minutes of starting that he passed.

[hdigh]

Did he die from his burn injuries or congestive heart failure from the fluid overload?

[theatredork]

Did he die from his burn injuries or congestive heart failure from the fluid overload?

Yeah, that's what I'm wondering as well. They definitely went overboard with the fluids.

[soapaddictOH]

Definitely fluid overload. He was pretty much drowning in his own secretions. It was horrible.