Burns are the leading cause of accidental injury and death in the United States and around the world. Every year, according to the American Burn Association, 450,000 people in the United States suffer burns that necessitate medical attention. About 3,500 people are killed in fires or burn accidents, which includes both fire and burn injuries as it’s difficult to determine whether a person who died in a fire died from smoke inhalation injuries or burns.
Of those hospitalized, 25,000 are severely burned patients and admitted to a specialized burn center. Forty-four (44%) percent of those admitted to a hospital for a burn cite fire/flame as the cause, 33% say their injuries were caused by scald, 9% by contact, 4% by electrical, 3% by chemical, and 7% by “other.”
Severe burns, if not properly treated, including receiving adequate fluid resuscitation in some cases, can result in significant morbidity and death.
Burn Care Resuscitation
Burn resuscitation involves the replacement of fluids in burn patients in order to combat hypovolemia and hypoperfusion caused by the body’s systemic response to a major burn. Hypovolemia is an abnormal depletion of fluid in the body that reduces overall blood volume in a burn patient as a result of blood loss or severe dehydration. Extensive and severe burns cause body fluid loss. Without treatment, hypovolemia can lead to hypovolemic shock (burn shock), which is a life-threatening emergency. Hypoperfusion is the lack of blood supply to an organ which also has the potential to be a very serious issue. Physical problems, pain, and cell death can result from blood deprivation, depending on the severity and duration.
What Is Burn Shock?
Burn shock is characterized by decreased cardiac output and increased capillary permeability during the first 24 to 48 hours after major burns, resulting in large fluid shifts and depletion of intravascular volume. Rapid, adequate fluid replacement is required to restore intravascular volume to maintain end-organ perfusion. Delays in fluid resuscitation and inadequate resuscitation are linked to an increased risk of death. Arterial lines are frequently used to monitor blood pressure; urine output is used to assess the sufficiency of fluid resuscitation .
Approach to Burn Shock Resuscitation
According to the American Burn Association’s practice guidelines, any patient with non-superficial burns that exceed 15% of total body surface area (TBSA) should receive formal fluid resuscitation. If possible, patients with severe burns should have two large-bore intravenous (IV) lines placed through un-burned skin. If necessary, IV lines can be placed through burned tissue to avoid delays in resuscitation.
An intravenous crystalloid solution, typically Lactated Ringer (LR) solution, is used to resuscitate a patient with moderate or severe burns. Following initial resuscitation, IV fluids are administered to meet baseline fluid requirements and maintain urine output. Any changes to the infusion rate are implemented as gradually as possible. Additional fluid is infused if urine output falls below a certain threshold or other clinical parameters indicate inadequate resuscitation. In such cases, a bolus of IV crystalloid is administered, and the crystalloid infusion is increased by 20 to 30 percent.
Factors such as patient age, body weight, burn severity, associated injury, and comorbidities can significantly alter individual patients’ actual fluid requirements. Patients with inhalation injury, for example, require higher resuscitation volumes than those without. As a result, fluid needs must be estimated with adjustments based on a burn patient’s physiologic response to resuscitation.
Monitoring fluid status is critical. Adults should maintain an hourly urine output of 0.5 mL/kg/hr. Patients who have little or no urine output after suffering severe burns, despite adequate resuscitation, will not survive.
It’s also important not to over-resuscitate. Over-resuscitation is risky and has been linked to a variety of morbidities such as acute respiratory distress syndrome, pneumonia, multi-organ failure, and abdominal, extremity, and orbital compartment syndromes. According to a survey of burn centers, 58% of patients received more fluid resuscitation than recommended. Medical professionals should carefully calculate fluid resuscitation needs and constantly adjust resuscitation efforts based on a patient’s physiologic response.
New York City attorneys Ronemus & Vilensky specialize in personal fire injury cases involving burn victims with many of our cases involving individuals suffering from deep burns and burn wounds as a result of a fire. Contact our NYC Burn Injury Attorneys today for a free consultation or call 212-779-7070.
