Burn edema can adversely effect burn care and grafting. Conversely, dehydration can also adversely affeect burn grafts. There is limited evidence regarding the most appropriate resuscitation strategies. A more conservative approach to fluid resuscitation is being advocated.
Calculate from the time of injury, not the time of admission. Target fluid resuscitation to the end point of a urinary output of 0. Albumin has been part of fluid resuscitation in burn care since the 's.
While recent controversy has emerged regarding its safety, a Cochrane Systematic Review did not find any mortality difference. Vasopressors may be considered if necessary to maintain perfusion pressures. If vasopressors or required, sepsis should be ruled out. C aution: Burned patients who have also experienced trauma may have higher volume and blood product requirements. Burn injuries may mask other injuries.
Blood products may be required after burn debridements. Higgs, B. McGrath, C. Goddard et al. Martyn and M. Martyn, D. White, G. Gronert, R. Jaffe, and J. Birch, G. Mitchell, G. Playford, and C.
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View at: Google Scholar J. Hudcova and R. Ract, P. Leblanc, and B. Dellinger, M. Levy, J. Carlet et al. Baur, U. Early excision and grafting of burns, especially of major burns, was not routine at that time.
Therefore, it is not surprising that only a total of three-patient studies were reported for the first week in three publications. Most likely, the three patients reported suffered only minor burns. In contrast to the conservative approach to treatment of burns of the past, current practice advocates early excision and grafting of burn wounds, especially of patients with major burns.
Thus, the potential for profound, denervation-type upregulation of AChRs is present as early as 3 days after burn injury when the burn-injured area is adjacent to muscle. The dramatic upregulation of AChRs on all muscles beneath the burn is also accompanied by the expression of the immature isoform of the receptor. Thus, the lack of clinical reports of hyperkalemia before 7 days after burn injury is probably a result of the following: 1 the previous treatment philosophy of not treating major burns aggressively with early excision and grafting did not provide the opportunity for challenge of major burns with succinylcholine within the first week; and 2 increased awareness of the dangers of hyperkalemia with succinylcholine has resulted in its lack of use in burn patients as early as 1 week during early excision and grafting of major burns.
Thus, it is my view that succinylcholine is probably safe up to 48 h after burn injury, but it may be wise to avoid it beyond that period. Patients may be particularly vulnerable if they have been immobilized in bed because of severity of illness or concomitant disease e. Sign In or Create an Account. Advanced Search. Sign In. Skip Nav Destination Article Navigation. Close mobile search navigation Article navigation. Secondly, the presence of hyperkalemia is independent of the severity of rhabdomyolysis or the extent of the burn.
Keywords: Creatine phosphokinase; Electric burns; Hyperkalemia; Rhabdomyolisis. All rights reserved.
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