Fluid resuscitation in electrical burn

[spenac]

Spenac, check your email. I just sent you a high priority email.

Man Ruff that was really mean thing to say about Itku2er, but is true. :twisted:

[medicv83]

Yeah, ultimately I think I was more or less looking at the Parkland formula more as a set in stone type of way to gain the appropriate fluid amount. Urinary output, ultimately will guide these burn patients course of fluid treatment then right? Adjust either by more or less depending on urine made, and address problems from there correct?

As far as the field goes, has anyone actually started fluid resuscitation based on this formula. We dont, considering our transport times, all will be generally less than 20 minutes from anywhere in the county. Surely there are circumstances with say prolonged scene time and so forth.

[triemal04]

medicv83-Sorry, maybe that didn't come across clear enough. I'm not advocating using the Parkland for electrical burns, not at all. What I am advocating is to remember that

This would be one of those times to treat your pt, how they are presenting and what you know is going on physiologically with them and ignore the formula.

To make that clearer; even if you can't "see" the damage that has been done to your pt, you know (or should) that they have a very high potential for internal injuries and cellular breakdown...so treat that as best you can. Hope that's clearer.

And no, you don't know the path of the electricity...it may be much worse than you think...or much less. Again, you are going to have to decide based on your pt's presentation and voltage involved what you will do...which means that for any significant burn they will be getting fluid. And while giving to much fluid can be a problem, don't become so concerned about this that you do nothing; an otherwise relatively healthy individual can easily take in 1L+ without problems. (this is going to sound bad, but bear with me) Don't get so caught up with what the pt will need overall that you ignore what they need now; for this situation, an estimate about damage and fluid needs is all you will have to work with, especially if you are dealing with short transport times. Use your judgement and use the amount of fluids you think is appropriate; what get's done later will be adjusted around what you have done in the field.

I have given fluid based on the Parkland formula before (for thermal burns)...and it is really strange the first time you do it to see how little is called for.

Now for the rest...yes, based on some of your own comments I do think you have very limited experience. You indicated in the past that you only started Paramedic school this January and had never worked as either a Basic, or Intermediate. Now who knows, maybe you were previously an RN, or RT, or PA, LPN, CNA, whatever...but I'm thinking probably not. You demonstrate that again in this thread: you based your impression of an entire profession (nursing) off of the experiences you've had with nurses at ONE HOSPITAL. So yes, Nancy, you are doing a disservice to both our profession and theirs by making that assumption. Don't. Do. It. Again. I'm glad you agree that learning is an ongoing process, but that doesn't mean you should just be learned about medicine; learn about your own profession and about the ones you'll be dealing with. Learn how the system actually works. It's not bad or wrong or a problem to be new, but it becomes a problem when someone starts to think they know it all and can make judgements that they aren't qualified to make.

And while you may not like the names...it worked didn't it? Got you to sit up and take notice about what I said? It's definitely not the best way to teach or get a point across, but it is one, and does work sometimes.

[medicv83]

blah blah blah...............thank you to the people who put in valuable information on this.

[chbare]

Yeah, ultimately I think I was more or less looking at the Parkland formula more as a set in stone type of way to gain the appropriate fluid amount. Urinary output, ultimately will guide these burn patients course of fluid treatment then right? Adjust either by more or less depending on urine made, and address problems from there correct?

As far as the field goes, has anyone actually started fluid resuscitation based on this formula. We dont, considering our transport times, all will be generally less than 20 minutes from anywhere in the county. Surely there are circumstances with say prolonged scene time and so forth.

Most patients I have transported were interhospital burns. I calculate the fluid delivered PTA and compare it to the parkland calculation. Then, I look at the overall hemodynamic status and deliver fluids based on that assessment while taking other disorders into consideration. Remember, these formulas are simply maintenance fluid calculations. They will not take other causes of fluid volume depletion into consideration. Again, you must be flexible and use a certain amount of clinical judgment when implementing your plan of care. Something I as a nurse must am not able to do. Sorry, could not help it, just playing bro.

As far as what I do when working a fresh burn. Again, be flexible and use the formula as a guideline. Typically, an otherwise healthy adult can tolerate a 20 ml/kg bolus of isotonic crystalloid up front. So, I have no problem hitting patients with a bolus of 1000-2000 ml up front, then taking it from there.

Take care,

chbare.

[AZCEP]

Use aggressive fluid resuscitation measures with close monitoring, and let the receiving facility worry about total fluid volume after 24 hours. One of the big mistakes most will make is to under dose the amount of fluid that is given.

[medicv83]

Sounds good! Thanks for the info yall! Once again, sorry if the nurse comments offended anyone