Burn Fluid Resuscitation

Excerpt

In the United States, approximately 500,000 people seek care for burn injuries each year. Among civilians, these injuries most commonly result from house fires, motor vehicle crashes, and work-related accidents. Burn injuries account for 5% to 10% of combat casualties. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) identify burns as one of the most common causes of home injuries in individuals aged 19 or younger. Several practice guidelines have been released to emphasize the importance of optimal care and management of burn injuries. Organizations such as the International Society for Burn Injuries (ISBI) and the American Burn Association (ABA) have published guidelines and updates to address the needs of both resource-limited and resource-abundant regions.

Burn injuries can result from various sources, including thermal elements, grease, friction, electricity, and chemicals. The severity of a burn depends on factors such as the affected area, duration of contact, and the patient’s preexisting health conditions. Accurate classification is essential for the proper assessment and treatment of burn patients. Burns are classified by depth—superficial burns affect only the epidermis; superficial partial-thickness burns extend into the papillary dermis; deep partial-thickness burns reach the reticular dermis; and full-thickness burns damage both skin layers and the underlying subcutaneous tissue.

Total body surface area (TBSA) is used to measure the percentage of burned skin. Only partial and full-thickness burns are considered when determining the need for fluid resuscitation. Fluid resuscitation is required for burns exceeding 20% TBSA in adults and 10% to 15% in children, although specific cutoffs may vary by institution. Various resuscitation formulas provide guidelines for initiating fluid replacement to prevent complications and improve patient outcomes.