The first 24-48 hours post-burn. Characterized by life-threatening hypovolemic shock from massive fluid shifts.

Secure the airway, establish IV access, and initiate aggressive fluid resuscitation to prevent hypovolemic shock.

"Third-spacing": Fluid shifts from intravascular space into interstitial tissue, causing edema and intravascular depletion.

Assess for inhalation injury. Early endotracheal intubation may be necessary due to rapid upper airway edema.

Initiate fluid resuscitation using the Parkland Formula: 4 mL Lactated Ringer's x kg x % TBSA burned.

Parkland Formula Timing

Administer half of the calculated 24-hour fluid volume in the first 8 hours POST-BURN. Second half over next 16 hours.

Target: 30-100 mL/hr (0.5-1 mL/kg/hr). Most reliable indicator of adequate renal perfusion and fluid resuscitation.

Insert nasogastric tube to decompress stomach, prevent vomiting/aspiration, and manage paralytic ileus common in major burns.

Administer IV opioids (e.g., morphine). IM or oral routes are ineffective due to poor perfusion in emergent phase.

Administer tetanus toxoid if immunization status is unknown or outdated. Skin barrier is compromised.

High hemoglobin & hematocrit initially due to fluid loss from the vascular space into tissues + Hyponatremia. Hyperkalemia - cell burst.

Begins 48-72 hours post-burn. Capillary permeability is restored, and fluid mobilization (diuresis) begins.

Prevent infection, support metabolic demands, begin wound care/debridement, and manage pain.

Fluid Shift in Acute Phase

Fluid shifts BACK from interstitial tissues into the intravascular space, leading to increased urine output (diuresis).

Risk in Acute Phase - Fluid Overload

During diuresis, the heart can be overloaded. Monitor for crackles, JVD, increased BP, and pulmonary edema.

Major cause of mortality. Implement strict aseptic technique, protective isolation, and meticulous wound care.

Daily hydrotherapy, debridement of eschar, and application of topical antimicrobials (e.g., silver sulfadiazine).

Nutrition in Acute Phase

Hypermetabolic state peaks. Initiate early enteral feeding (within 24h) with high-protein, high-calorie diet.

Caloric needs can double (up to 5000 kcal/day). Use indirect calorimetry if possible; monitor pre-albumin.

Stress-related gastric ulcer. Prevent with prophylactic H2 blockers (e.g., famotidine) or PPIs.

Help

Options

focusNode

Didn't know it?
click below

Knew it?
click below

Don't Know

Remaining cards (0)

Know

retry

shuffle

restart

0:00

Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

Normal Size Small Size show me how

Burns Emergent

Question	Answer
Emergent Phase	The first 24-48 hours post-burn. Characterized by life-threatening hypovolemic shock from massive fluid shifts.
Primary Goal	Secure the airway, establish IV access, and initiate aggressive fluid resuscitation to prevent hypovolemic shock.
Fluid Shift	"Third-spacing": Fluid shifts from intravascular space into interstitial tissue, causing edema and intravascular depletion.
Airway	Assess for inhalation injury. Early endotracheal intubation may be necessary due to rapid upper airway edema.
Fluids	Initiate fluid resuscitation using the Parkland Formula: 4 mL Lactated Ringer's x kg x % TBSA burned.
Parkland Formula Timing	Administer half of the calculated 24-hour fluid volume in the first 8 hours POST-BURN. Second half over next 16 hours.
Urine Output	Target: 30-100 mL/hr (0.5-1 mL/kg/hr). Most reliable indicator of adequate renal perfusion and fluid resuscitation.
NG Tube	Insert nasogastric tube to decompress stomach, prevent vomiting/aspiration, and manage paralytic ileus common in major burns.
Pain Management	Administer IV opioids (e.g., morphine). IM or oral routes are ineffective due to poor perfusion in emergent phase.
Tetanus Prophylaxis	Administer tetanus toxoid if immunization status is unknown or outdated. Skin barrier is compromised.
Hemoconcentration	High hemoglobin & hematocrit initially due to fluid loss from the vascular space into tissues + Hyponatremia. Hyperkalemia - cell burst.
AP Onset	Begins 48-72 hours post-burn. Capillary permeability is restored, and fluid mobilization (diuresis) begins.
Goal AP	Prevent infection, support metabolic demands, begin wound care/debridement, and manage pain.
Fluid Shift in Acute Phase	Fluid shifts BACK from interstitial tissues into the intravascular space, leading to increased urine output (diuresis).
Risk in Acute Phase - Fluid Overload	During diuresis, the heart can be overloaded. Monitor for crackles, JVD, increased BP, and pulmonary edema.
AP Infection Control	Major cause of mortality. Implement strict aseptic technique, protective isolation, and meticulous wound care.
Wound Care AP	Daily hydrotherapy, debridement of eschar, and application of topical antimicrobials (e.g., silver sulfadiazine).
Nutrition in Acute Phase	Hypermetabolic state peaks. Initiate early enteral feeding (within 24h) with high-protein, high-calorie diet.
Caloric Needs	Caloric needs can double (up to 5000 kcal/day). Use indirect calorimetry if possible; monitor pre-albumin.
Curling's Ulcer	Stress-related gastric ulcer. Prevent with prophylactic H2 blockers (e.g., famotidine) or PPIs.

Created by: Wasurenboh

"Know" box contains:
Time elapsed:
Retries: