A 30-year-old man is admitted with full thickness bums covering both upper extremities and the anterior chest. Fluid resuscitation should be begun through
|A||an antecubital vein|
|B||a femoral vein|
|C||an internal jugular vein|
|D||a saphenous vein|
a. Resuscitation begins by starting intravenous LR solution at a rate of 1000 mL/h in adults and 20 mL/kg per hour in young children.
b. Burn patients requiring intravenous resuscitation (i.e., generally those with burns greater than 20% TBSA. should have a Foley catheter placed and urine output monitored hourly, the goal being 30 mL/h in adults and 1.0 mL/kg per hour in young children.
c. Once the extent of the burn is ascertained, resuscitation should be tailored to the injury using the Parkland formula , as both over- and underresuscitation are deleterious.
d. Patients with burns covering less than 50% TBSA usually can begin resuscitation via two large-bore peripheral intravenous lines.
e. Because of the high incidence of septic thrombophlebitis, lower extremities should not be used as portals for peripheral intravenous lines.
f. Upper extremities are preferable, even if the intravenous line must pass through burned skin or eschar.
g. Patients with burns greater than 50% TBSA, or those who have associated medical problems, are at the extremes of age, or have concomitant inhalation injuries should have additional central venous access established with invasive hemodynamic monitoring.
h. Because of the hemodynamic instability in patients with burns greater than 65% TBSA, these patients should be transferred as quickly as possible to a burn center so they can be monitored in an intensive care setting.