The two most important problems encountered clinically with burned patients are infection and dehydration. When a person is burned and depending on the severity of burn, the blood vessels including the capillaries may be affected. Combined with the release of chemical substances into the blood, this will lead to increased capillary permeability to fluids, leading to the leaking of fluids from the blood vessels into the tissues. The higher the percentage of burned skin, the more severe the loss of fluid will be and the greater the dehydration will be.
In a third degree burn the entire thickness of skin (epidermis and dermis) is involved and nerve endings have been destroyed. The body’s barrier against water loss is no longer there. When the protective covering does not exist, fluid seeps from the burned area causing dehydration and electrolyte imbalance. Unless fluids are replaced immediately, renal shut down and hypovolemic shock will occur. Skin is both a physical barrier, preventing water loss, and also a chemical barrier, preventing the growth of bacteria.
Fluid replacement is one of the important objectives in the initial treatment of burned patients. The amount of fluid needed and the method of fluid given depends on the surface area of the skin burned as well as other factors. There are many formulas used to calculate the amount of fluid needed for resuscitation; one of them is called the Parklund Formula in which after the amount of fluids is calculated, it is given through an IV route and the type of fluid is usually Ringer Lactate because it’s composition is simillar to the extracellular fluid.
Dehydration can be a life threatening complication that may even lead to death. Urine output (0.5 ml/kg/hour in adult and 1 ml/kg/hour in children) is one of the methods used to evaluate adequate fluid resuscitation. Over resuscitation may lead to compartment syndrome. Patients with minor burns can be resuscitated with oral rehydration therapy. You have to make sure that you are taking enough fluids, not vomiting and is producing a satisfactory amount of urine.
Edema (accumulation of fluid in bodily tissue or body cavity) may become worse after fluid resuscitation and if this edema is in a compartment (closed space of nerves, muscle tissue and blood vessels) covered by dead tissue as a result of the burn which is inelastic and can’t expand, this edema may lead to compression of the blood vessels in the compartment leading to compression of circulation in which escharotomy may be needed to release that pressure. It is advisable to watch the burned areas, especially in the extremities, for signs of decrease blood flow to the affected area.
This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.