Evaluating the adequacy of fluid resuscitation is fundamental to quality care.
Calculating Parklands fluid resuscitation formula is the first step to estimating fluid requirements, but once commenced, fluid resuscitation amounts should be titrated according to an assessment of resuscitation and perfusion end points:
- Heart rate
- Blood pressure
- Pulse pressure
- Urine output:
- Insert an indwelling urinary catheter
- Monitor urine output hourly
- Urine output is a simple and easy method to assess fluid balance
- Distal pulses
- Capillary refill
- Colour and uninjured turgor
- Blood gas and serum lactate
Urine output goals should be between 0.5 – 1ml/kg/hr for adults and 1ml/kg/hr for children <30 kilograms (39,45-50).
Burns of the perineum also are best cared for with an indwelling Foley catheter to decrease urinary soiling of the wound.
Myoglobinuria in electrical burn injury
Pigmented urine (light pink to dark red) present following electrical burn injury is indicates extensive muscle damage.
When excreted into the urine, myoglobin can precipitate tubular obstruction and acute kidney injury. Increase fluid resuscitation amounts so that myoglobin pigments can be cleared quickly