Pediatric emergency medicine trisk 3224 3224

years. The Galveston Shriners formula uses BSA rather than weight to
calculate fluid therapy. Galveston Shriners recommends 5,000 mL/m2/% of
BSA, half during the first 8 hours from the time of injury and half during
the next 16 hours, plus 2,000 mL/m2/day as maintenance.
TABLE 104.2
FLUID RESUSCITATION FORMULAS
Parkland: 4 mL/kg/% of BSA second- and third-degree burns, half in the
first 8 hrs following injury, half in the next 16 hrs. Add maintenance
with 5% dextrose containing fluid in children <5 yrs old
Galveston Shriners: 5,000 mL/m2 /% of BSA second- and third-degree
burns, half in the first 8 hrs, half in the next 16 hrs. Add 2,000 mL/m2
/day maintenance with 5% dextrose containing fluid
Inadequate resuscitation can cause organ failure and death, while
overresuscitation, or excessive fluid administration, is to be avoided
because it may cause pulmonary edema and tissue edema with resultant
compartment syndrome that compromises local blood supply.
A combination of endpoints is used to ensure adequate resuscitation,
including urine output, mean arterial pressure, and biochemical markers
such as base excess and lactate. Urine output should be measured to ensure
adequate fluid resuscitation. Children should produce at least 1 mL/kg/hr of
urine. Hyperglycemia may cause an osmotic diuresis and complicate care of
the patient with burn injury. Before infusions are decreased in response to
excessive urine output, a measurement of blood glucose should be made.
Inadequate fluid resuscitation is usually manifested by oliguria. Rarely,
intrinsic renal disease is responsible for oliguria, as may occur after
electrical injuries because of myoglobinuria.
Trauma associated with burns may increase fluid requirements.
Neurogenic shock from unrecognized cervical spine or head injury may
cause hypotension, usually with a relative bradycardia. Toxins, such as
cyanide, ingested before the burn or inhaled during the fire can depress
myocardial function or vascular tone. Any patient with shock that appears

out of proportion to the extent of the burn injury, or who is poorly