Behind The Knife: The Surgery Podcast Journal Review in Burn Surgery: Fluid Resuscitation
Aug 4, 2025
Discover the intricacies of burn fluid resuscitation in trauma cases! The hosts discuss the initial fluid rates, emphasizing why lactated Ringer's is preferred over saline. Learn how pediatric rates differ and the importance of urine output monitoring. They explore the significance of individualized titration versus standard formulas, alongside the latest literature impacting guidelines. Strategies for managing low urine output and the controversial use of colloids are evaluated. Plus, find out about adjuncts to minimize crystalloid needs!
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Get IV Access Wherever Possible
- Place two large-bore IVs early and place them through burned skin if necessary to enable immediate resuscitation.
- If peripheral access fails, obtain intraosseous or central access without delay.
Begin With Standard Initial Fluid Rates
- Start adult burn patients on 500 mL/hr of lactated Ringer's as the initial fluid rate per ABA/ABLS guidance.
- Use 250 mL/hr for school-aged children and 125 mL/hr for younger children, and place two large-bore IVs early.
Use Foley Output As Gold Standard
- Insert a Foley catheter early and monitor hourly urine output as the gold-standard resuscitation endpoint.
- Use Foley output to guide hourly fluid adjustments and detect resuscitation failure.