Critical Care Scenarios Lightning rounds 57: Burn critical care with Clint Leonard
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Nov 12, 2025 Dive into the complex world of burn critical care with insights from an NP specializing in the burn ICU. Discover how different burn mechanisms, from flames to electrical injuries, shape patient treatment. Learn about fluid resuscitation strategies, the timing of excisions, and innovative grafting techniques. Clint Leonard shares the challenges of hypermetabolism and nutrition needs in burn patients, highlighting the importance of a multidisciplinary approach to care. Tune in for a blend of practical advice and compelling patient stories!
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20% TBSA Marks Systemic Burn Risk
- Burns >20% TBSA produce systemic inflammatory response and usually need ICU-level resuscitation.
- Clint Leonard uses 20% TBSA as a rule of thumb to anticipate burn shock and critical care needs.
Titrate Fluids By Urine Output
- Titrate fluid using urine output rather than rigid Parkland volumes to avoid over-resuscitation.
- Monitor hourly urine and adjust fluids to avoid worsening edema and progression of burn depth.
Burn Shock Resembles Distributive Shock
- Major fluid losses are from systemic third-spacing driven by inflammation rather than only transdermal evaporation.
- Burns behave more like distributive shock than classic hypovolemia, per Clint Leonard.