Monitoring fluid resuscitation

The patient with major burns is at risk of inappropriate fluid resuscitation if there is not close monitoring. A urinary catheter is mandatory - see submenu. Other indices required are:

• pulse
• blood pressure:
  • spurious readings can be obtained with a sphygmomanometer due to burn oedema
  • an arterial line is the preferred means of monitoring for big burns
• central venous pressure; very helpful in the following circumstances:
  • pre-existing poor cardiac reserve
  • multiple trauma - allows more accurate fluid challenge
• blood gases:
  • important to identify acidaemia
  • acidaemia may reflect indequate tissue perfusion, or more rarely the need for escharotomy
• pulse oximeter:
  • can give constant pulse reading
  • may give spurious readings in carbon monoxide poisoning
• serum electrolytes; serial values are helpful as:
  • Hartmann infusion can cause hyponatraemia
  • electrical burns can cause hyperkalaemia

For larger burns, a nasogastric tube is warranted to indicate and protect against the effects of gastroparesis. Also, it may provide a route for early enteral feeding in a patient too compromised to eat normally.