Clinical Challenges in Burn Surgery: Burn Resuscitation - Getting Things Started - Part 1 of 2

A patient with a large TBSA burn injury presents to a local emergency department and you are the only surgeon on duty that evening. With snow covered roads and poor visibility, the patient requires initial stabilization prior to transfer to the regional burn center. You are faced with some difficult clinical decisions as you begin their resuscitation. Join Drs. Tam Pham, Rob Cartotto, Julie Rizzo, Alex Morzycki and Jamie Oh as they discuss the clinical challenges in initiating burn resuscitation, pitfalls in long-distance transport, and more.

Hosts:
· Dr. Tam Pham: UW Medicine Regional Burn Center

· Dr. Robert Cartotto: University of Toronto, Ross Tilley Burn Centre

· Dr. Julie Rizzo: Brooke Army Medical Center

· Dr. Alex Morzycki: UW Medicine Regional Burn Center

· Dr. Jamie Oh: UW Medicine Regional Burn Center

Learning Objectives:
· Describe initial fluid strategies, including the recommendations of the Advanced Burn Life Support (ABLS) course, traditional resuscitation formulas, and the Rule of 10.

· Describe logistical and medical challenges of long-distance transport to a regional burn center.

· Understand recent advances learned from recent conflicts in military burn casualty care.

· List options for intravenous access.

· Understand endpoints of resuscitation, including adjuncts which may help guide fluid titration.


1. Cartotto R, Johnson LS, Savetamal A, et al. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. J Burn Care Res 2023

https://pubmed.ncbi.nlm.nih.gov/38051821/

2. Renz EM, Cancio LC, Barillo DJ, et al. Long-Range Transport of War-Related Burn Casualties. J Trauma 2008 https://pubmed.ncbi.nlm.nih.gov/18376156/

3. Adibfar A, Camacho F, Rogers AD, Cartotto R. The Use of Vasopressors During Acute Burn Resuscitation. Burns 2021 https://pubmed.ncbi.nlm.nih.gov/33293152/

4. Chung KK, Wolf SE, Cancio LC, et al. Resuscitaiton of Severely Burned Military Casualties: Fluid Begets More Fluid. J Trauma 2009 https://pubmed.ncbi.nlm.nih.gov/19667873/

5. Chung KK, Salinas J, Renz EM, et al. Simple Derivation of the Initial Fluid Rate for the Resuscitation of Severely Burned Adult Combat Casualties: in Silico Validation of the Rule of 10, J Trauma 2009 https://pubmed.ncbi.nlm.nih.gov/20622619/

Joint Trauma System Clinical Practice Guideline (CPG)-Burn Care, updated 2022

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