Quemados

The first 48 post-burn hours are divided into six 4-hour periods in order to facilitate the nursing routine and eliminate possible complications arising from the large volumes of fluid infused.According to the formula we administer Ringer's lactate alone for the first 24 hours post-burn, giving a total amount of 4 ml/kg/% TI1SA (Fig. 1). For the second 24-hour post-burn we begin administeringplasma in an amount of 0.5 ml/kg/% TBSA, during the first two periods in order to "expand" the intravascular volume (Fig. 2). Adequate urine output (50-100 ml/h) is maintained with the administration of5%-glucose, according to the formula of SDSP (Scott, McDougall, Slade and Pruit 1978).
The rate of fluid administration is in accordance with Baxter's proposal (1979) in order to maintain thefunctional extracellular fluid volume within + 10% of the individually calculated volume. 50% of the calculated volume of Ringer's lactate is given during the first two periods and the rest is evenlyadministered over the remaining 4 periods.
Monitoring during the first post-burn days is focused to determine the possible complications and the efficacy of the initial therapy (Fig. 6). Many suchparameters have been proposed, some of which, in our view, are not totally justified, since they give academic and scientific information, without substantial benefit to the patient's care. For this reason weestimate routinely the efficacy and the side effects of the initial therapy by the determination of:
Cerebral function, according to clinical criteria
Hourly urine output, ranging between 50-100ml/h, in relation to urine specific gravity and creatinine value
Central venous pressure, every three hours, as a relative parameter only, since the pulmonary artery wedge pressure (PAWP), althoughaccurate, is accompanied by a high complication rate especially when the Swan-Ganz catheter is inserted through burned areas
Haematocrit, every 6 hours, as a parameter of efficacy of the reduction...