Massive
fluid shifts occur during this period that can lead to
a severe impairment in oxygen delivery to tissues. An
understanding of these early fluid shifts is necessary
in order to avoid hemodynamic instability and initiate
the appropriate treatment modalities. Appropriate
monitoring is also necessary. The basic concepts of
the pathophysiology and treatment of burn shock will
be described.
Edema
Formation
--
Time Course: peak
shift 4-6 hrs
continuous 2-3 days
--
Protien rich fluid
--
Edema increases tissue pressure (need for
escharotomy)
--
Resorption over next 5-7 days (can cause
hypervolemia)
Increased
Vascular Permeability
--
altered microcirculation from direct heat injury
and inflammation
--
increased protiens permeability leading to large
plasma leak
--
accumulation of protien rich edema below eschar
--
hypovolemia
Typical extensive total body edema seen in a
resuscitated large burn demonstrating large fluid
shifts.
Plasma loss is evident in a superficial burn with
plasma filled blisters.
