الفهرس 
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Abstract
SUMMARY
n understanding of the pathophysiological mechanisms
underlying burn injury is essential if clinicians are to
resuscitate patients successfully.
All burned patients should initially be treated with the
principles of Advanced Burn and /or Trauma Life Support.
Burn Shock Resuscitation by Fluid resuscitation is aimed
at supporting the patient throughout the initial 24 hour to 48
hour period of hypovolemia. The primary goal of therapy is to
replace the fluid sequestered as a result of thermal injury. The
critical concept in burn shock is that massive fluid shifts can
occur even though total body water may remain unchanged and
could even increase at the expense of plasma volume and blood
volume.
Many formulas exist and many end pointouscitaionf res
parameters have been recommended. But the commonest
strategy is to use the Parkland formula to calculate the initial
fluid amount and then to adjust the fluid rate according to the
hourly urine output. Although the Parkland formula is still the
most commonly employed resuscitation formula worldwide, it
is far from a perfect solution the most consistent criticism of
the Parkland formula is that the patients tend to receive more
fluid than the formula would have predicted based on the
patient’s weight and /TBSA (Fluid creep phenomena).
A
Although the exact causes of fluid creep remain
undetermined, controlling its magnitude and complications
certainly requires several strategies, which may include
restriction of early fluid resuscitation, tighter titration of fluid
administration, colloid administration, and possibly the use of
adjunctive pharmacologic agents as well as markers of
resuscitation other than urinary output.
Despite its widespread use, urine output is not generally
viewed as a perfect measure of overall tissue perfusion invasive
monitoring using central venous pressure and pulmonary artery
catheterization failed to change mortality or morbidity in burn
patients.
However, a reliable and accurate marker of cardiac
preload would appear to be an attractive tool to guide
resuscitation in burns patients, Intrathoracic blood volume (ITBV)
has been shown to be closely correlated to cardiac output, and that
this correlation is not simply a mathematical coupling achieved
Haemodynamic measurements were made using the COLD
system (Pulsion Medical Systems], resuscitation targets with less
fluid administered, less oedema formation, and lower organ
dysfunction scores using a intrathoracic blood volume-guided and
cardiac output-guided approach compared with a Parkland
approach other methods include measuring trans-esophageal
echocardiography, partial carbon dioxide rebreathing, and
impedance electrocardiography. Comparisons of these various
techniques demonstrate that they are somewhat reliable for
determining cardiac output.
Parameters derived from trans cardiopulmonary
thermodilution using the PiCCO system have shown good
correlation with values from a conventional pulmonary artery
catheter in burned patients but have failed to prove superior
resuscitation outcomes regarding patient morbidity and
mortality, Invasive monitors continue to become more
sophisticated Although these devices are interesting, their use
for burn resuscitation is undefined.
Salinas et al. (2011) reported the implementation of a
computer decision support system for burn resuscitation that
resulted in a reduction of infused volumes, an improved
achievement of hourly urine outputs and a reduction of
mortality. Implementation of the nurse-driven burn
resuscitation protocol improved nurses’ awareness and
assessment of fluid status during resuscitation and improved
patients’ outcomes.
Important djuvants to succesful burn shock resuscitation
are Control of infection: deep venous thrombosis chemoprophylaxis,
Stress Ulcers prophylaxi