Monitoring

• The fluid loss from major burns requires careful assessment of intravascular volume status. The traditional markers of fluid resuscitation in burns of central venous pressure, urine output and haematocrit are generally inadequate.

• Either invasive or non-invasive cardiac output monitoring is needed for accurate titration of fluid. This is particularly applicable in the presence of a hyperdynamic, vasodilated circulation which often commences within 1-2 days. Although infection is not necessarily present, vasopressor therapy may be needed to maintain adequate systemic blood pressures.

• Pulmonary artery and central venous catheters should not be inserted through affected skin areas if at all possible.

• Insertion of intravascular catheters, urinary catheters and NG tubes should be carried out soon after admission as rapid onset swelling within a few hours may make these procedures impossible.

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