Which type of fluid should the nurse expect to prepare and administer as fluid resuscitation during the emergent phase of burn recovery?
A. Colloids
B. Crystalloids
C. Fresh-frozen plasma
D. Packed red blood cells
Correct Answer: B. Crystalloids
Although not universally true, most fluid resuscitation for burn injuries starts with crystalloid solutions, such as normal saline and Ringer’s lactate. Burn patients receive a larger amount of fluids in the first hours than any other trauma patients. Initial resuscitation is based on crystalloids because of the increased capillary permeability occurring during the first 24 h. After that time, some colloids, but not all, are accepted.
Option A: Colloids are not generally used during the fluid shift phase because these large particles pass through the leaky capillaries into the interstitial fluid, where they increase the osmotic pressure. Increased osmotic pressure in the interstitial fluid can worsen the capillary leak syndrome and make maintaining the circulating fluid volume even more difficult.
Option C: Fresh frozen plasma appears to be a useful and effective immediate burn resuscitation fluid but its benefits must be weighed against its costs, and risks of viral transmission and acute lung injury.
Option D: The burn client rarely requires blood during the emergent phase unless the burn is complicated by another injury that involves hemorrhage. Ongoing blood loss, anemia, hypoxia, and cardiac disease are the most common reasons for blood transfusion in burn patients. Other important causes include age, percentage of burn (TBSA), need for further operation, presence of acute respiratory distress syndrome, sepsis, and evidence of cardiac ischemia.
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