Factors affecting fluid resuscitation in the burn patient: the collaborative role of the APN

Throughout the first critical 24 hr after the injury is sustained, the burn patient must receive fluid resuscitation to prevent hypovolemia and ensure adequate tissue perfusion. Delayed or inadequate fluid resuscitation results in suboptimal tissue perfusion, which can lead to multisystem organ failure and death. Overresuscitation can be more problematic than underresuscitation and has been associated with the development of abdominal compartment syndrome, compartment syndrome of the extremities, airway obstruction, and pulmonary edema. The term fluid creep is used to describe the tendency to give too much fluid and can result from the hemodynamic consequence of opioid creep. Experts in the field agree that fluid resuscitation of the burn patient is a priority. Factors affecting fluid resuscitation in the burn patient are at the cornerstone of burn management. The advanced practice nurse (APN) can play a vital role in implementing strategies to ensure optimal resuscitation in the burn patient. Through collaboration, the APN in both the burn center and the emergency department must make certain that the educational needs of the staff are addressed and be diligent in providing significant education, essential tools, and assistance to the staff nurses in an effort to promote best-practice and evidence-based care.