Medical Surgical Critical Care Burns #2

Question

An ambulance brought a client removed from a burning house fire. The client is in hypovolemic shock. Which of these IV solutions should be administered immediately?

Answers

  1. Lactated Ringers (LR)
    • Rationale:

      This answer is correct because Lactated Ringers (LR) is the only isotonic solution in the answer options. Isotonic solutions are best to use immediately within the first 24 hours with burns to decrease intravascular water shift into the interstitium, which leads to reduced swelling and fewer intubations with major burns.

  2. Dextrose 5% in Water (D5W)
    • Rationale:

      This answer is not correct because D5W is dextrose in water is a hypotonic solution. It produces free water at the same time dextrose is processed.

  3. 0.45 Normal Saline
    • Rationale:

      This answer is not correct because 0.45 Normal Saline is a hypotonic solution. Isotonic solutions are best to use immediately within the first 24 hours with burns to decrease intravascular water shift into the interstitium, which leads to reduced swelling and fewer intubations with major burns.

  4. D5 Lactated Ringers
    • Rationale:

      This answer is not correct because D5LR is a hypertonic solution. Solutions that contain dextrose plus electrolytes are hypertonic.

Overview

When a client is in hypovolemic shock caused from burns, capillaries leak out and intravascular volume shifts resulting in interstitial edema, depletion of vascular volume, plus electrolyte imbalances. Lactated Ringers is the only isotonic solution and decreases intravascular water shift into the interstitium, which leads to reduced swelling and fewer intubations with major burns.

Explanation

Learning Outcomes

With hypovolemic shock resulting from burns, capillaries leak out and intravascular volume shifts resulting in interstitial edema, depletion of vascular volume, plus electrolyte imbalances. Isotonic solutions are best to use immediately within the first 24 hours with burns to decrease intravascular water shift into the interstitium, which leads to reduced swelling and fewer intubations with major burns. Dextrose 5% in Water (D5W), 0.45 Normal Saline, and D5Lactated Ringers are not isotonic and should not be used in the first 24 hours of burns.

Test Taking Tip

Know the isotonic solutions used for burn victims. The two solutions used are Lactated Ringers and 0.9 Normal Saline.

Video Rationale