Mr. Rawles,
I always read your site with interest, especially the medical advice that is written by Dr. Koelker and others, as this is my area of expertise.
Dr. Koelker’s article regarding burn care made very brief mention of a technique called hypodermoclysis as an alternative method for intravenous infusion of fluids in the event of a severe burn. Essentially, hypodermoclysis involves using a regular IV catheter to infuse fluids into the patient’s subcutaneous tissue. Unfortunately, it wouldn’t be a replacement for IV fluids in the case she uses as an example. It appears that the maximum amount of fluids that can be infused over a 24-hour period is about 3,000 mL, using two sites, which would fall short of her fluid replacement calculations using the Parkland formula.
I think in combination with oral rehydration therapy in a conscious patient, hypodermoclysis would be a valid option to assist in maintaining fluid balance in a burn patient, but would not otherwise be sufficient to keep a burn patient hydrated.
Additionally, in a TEOTWAWKI situation with limited resources, knowing when to provide “comfort care” versus aggressive fluid resuscitation might be useful. Although there are newer guidelines with regards to burn survivability, they probably only apply to burn centers. Once upon a time, the age of the patient + the % area of burned skin = the patient’s chance of dying. A revision adds an additional 17% chance of death if the patient’s burn includes an inhalation injury.
For further reading:
- Hypodermoclysis: An Alternative Infusion Technique. Am Fam Physician. 2001 Nov 1;64(9):1575-1579.
- Simplified Estimates of the Probability of Death After Burn Injuries: Extending and Updating the Baux Score. J Trauma. 2010 Mar;68(3):690-7
– Todd B., MD