In excessive burns, least useful is -
We know that Ringer's lactate is the preferred agent during initial 24 hrs.
Nasogastric intubation is done to decrease the risk of emesis and possible aspiration (as parlytic ileus develops in a pt. with significant burn)
Dextran is a colloid and can be used in 2nd 24 hrs., however albumin is the preferred and most widely used colloid.
Blood has also role in burn patient.
The need for Blood replacement is significant in extensive burns. Besides injury to red blood cells and their decreased half-life resulting in their early destruction, many patients may be anaemic. Hence, repeated and frequent transmission to maintain a hematocrit around 35% is necessary.
Schwartz 9/e p201 writes- "The role of blood transfusion in burns has undergone a re-evaluation in recent years. A large multicenter study found that increased numbers of transfusions were associated with
increased infections and a higher mortality rate in burn patients, even when correcting for burn severity. A follow-up study implanting a restrictive transfusion policy in burned children showed that a hemoglobin threshold of 7 g/dL had no more adverse outcomes versus a traditional transfusion trigger of 10 g/dL.
These data, in concert with other reported complications such as transfusion-related lung injury, have led to recommendations that blood transfusions be used only when there is an apparent physiologic need."
Blood
Dextran
Ringer lactate
Nasogastric intubation