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US Army Institute of Surgical Research

US Army Institute of Surgical Research. The Nurse’s Role using the Burn Resuscitation Decision Support System (BRDSS) Maria L. Serio-Melvin, MSN, RN, CCRN, CNS-BC. Disclaimer.

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US Army Institute of Surgical Research

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  1. US Army Institute of Surgical Research The Nurse’s Role using the Burn Resuscitation Decision Support System (BRDSS) Maria L. Serio-Melvin, MSN, RN, CCRN, CNS-BC

  2. Disclaimer “The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of defense.”

  3. Importance • Burns represent 5% of overall casualties, but 10% of potentially survivable deaths. • Severely burned patients require “significant intravenous resuscitation” (Chung et al, 2006) .

  4. Burn Fluid Resuscitation • Cornerstone of post admission burn care • Labor intensive • Titration of the hourly fluid based on various clinical end points. • Difficult resulting in great variability of treatment.

  5. Consequences of poor resuscitation Over Resuscitation: Abdominal and extremity compartment syndromes Under Resuscitation: end stage organ failure 70%-100% mortality rate Alvarado et al, Burns 2008

  6. Problem • From 2004 thru Jan 2006, 36% of Wounded Warriors were diagnosed with ACS • Burn Resuscitation Guidelines and a standardized Burn Flow Sheet were implemented • (Ennis et al, J of T, 2008)

  7. Solution?

  8. Solution?

  9. Solution!!

  10. Green line: 2 ml/kg/TBSA/24hr Yellow line: 4 ml/kg/TBSA/24hr Orange line: 200 ml/kg/24hr Red line: 250 ml/kg/24hr

  11. Table turns orange when 200 ml/kg/24hr threshold is reached

  12. Trigger to notify provider of high resuscitation volume Consider serial bladder pressure measurements Consider adjuncts to reduce total volume infused

  13. Graph turns red when 250 ml/kg threshold is reached Trigger to notify provider will also appear

  14. BRDSS Intake and Output Table

  15. Implementation • Nurse driven • Human interface instrumental • Educator • Enforcer • Liaison • Analysis done after every resuscitation.

  16. Advantages • Hourly LR fluid rate recommendations • Immediate, easily extractable data • Improve the number of times the UOP is w/in the target range. • Prevent under or over fluid resuscitation.

  17. Advantages • Decrease variability of treatment • Improves documentation • Improves communication • Provides data used to improve resuscitation practices.

  18. Advantages • Instills confidence in nurses and doctors • Provides easily retrievable data for future PI and research projects. • CCCE lays the ground work for future Clinical Trials

  19. Acknowledgements • Dr. Jose Salinas • Mr. Nolan Clayton • Mr. Drew Gibson • Mr. Pat McGiver • Combat Critical Care Engineering task area • Dr. Steven Wolf • Dr. Lee Cancio • Dr. Kevin Chung • Dr. Evan Renz • Dr. Booker King • Dr. Todd Huzar • Ms. Kellie Miller • Ms. Hope Greeley • Mr. Andy Wallace • ISR Clinical Division doctors and nurses

  20. Thank You!

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