Burn excision and grafting: blood loss, temperature, massive transfusion

Model answer

Prep (5). Arterial line, two large-bore or central access, generous crossmatch with MTP on standby, forced-air and fluid warmers primed with theatre temperature raised, calcium drawn, TXA plan clear, suxamethonium off the tray, ICU bed booked, staging threshold agreed (taught burns-theatre preparation).^[5][6][7]

Intraop (5). Balanced 1:1:1-theme products (PROPPR: exsanguination deaths 9.2 vs 14.6 percent, haemostasis 86 vs 78 percent), serial ionised calcium with replacement (citrate chelation near-universal in series), TXA 1 g IV within 3 hours of injury pattern (harm signal after 3 hours), rewarm continuously against the hypothermia limb of the lethal triad, and stage or pack when lactate, temperature, or coagulation declare failure.^{[5][7][1][4][6]}

Relaxant (5). No suxamethonium on day 5 — unequivocally contraindicated in thermal trauma with potassium efflux described from 5 to 15 days persisting 2 to 3 months; rocuronium 1.2 mg per kg rapid-sequence regimen instead.^[8][3][10]