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

Meet the patient

A 45-year-old with 40 percent TBSA flame burns is listed for tangential excision and grafting on day five. The burns ICU has resuscitated him through the Parkland phase; now the surgeon wants to excise 30 percent in one sitting. The raw surface he is about to create is an open vascular bed — surgical teaching treats major excision as controlled trauma surgery with blood-volume-scale loss (taught burns-theatre preparation; balanced-product resuscitation below follows trial evidence).^[5]

Two sentences frame the case and separate a pass from a fail: I will not start without blood in theatre and a warmer on, and I will stage the excision if physiology collapses. Everything below is the craft that makes those sentences true.^[5][6]

References10ShowHide

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2. [2]Baxter CR Fluid volume and electrolyte changes of the early postburn period Clin Plast Surg, 1974.PMID 4609676
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4. [4]Roberts I, Shakur H, Afolabi A, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet, 2011.PMID 21439633
5. [5]Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA, 2015.PMID 25647203
6. [6]Moore EE, Moore HB, Kornblith LZ, et al. Trauma-induced coagulopathy. Nat Rev Dis Primers, 2021.PMID 33927200
7. [7]Giancarelli A, Birrer KL, Alban RF, et al. Hypocalcemia in trauma patients receiving massive transfusion. J Surg Res, 2016.PMID 27083965
8. [8]Gronert GA, Theye RA Pathophysiology of hyperkalemia induced by succinylcholine. Anesthesiology, 1975.PMID 1147311
9. [9]Yentis SM Suxamethonium and hyperkalaemia. Anaesth Intensive Care, 1990.PMID 2186663
10. [10]Li G, Cheng L, Wang J Comparison of Rocuronium with Succinylcholine for Rapid Sequence Induction Intubation in the Emergency Department: A Retrospective Study at a Single Center in China. Med Sci Monit, 2021.PMID 33441534