For burns greater than 20% TBSA, what action should be taken as soon as IV/IO access is established?

• A. Initiate fluid resuscitation as soon as IV/IO access established
• B. Apply topical antibiotics
• C. Begin oral fluids
• D. Elevate the limb

Answer: (A)

Burn shock from significant burns is driven by loss of intravascular volume from capillary leak, so restoring circulating volume as the immediate priority is essential. Once IV or IO access is secured, you should begin crystalloid fluid resuscitation right away to re-establish perfusion. In practice, a calculated resuscitation plan guides the rate (for example, using a Parkland-style approach that totals the fluid over 24 hours, with half given in the first 8 hours and the rest over the next 16 hours), and you adjust based on how the patient is perfusing. Use lactated Ringer’s as the fluid of choice when available, and monitor targets such as urine output (about 0.5 mL/kg/hr in adults; higher in children) and vital signs to guide ongoing adjustments. Topical antibiotics, oral fluids, and limb elevation are not the immediate actions that address the systemic fluid loss and perfusion needs in burns greater than 20% TBSA.