This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Initial Care of the Burn Patient, Subject name: Surgery
[{'content': 'True statement about burn resuscitation - \nSelect and explain. \nA. Colloid preferred in initial 24 hrs, B. Colloid preferred if burnt area is > 15 % of total BSA, C. Half of the calculated fluid given in initial 8 brs., D. Urine output should be maintained at 50-60 mL/hr.', 'role': 'user'}, {'content': "Answer: C \nExplanation: Ans. is 'c' i.e.. Half of the calculated fluid given in initial 8 hrs. o Proper fluid management is critical to survival in a bum patient.o The hypovolemic shock in bum patient is special in the sense that the total body water remains unchanged in a burn patient. The thermal injury leads to a massive fluid shift from intravascular compartment to the extravascular compartment (interstitial -fintacellular) leading to edema formation (in both burned parts and non burned parts of body).o This fluid shift is maximum in the first 24 hrs.o Fluid resuscitation begins with an isotonic crystalloid solution- Ringer's lactate solution (RL) is the preferred solution (Normal saline should be avoided as the volumes required for resuscitation may lead to hyperchloremic metabolic acidosis). The concept behind the continuous fluid resuscitation is that the bum (and/or inhalation injury) drives an inflammatory response that leads to capillary leak; as the plasma leaks into the extravascular space, crystalloid administration would maintain the intravascular volume.The quantity of crystalloid needed for adequate resuscitation is determined by Parkland formula i.e., 4 mL/kg per % of TBS A bum. (Note that a number of formulas exist for calculating fluid needs during burn resuscitation, suggesting that no one formula benefits all patients. Parkland is one of the most commonly used formulas).Half of the calculated fluid is given in first 8 hrs and half in next 16 hrs.o Colloids are given in the next 24 hrs. The reason behind it being the observation that in the initial period, the vascular permeability is so large that even larger protein molecules leak from the capilaries. (But some workers, prefer to use colloids after 8 to 12 hrs, while there are some who use it from the very beginning),o A number of parameters are widely used to assess bum resuscitation, but the most common remain the simple outcomes of blood pressure and urine output. As in any critically ill patimt, the target MAP is 60 mitiHg to ensure optimal end-organ perfusion. Goals for urine output should be 30 mL/h in adults and 1 to 1.5 mL/kg per hour in pediatric patients.o There is no use of diuretics in bum resuscitation.o Children under 20 kg have the additional requirement as they do not have sufficient glycogen stores to maintain an adequate glucose level in response to the inflammatory' response. Specific pediatric formulas have been described, but the simplest approach is to add maintenance IV fluid with glucose supplementation in addition to the calculated resuscitation fluid with lactated Ringer's.", 'role': 'assistant'}]