When should two large bore IVs be started for patients with burns?

Starting two large bore IVs is critical in the management of burn patients, particularly to ensure rapid access for fluid resuscitation. The appropriate criterion for initiating this practice is based on the extent of burns, specifically when the total body surface area (TBSA) affected by burns is over 20%. When burns cover this significant area, the risk of hypovolemic shock increases due to potential fluid loss through damaged skin.

Large bore IVs facilitate the rapid administration of crystalloids and other fluids that are essential for maintaining hemodynamic stability. Fluid resuscitation is crucial in the immediate management of burn injuries to prevent complications related to inadequate circulatory volume. Thus, in cases where TBSA exceeds 20%, the necessity for two large bore IVs becomes evident, as it prepares the healthcare provider to begin fluid resuscitation promptly and effectively.

While it might be tempting to think that IVs should be started immediately upon arrival or only if the patient is unresponsive, the rationale for fluid resuscitation is specifically tied to the extent of burns and the associated risks. It is essential to assess burns comprehensively to determine the right time and necessity for intravenous access. Initiating IVs solely because they are needed for fluid resuscitation