Examkin

Question

Difficulty: HardTrauma and Burns

A 52-year-old man weighing 85 kg85\text{ kg} is brought to the emergency department after being trapped in a residential garage fire. The injury occurred exactly 2 hours prior to his arrival. On examination, he has deep partial-thickness and full-thickness burns involving the entire anterior trunk, the entire right upper extremity, and the anterior surface of the left lower extremity. He has no inhalation injury, and his airway is patent. Intravenous access is established. According to current Advanced Trauma Life Support (ATLS) guidelines for adult thermal burns, what should be the initial intravenous fluid infusion rate in mL/hr\text{mL/hr} to administer the first half of his calculated resuscitation volume?

Answer: 510 mL/hr

Answer

510
The correct rate is 510 mL/hr510\text{ mL/hr}. First, the total body surface area (TBSA) is calculated using the Rule of Nines: the entire anterior trunk accounts for 18%18\%, the entire right upper extremity is 9%9\%, and the anterior surface of the left lower extremity is 9%9\%, yielding a total of 36%36\% TBSA. According to current ATLS guidelines for adult thermal burns, the total 24-hour fluid requirement is calculated as 2 mL×85 kg×36=6,120 mL2\text{ mL} \times 85\text{ kg} \times 36 = 6,120\text{ mL}. Exactly half of this total (3,060 mL3,060\text{ mL}) is mandated to be administered within the first 8 hours from the time of injury. Because 2 hours have already elapsed prior to emergency department arrival, the required 3,060 mL3,060\text{ mL} must be infused over the remaining 6 hours. Therefore, the hourly rate is 3,060 mL/6 hours=510 mL/hr3,060\text{ mL} / 6\text{ hours} = 510\text{ mL/hr}.

Step-by-Step Solution

1
Calculate the burned Total Body Surface Area (TBSA) using the Rule of Nines.
Anterior trunk (18%18\%) + right arm (9%9\%) + anterior left leg (9%9\%) = 36%36\% TBSA.
Accurate estimation of TBSA is required to determine total fluid needs.
2
Calculate the total 24-hour fluid requirement using the current ATLS multiplier for adult thermal burns.
2 mL×85 kg×36%=6,120 mL2\text{ mL} \times 85\text{ kg} \times 36\% = 6,120\text{ mL}.
Current ATLS guidelines recommend 2 mL/kg/%TBSA2\text{ mL/kg/\%TBSA} for adult thermal burns to prevent fluid creep and over-resuscitation.
3
Determine the fluid volume that must be given in the first phase of resuscitation.
6,120 mL/2=3,060 mL6,120\text{ mL} / 2 = 3,060\text{ mL}.
Half of the calculated 24-hour total must be administered within the first 8 hours from the time of injury.
4
Adjust the remaining time for the first phase based on the pre-hospital delay.
8 hours−2 hours elapsed=6 hours remaining8\text{ hours} - 2\text{ hours elapsed} = 6\text{ hours remaining}.
The 8-hour window begins at the time of injury, not at the time of arrival to the hospital.
5
Calculate the hourly infusion rate.
3,060 mL/6 hours=510 mL/hr3,060\text{ mL} / 6\text{ hours} = 510\text{ mL/hr}.
This rate ensures the patient receives the correct first-half volume precisely within the 8-hour post-injury window.

Key Concept

Burn fluid resuscitation calculations require applying the Rule of Nines for TBSA, using the 2 mL/kg2\text{ mL/kg} multiplier for adult thermal burns, and subtracting pre-hospital elapsed time from the initial 8-hour administration window.
Rate this question

Topics

Trauma and Burns

More questions from this topic