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Difficulty: HardTrauma and Burns

A 4545-year-old male construction worker is brought to the emergency department after a high-voltage electrical injury. He accidentally touched a live power line and was thrown to the ground. The incident occurred exactly 3 hours3\text{ hours} prior to his arrival at the trauma center. No intravenous fluids were administered during transport. The patient weighs 90 kg90\text{ kg}. On physical examination, there are deep, full-thickness burns covering his entire anterior torso and his entire right upper extremity. The remainder of his skin is unaffected. A Foley catheter is placed, yielding dark red urine. According to the Advanced Trauma Life Support (ATLS) guidelines, at what rate (in mL/hr\text{mL/hr}) should intravenous lactated Ringer solution be administered over the remainder of the first 8-hour post-injury window?

Answer: 972 mL/hr

Answer

972 mL/hr
The correct calculation appropriately utilizes the ATLS multiplier for electrical burns (4 mL/kg/%TBSA), divides the 24-hour total in half for the first 8-hour window, and divides that half strictly by the remaining 5 hours since the injury occurred 3 hours prior.

Step-by-Step Solution

1
Calculate the burned body surface area using the Rule of Nines
27% TBSA
Accurate TBSA is required for the fluid resuscitation formula. Anterior torso = 18%, right upper extremity = 9%.
2
Select the appropriate ATLS fluid multiplier for electrical injuries
4 mL/kg/%TBSA
High-voltage electrical burns with suspected myoglobinuria require higher fluid volumes (4 mL) to flush the kidneys compared to standard thermal burns (2 mL).
3
Calculate the total 24-hour fluid volume
9,720 mL
4 mL × 90 kg × 27% = 9,720 mL total for the first 24 hours.
4
Determine the fluid volume for the first 8-hour window
4,860 mL
Standard ATLS guidelines dictate that 50% of the calculated 24-hour fluid volume is given in the first 8 hours post-injury.
5
Calculate the infusion rate over the remaining hours of the first window
972 mL/hr
Because 3 hours have already elapsed since the injury, the 4,860 mL must be infused over the remaining 5 hours (4,860 / 5).

Key Concept

Fluid resuscitation for electrical burns with myoglobinuria utilizes 4 mL/kg/%TBSA, with half administered over the first 8 hours from the time of injury.
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Topics

Trauma and Burns

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