A 28-year-old man is brought to the emergency department via ambulance after being rescued… — USMLE Step 2 CK

A 28-year-old man is brought to the emergency department via ambulance after being rescued from a house fire. The incident occurred exactly 2 hours prior to arrival. He weighs $80$ kg. Primary survey reveals a patent airway, clear breath sounds bilaterally, and a heart rate of $115$ /min. Physical examination shows deep partial-thickness and full-thickness burns covering his entire anterior torso, entire right arm, and the anterior surface of his right leg. Peripheral intravenous access is established. Based on current Advanced Trauma Life Support (ATLS) guidelines for adult thermal burn resuscitation (using $2 \text{ mL/kg/\%TBSA}$ ), what should be the initial intravenous crystalloid fluid infusion rate programmed for the remainder of the first 8 hours post-injury?

Answer: 480 mL/hr

Answer

480 mL/hr

The patient requires acute burn resuscitation based on the extent of his injuries and time elapsed. The Rule of Nines dictates that the anterior torso is 18%, the entire right arm is 9%, and the anterior right leg is 9%, resulting in a 36% TBSA. Using the current ATLS recommendation of

2 \text{ mL/kg/\%TBSA}

, the total 24-hour fluid requirement is

2 \times 80 \times 36 = 5760 \text{ mL}

. Half of this volume (

2880 \text{ mL}

) must be given in the first 8 hours calculated from the time of injury. Because 2 hours have already passed since the fire, the remaining

2880 \text{ mL}

must be infused over the next 6 hours, yielding a target rate of

480 \text{ mL/hr}

Step-by-Step Solution

Calculate the involved Total Body Surface Area (TBSA).

TBSA = 36%

The Rule of Nines assigns 18% to the anterior torso, 9% to an entire arm, and 9% to the anterior half of a leg.

Calculate the total 24-hour fluid resuscitation volume.

Total volume = 5760 mL

Using the ATLS formula:

2 \text{ mL} \times 80 \text{ kg} \times 36\% \text{ TBSA} = 5760 \text{ mL}

Determine the fluid volume for the first 8 hours.

First 8-hour volume = 2880 mL

Half of the total 24-hour fluid requirement must be given in the first 8 hours post-injury (

5760 / 2 = 2880 \text{ mL}

Calculate the hourly infusion rate.

Infusion rate = 480 mL/hr

The 2880 mL must be administered over the remaining 6 hours of the first 8-hour window (8 hours - 2 hours elapsed = 6 hours).

2880 / 6 = 480 \text{ mL/hr}

Key Concept

Burn fluid resuscitation calculations require determining TBSA via the Rule of Nines, calculating the 24-hour fluid requirement, and administering half of that total volume over the first 8 hours, strictly calculated from the time of injury (not the time of hospital presentation).

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