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Difficulty: MediumTrauma and Burns

A 45-year-old woman is brought to the emergency department 30 minutes after being rescued from a residential fire. Her airway is patent, and she is hemodynamically stable. Physical examination reveals deep partial-thickness and full-thickness burns involving her entire anterior trunk, her entire right arm, and her entire right leg. Her estimated weight is 80 kg80 \text{ kg}. Using the Parkland resuscitation formula (4 mL/kg/%TBSA4 \text{ mL/kg/} \% \text{TBSA}), what should be the target rate of intravenous lactated Ringer solution administration, in mL/hour\text{mL/hour}, for the first 8 hours following her injury?

Answer: 900 mL/hour

Answer

900
The correct administration rate is 900 mL/hour900 \text{ mL/hour}. According to the Rule of Nines for adult patients, the anterior trunk constitutes 18%18\% TBSA, an entire arm is 9%9\%, and an entire leg is 18%18\%, totaling 45%45\% TBSA burned. Applying the given Parkland formula (4 mL×weight in kg×%TBSA4 \text{ mL} \times \text{weight in kg} \times \% \text{TBSA}), the total 24-hour fluid requirement is 4×80×45=14,400 mL4 \times 80 \times 45 = 14,400 \text{ mL}. Standard burn resuscitation guidelines dictate that 50%50\% of this total volume (7,200 mL7,200 \text{ mL}) must be administered over the first 8 hours following the injury. Dividing this initial volume by 8 hours yields an hourly rate of 900 mL/hour900 \text{ mL/hour}.

Step-by-Step Solution

1
Calculate the Total Body Surface Area (TBSA) affected by the burns.
Anterior trunk (18%) + entire right arm (9%) + entire right leg (18%) = 45% TBSA.
Accurate estimation of the burn area using the Rule of Nines is required to calculate fluid needs.
2
Calculate the total volume of fluid required for the first 24 hours.
4 mL×80 kg×45=14,400 mL4 \text{ mL} \times 80 \text{ kg} \times 45 = 14,400 \text{ mL}
The Parkland formula is used to determine the total 24-hour resuscitation volume requirement.
3
Determine the fluid volume to be administered during the first 8 hours.
14,400 mL/2=7,200 mL14,400 \text{ mL} / 2 = 7,200 \text{ mL}
Standard burn resuscitation guidelines dictate that half (50%) of the total 24-hour fluid volume must be given in the first 8 hours.
4
Calculate the hourly intravenous infusion rate.
7,200 mL/8 hours=900 mL/hour7,200 \text{ mL} / 8 \text{ hours} = 900 \text{ mL/hour}
The rate is needed to properly set the infusion pump for the initial phase of resuscitation.

Key Concept

Calculation of burn fluid resuscitation rates using the Rule of Nines and the Parkland formula.
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Topics

Trauma and Burns

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