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Difficulty: MediumTrauma and Burns

A 35-year-old man is brought to the emergency department after being rescued from a burning building. The fire department successfully extracted him from the fire 2 hours ago. On examination, the patient is hemodynamically stable and weighs 90 kg (198.4198.4 lbs). He has severe deep partial-thickness and full-thickness burns involving his entire anterior trunk, his entire right arm, and the anterior aspect of his left leg. The remainder of his skin, including his face, neck, and posterior surfaces, is unaffected. Large-bore intravenous access is obtained. Using the traditional Parkland formula (44 mL/kg/% total body surface area), at what rate (in mL/hr) should intravenous lactated Ringer solution be administered to this patient initially?

Answer: 1080 mL/hr

Answer

1080
The initial fluid resuscitation rate is properly calculated by first determining the burned TBSA (3636%), computing the total 24-hour fluid need (12,96012,960 mL), dividing by two for the first 8-hour requirement (6,4806,480 mL), and dividing that volume by the remaining 6 hours since the burn occurred 2 hours prior to arrival (1,0801,080 mL/hr).

Step-by-Step Solution

1
Calculate the total body surface area (TBSA) burned using the Rule of Nines.
TBSA = 36%
The entire anterior trunk is 18%, the entire right arm is 9%, and the anterior aspect of the left leg is 9%.
2
Calculate the total 24-hour fluid requirement using the traditional Parkland formula.
12,960 mL
4 mL x 90 kg x 36% = 12,960 mL.
3
Determine the fluid volume required for the first 8 hours post-injury.
6,480 mL
Half of the total 24-hour fluid volume (12,960 mL / 2) must be administered in the first 8 hours.
4
Calculate the remaining time in the first 8-hour window.
6 hours
The patient was extracted from the fire 2 hours ago, meaning 2 hours of the 8-hour window have already elapsed (8 - 2 = 6).
5
Calculate the required hourly intravenous fluid rate.
1,080 mL/hr
6,480 mL divided by the remaining 6 hours equals 1,080 mL/hr.

Key Concept

Burn fluid resuscitation calculation requires determining the TBSA with the Rule of Nines, computing total fluid needs via the Parkland formula, and adjusting the initial infusion rate based on the time elapsed since the burn occurred.
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Topics

Trauma and Burns

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