Helicopter transport arrives at a regional burn center carrying a 30-year-old female who w… — USMLE Step 2 CK

Helicopter transport arrives at a regional burn center carrying a 30-year-old female who was trapped in a residential fire. She currently weighs $70\text{ kg}$ . The injury occurred exactly $2\text{ hours}$ prior to her arrival. Physical examination reveals full-thickness burns involving her entire anterior trunk, her entire right lower extremity, and her entire left upper extremity. The trauma team confirms this accounts for exactly $45\%$ of her total body surface area (TBSA). Large-bore intravenous access is established. Utilizing the classic Parkland formula ( $4\text{ mL/kg/\%TBSA}$ ), what is the targeted fluid administration rate in $\text{mL/hr}$ for the remainder of the first 8-hour post-burn period?

Answer: 1050 mL/hr

Answer

1050

The correct infusion rate is found by calculating the total 24-hour fluid requirement (

12,600\text{ mL}

), allocating half of that volume to the first 8 hours post-injury (

6,300\text{ mL}

), and dividing that volume by the time remaining in that 8-hour window (

6\text{ hours}

). This yields a target rate of

1,050\text{ mL/hr}

Step-by-Step Solution

Identify the key variables required for the calculation.

Weight =

70\text{ kg}

, TBSA =

45\%

, Elapsed time =

2\text{ hours}

These values are strictly necessary to apply the formula and adjust for the pre-hospital delay.

Calculate the total 24-hour fluid volume.

4\text{ mL} \times 70\text{ kg} \times 45 = 12,600\text{ mL}

The classic Parkland formula estimates the total fluid deficit over the first 24 hours post-burn.

Determine the fluid volume required for the first resuscitation period.

12,600\text{ mL} / 2 = 6,300\text{ mL}

Standard burn resuscitation guidelines dictate that half of the total 24-hour volume must be administered in the first 8 hours.

Calculate the remaining time in the first 8-hour window.

8\text{ hours} - 2\text{ hours elapsed} = 6\text{ hours remaining}

The 8-hour clock begins precisely at the time of injury, not at the time of hospital arrival.

Calculate the target hourly infusion rate.

6,300\text{ mL} / 6\text{ hours} = 1,050\text{ mL/hr}

The remaining volume must be divided equally over the remaining hours of the first 8-hour period to catch up on fluid deficits safely.

Key Concept

Parkland formula fluid resuscitation and time-delay adjustment

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