A 42-year-old woman is brought to the emergency department via ambulance after being rescu… — USMLE Step 2 CK

A 42-year-old woman is brought to the emergency department via ambulance after being rescued from a house fire. Paramedics report the injury occurred exactly 2 hours prior to her arrival. On physical examination, she is in significant pain but has a patent airway with no signs of inhalation injury. She has deep partial-thickness and full-thickness burns involving her entire anterior torso, her entire left arm, and the anterior surface of her left leg. The remainder of her skin is uninjured. Her weight is $75\text{ kg}$ . Large-bore intravenous access is established. Based on the most current Advanced Trauma Life Support (ATLS) guidelines for adult thermal burns, what should be the initial rate of intravenous lactated Ringer solution administration for this patient in $\text{mL/hr}$ ?

Answer: 450 mL/hr

Answer

450

Based on the 10th edition ATLS guidelines, adult thermal burns are resuscitated starting at

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

(modified Parkland formula). For this patient (

75\text{ kg}

36\%\text{ TBSA}

), the 24-hour requirement is

2 \times 75 \times 36 = 5,400\text{ mL}

. Half of this volume (

2,700\text{ mL}

) is given in the first 8 hours post-injury. Because 2 hours have elapsed since the injury occurred, the

2,700\text{ mL}

must be infused over the remaining 6 hours, resulting in a rate of

450\text{ mL/hr}

Step-by-Step Solution

Calculate the total percentage of body surface area (%TBSA) burned.

36%

Using the Rule of Nines: anterior torso is 18%, entire left arm is 9%, and anterior left leg is 9%. Sum = 36%.

Calculate the total 24-hour fluid resuscitation volume.

5,400 mL

Current ATLS guidelines for adult thermal burns recommend 2 mL x weight (kg) x %TBSA. Therefore, 2 x 75 x 36 = 5,400 mL.

Determine the fluid volume required for the first 8 hours post-injury.

2,700 mL

Half of the 24-hour total volume is administered in the first 8 hours post-injury. 5,400 / 2 = 2,700 mL.

Calculate the hourly infusion rate.

450 mL/hr

Since 2 hours have elapsed since the injury, the 2,700 mL must be given over the remaining 6 hours (8 - 2 = 6). 2,700 / 6 = 450.

Key Concept

Initial fluid resuscitation for adult thermal burns using the modified Parkland formula (ATLS 10th edition).

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