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Difficulty: MediumTrauma and Burns

A 4545-year-old man is brought to the burn center via helicopter after an industrial explosion. The incident occurred exactly 33 hours prior to his arrival. He weighs 100100 kg. Physical examination reveals deep partial-thickness burns over his entire anterior trunk, entire right arm, and entire left arm. His airway is secure, and he is hemodynamically stable. Two large-bore intravenous lines are placed. Based on current Advanced Trauma Life Support (ATLS) guidelines (using 2 mL/kg×%TBSA2 \text{ mL/kg} \times \%\text{TBSA} for adult thermal burns), at what rate (in mL/hr\text{mL/hr}) should the intravenous lactated Ringer's solution be administered for the remainder of the first 88-hour post-injury period?

Answer: 720 mL/hr

Answer

720
The correct infusion rate is 720 mL/hr720 \text{ mL/hr}. To determine this, first calculate the TBSA using the Rule of Nines: the entire anterior trunk (18%18\%), right arm (9%9\%), and left arm (9%9\%) sum to 36%36\%. Using the modern ATLS fluid resuscitation formula for adults with thermal burns (2 mL×weight in kg×%TBSA2 \text{ mL} \times \text{weight in kg} \times \%\text{TBSA}), the total 24-hour fluid requirement is 2×100×36=7200 mL2 \times 100 \times 36 = 7200 \text{ mL}. Exactly half of this volume (3600 mL3600 \text{ mL}) must be administered in the first 8 hours from the time of the injury. Since the injury occurred 33 hours prior to arrival, there are only 55 hours remaining in this initial 8-hour window. Therefore, the rate is 3600 mL/5 hours=720 mL/hr3600 \text{ mL} / 5 \text{ hours} = 720 \text{ mL/hr}.

Step-by-Step Solution

1
Calculate the estimated burn size using the Rule of Nines.
36%36\% TBSA
Accurate estimation of Total Body Surface Area (TBSA) is required to calculate fluid needs. Anterior trunk = 18%18\%, right arm = 9%9\%, left arm = 9%9\%.
2
Calculate the total 24-hour fluid requirement using the ATLS formula.
7200 mL7200 \text{ mL}
The formula is 2 mL×weight in kg×%TBSA2 \text{ mL} \times \text{weight in kg} \times \%\text{TBSA}. Therefore, 2×100×36=7200 mL2 \times 100 \times 36 = 7200 \text{ mL}.
3
Determine the fluid volume targeted for the first 8 hours post-injury.
3600 mL3600 \text{ mL}
Half of the total 24-hour calculated volume must be administered during the first 8 hours following the time of the burn.
4
Calculate the infusion rate over the remaining time in the first 8-hour window.
720 mL/hr720 \text{ mL/hr}
Because 33 hours have already passed since the injury, the 3600 mL3600 \text{ mL} must be delivered over the remaining 55 hours (3600/5=7203600 / 5 = 720).

Key Concept

Burn resuscitation fluid calculation requires assessing TBSA, using the 2 mL/kg/TBSA2 \text{ mL/kg/}\text{TBSA} formula, providing half the total fluid in the first 8 hours, and subtracting any elapsed time from that 8-hour window to determine the current hourly rate.
Estimated Time:1m 30s
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Topics

Trauma and Burns

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