Examkin

Question

Difficulty: MediumTrauma and Burns

A 2727-year-old male is brought to the emergency department 22 hours after sustaining thermal injuries in an industrial flash fire. He is awake and alert. His airway is intact with no evidence of inhalational injury. Vital signs show a blood pressure of 115/75115/75 mm Hg, a heart rate of 108/min108/min, and a respiratory rate of 18/min18/min. Physical examination reveals deep partial-thickness burns over his entire anterior chest and abdomen, as well as his entire left upper extremity (circumferential). He weighs 8080 kg. Peripheral intravenous access is established.

Using the traditional Parkland formula (44 mL/kg/%\% total body surface area), what is the appropriate intravenous fluid administration rate (in mL/hr) for the remainder of the first 88 hours following the injury?

Answer: 720 mL/hr

Answer

The correct administration rate is 720720 mL/hr.
The target fluid administration rate is 720720 mL/hr. Using the Rule of Nines, the entire anterior trunk (chest and abdomen) accounts for 18%18\% TBSA, and the entire left arm accounts for 9%9\% TBSA, yielding a total of 27%27\% TBSA. The traditional Parkland formula calculates the 2424-hour fluid requirement as 44 mL ×\times weight in kg ×\times %\% TBSA. For an 8080 kg patient with a 27%27\% TBSA burn, the total volume is 4×80×27=86404 \times 80 \times 27 = 8640 mL. Half of this volume (43204320 mL) must be administered within the first 88 hours following the injury. Because the patient arrived 22 hours after the injury, the 43204320 mL must be infused over the remaining 66 hours. Dividing 43204320 mL by 66 hours yields a precise rate of 720720 mL/hr.

Step-by-Step Solution

1
Determine the Total Body Surface Area (TBSA) involved in the burn using the Rule of Nines.
Anterior chest and abdomen (anterior trunk) = 18%18\%. Left upper extremity = 9%9\%. Total TBSA = 27%27\%.
Accurate estimation of burn size is required to calculate fluid resuscitation volumes.
2
Calculate the total 24-hour resuscitation fluid volume.
Using the formula: 44 mL ×\times 8080 kg ×\times 27%27\% TBSA = 86408640 mL total.
The traditional Parkland formula establishes the baseline fluid requirement for the first 24 hours post-burn.
3
Calculate the fluid volume to be administered in the first phase of resuscitation.
86408640 mL / 22 = 43204320 mL.
Standard burn management dictates that half of the total calculated 24-hour fluid volume must be given in the first 8 hours.
4
Determine the time remaining in the first 8-hour window and calculate the hourly rate.
Time remaining = 88 hours - 22 hours elapsed = 66 hours. Rate = 43204320 mL / 66 hours = 720720 mL/hr.
The 8-hour window begins at the time of injury, not at the time of hospital arrival. The rate must be adjusted to deliver the target volume in the remaining time.

Key Concept

Calculation of burn resuscitation fluids using the Rule of Nines and Parkland formula, with critical adjustments for pre-hospital elapsed time.
Rate this question

Topics

Trauma and Burns

More questions from this topic