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Difficulty: MediumTrauma and Burns

A 4545-year-old man is brought to the emergency department by ambulance following an industrial boiler explosion. The injury occurred exactly 22 hours prior to his arrival. He sustained deep partial-thickness and full-thickness thermal burns to his entire anterior trunk and his entire left lower extremity. His airway is intact without signs of inhalation injury, and there is no evidence of electrical injury. The patient weighs 80 kg80\text{ kg} (176 lbs176\text{ lbs}). No intravenous fluids were administered in the prehospital setting. According to current Advanced Trauma Life Support (ATLS) guidelines for adult thermal burns, the medical team initiates resuscitation with lactated Ringer solution. What is the appropriate initial rate of intravenous fluid administration in mL/hr\text{mL/hr} for this patient?

Answer: 480 mL/hr

Answer

480
The correct infusion rate is 480 mL/hr480\text{ mL/hr}. Using the Rule of Nines, the patient has 36% TBSA36\%\text{ TBSA} burned (anterior trunk 18%18\%, left leg 18%18\%). According to current ATLS guidelines for adult thermal burns, the total 2424-hour fluid requirement is 2 mL×80 kg×36=5760 mL2\text{ mL} \times 80\text{ kg} \times 36 = 5760\text{ mL}. Half of this volume (2880 mL2880\text{ mL}) must be given in the first 88 hours from the time of injury. Because the injury occurred 22 hours prior to arrival, there are 66 hours remaining in this window. Therefore, the rate is 2880 mL÷6 hours=480 mL/hr2880\text{ mL} \div 6\text{ hours} = 480\text{ mL/hr}.

Step-by-Step Solution

1
Calculate the Total Body Surface Area (TBSA) burned using the Rule of Nines.
18%18\% (anterior trunk) + 18%18\% (entire left lower extremity) = 36% TBSA36\%\text{ TBSA}.
Accurate estimation of the burn size is required for standard resuscitation formulas.
2
Calculate the total 2424-hour fluid requirement using the current ATLS thermal burn formula.
2 mL×80 kg×36%=5760 mL2\text{ mL} \times 80\text{ kg} \times 36\% = 5760\text{ mL}.
Current ATLS guidelines recommend 2 mL/kg/%TBSA2\text{ mL/kg/\%TBSA} for adults with thermal burns to prevent over-resuscitation and complications like abdominal compartment syndrome.
3
Determine the fluid volume to be administered in the first 88 hours.
5760 mL÷2=2880 mL5760\text{ mL} \div 2 = 2880\text{ mL}.
Half of the total calculated 2424-hour fluid volume must be administered in the first 88 hours post-injury.
4
Calculate the hourly infusion rate adjusted for the delayed presentation.
2880 mL÷6 hours=480 mL/hr2880\text{ mL} \div 6\text{ hours} = 480\text{ mL/hr}.
The 88-hour window begins at the time of injury, not arrival. Since 22 hours have elapsed, the 2880 mL2880\text{ mL} must be infused over the remaining 66 hours.

Key Concept

Calculation of initial fluid resuscitation rate in adult thermal burns incorporating updated ATLS formulas and adjustment for prehospital time delays.
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Topics

Trauma and Burns

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