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Difficulty: MediumTrauma and Burns

A 42-year-old man is brought to the emergency department via helicopter following a structural fire. The injury occurred exactly 2 hours prior to arrival. He weighs 90 kg90 \text{ kg}. Physical examination reveals deep partial-thickness and full-thickness burns involving his entire anterior trunk, his entire right arm, and the entire anterior surface of his right leg. The remainder of his skin is intact. During transport, paramedics administered 480 mL480 \text{ mL} of intravenous lactated Ringer solution. The trauma team initiates fluid resuscitation using the traditional Parkland formula (4 mL×weight in kg×%TBSA4 \text{ mL} \times \text{weight in kg} \times \% \text{TBSA}). At what rate (in mL/hr\text{mL/hr}) should the lactated Ringer infusion be set for the remainder of the first 8-hour period following the injury?

Answer: 1000 mL/hr

Answer

1000
The patient requires 12,960 mL total in 24 hours (4×90×364 \times 90 \times 36). Half of this (6,480 mL) belongs in the first 8 hours. Deducting the 480 mL given en route leaves 6,000 mL. Because 2 hours have passed since the injury, this 6,000 mL must be given over the remaining 6 hours, yielding a rate of 1000 mL/hr.

Step-by-Step Solution

1
Calculate the Total Body Surface Area (TBSA) affected by the burns.
Entire anterior trunk (18%) + entire right arm (9%) + anterior right leg (9%) = 36% TBSA.
The Rule of Nines is required to accurately estimate burn surface area for fluid calculation.
2
Calculate the total 24-hour fluid requirement using the traditional Parkland formula.
4 mL×90 kg×36=12,960 mL4 \text{ mL} \times 90 \text{ kg} \times 36 = 12,960 \text{ mL}.
The Parkland formula dictates the total volume of lactated Ringer solution needed in the first 24 hours post-injury.
3
Determine the fluid requirement for the first 8 hours.
12,960 mL÷2=6,480 mL12,960 \text{ mL} \div 2 = 6,480 \text{ mL}.
Standard burn resuscitation guidelines state that half of the total 24-hour volume must be given in the first 8 hours from the time of injury.
4
Calculate the remaining volume to be administered.
6,480 mL−480 mL=6,000 mL6,480 \text{ mL} - 480 \text{ mL} = 6,000 \text{ mL}.
Fluids given by EMS en route must be deducted from the total 8-hour requirement.
5
Calculate the required infusion rate for the remaining time.
6,000 mL÷6 hours=1000 mL/hr6,000 \text{ mL} \div 6 \text{ hours} = 1000 \text{ mL/hr}.
The 8-hour window begins at the time of injury. Since 2 hours have elapsed, there are 6 hours left to infuse the remaining 6,000 mL.

Key Concept

Burn fluid resuscitation requires accurate TBSA estimation using the Rule of Nines, application of the appropriate formula, and adjustment of the infusion rate based on the time elapsed since the injury and any pre-hospital fluids already administered.
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Topics

Trauma and Burns

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