A 32-year-old male is brought to the emergency department after being rescued from a struc… — USMLE Step 2 CK

A 32-year-old male is brought to the emergency department after being rescued from a structure fire. He sustained deep partial-thickness and full-thickness thermal burns involving his entire anterior chest and abdomen, his entire right lower extremity, and his entire right upper extremity. The patient currently weighs $80\text{ kg}$ . The injury occurred exactly $2\text{ hours}$ prior to his arrival at the emergency department. Two large-bore peripheral intravenous lines are placed. Following current Advanced Trauma Life Support (ATLS) guidelines for adult thermal burns (which recommend $2\text{ mL/kg/\%TBSA}$ ), what should be the initial continuous intravenous infusion rate of lactated Ringer solution in $\text{mL/hr}$ ?

Cevap: 600 mL/hr

Cevap

600

The patient requires an initial fluid infusion rate of

600\text{ mL/hr}

. According to the Rule of Nines, the TBSA burned is

45\%

(anterior trunk

18\%

+ right leg

18\%

+ right arm

9\%

). Using the current ATLS recommendation for adult thermal burns (

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

), the total 24-hour fluid requirement is

2 \times 80 \times 45 = 7200\text{ mL}

. Half of this volume (

3600\text{ mL}

) must be administered within the first 8 hours post-injury. Because 2 hours have already elapsed since the burn occurred, the

3600\text{ mL}

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

600\text{ mL/hr}

Adım Adım Çözüm

Calculate the Total Body Surface Area (TBSA) involved using the Rule of Nines.

Anterior chest and abdomen (18%) + right lower extremity (18%) + right upper extremity (9%) = 45% TBSA.

Accurate estimation of the burn area is required to calculate the fluid resuscitation volume.

Calculate the total 24-hour fluid requirement.

2 \text{ mL} \times 80 \text{ kg} \times 45\% = 7200 \text{ mL}

Current ATLS guidelines recommend 2 mL/kg/%TBSA for adult thermal burns to prevent over-resuscitation and subsequent compartment syndromes.

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

7200 \text{ mL} / 2 = 3600 \text{ mL}

Standard burn resuscitation protocols require half of the total calculated 24-hour volume to be administered in the first 8 hours.

Calculate the hourly infusion rate based on the time elapsed since the injury.

8 hours - 2 hours delay = 6 hours remaining.

3600 \text{ mL} / 6 \text{ hours} = 600 \text{ mL/hr}

The 8-hour window begins at the time of injury, not at the time of arrival. Fluid must be given over the remaining hours.

Anahtar Kavram

Burn resuscitation fluid calculation using the ATLS modified formula (2 mL/kg/%TBSA) and adjusting the hourly rate based on the time elapsed since the injury.

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Cevap

Adım Adım Çözüm

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