A 50-year-old man is brought to the emergency department via ambulance exactly 2 hours aft… — USMLE Step 2 CK

A 50-year-old man is brought to the emergency department via ambulance exactly 2 hours after being caught in a large brush fire. His estimated weight is $75 \text{ kg}$ . On physical examination, the patient is awake and speaking in full sentences without hoarseness. Airway is patent. He has deep partial-thickness and full-thickness burns involving his entire anterior trunk, his entire right arm, and the anterior surface of his left leg. The remainder of his body surface is unaffected. A large-bore peripheral intravenous line is established. Based on the most current Advanced Trauma Life Support (ATLS) guidelines for adult thermal burns, what is the target intravenous fluid administration rate for the remainder of the first 8 hours post-injury?

Cevap: 450 mL/hr

Cevap

450

Based on the ATLS 10th edition update, the initial fluid resuscitation for adults with thermal burns is calculated using

2 \text{ mL} \times \text{weight (kg)} \times \text{\%TBSA}

. For a

75 \text{ kg}

man with

36\%

TBSA burns, this equals

5400 \text{ mL}

for the first 24 hours. Half of this volume (

2700 \text{ mL}

) must be given in the first 8 hours after the burn occurred. Because the patient arrived 2 hours post-injury, this

2700 \text{ mL}

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

450 \text{ mL/hr}

Adım Adım Çözüm

Calculate the total percentage of burned surface area (%TBSA).

Anterior trunk = 18%, Entire right arm = 9%, Anterior left leg = 9%. Total = 18% + 9% + 9% = 36% TBSA.

The Rule of Nines dictates the body is divided into areas representing 9% (or multiples of 9%) to estimate burn extent.

Calculate the total fluid requirement for the first 24 hours.

2 \text{ mL} \times 75 \text{ kg} \times 36 = 5400 \text{ mL}

total.

Current ATLS guidelines recommend

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

for adult thermal burns to minimize the risk of over-resuscitation and compartment syndrome.

Determine the fluid volume required for the first 8 hours.

5400 \text{ mL} / 2 = 2700 \text{ mL}

Half of the total 24-hour fluid requirement must be given within the first 8 hours from the time of injury.

Calculate the remaining time for the first 8-hour window.

8 \text{ hours} - 2 \text{ hours elapsed} = 6 \text{ hours remaining}

The 8-hour window begins at the time of the injury, not the time of arrival at the hospital.

Determine the hourly intravenous fluid rate.

2700 \text{ mL} / 6 \text{ hours} = 450 \text{ mL/hr}

This steady rate ensures the patient receives the target 2700 mL over the correct physiological timeframe.

Anahtar Kavram

Fluid resuscitation in adult thermal burns (ATLS 10th Edition guidelines)

Tahmini Süre:1m 30s

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