A 35-year-old man weighing 70 \text{ kg} is brought to the emergency department 2 \text{ h… — USMLE Step 2 CK

A $35$ -year-old man weighing $70 \text{ kg}$ is brought to the emergency department $2 \text{ hours}$ after being rescued from a structural fire. On examination, he is hemodynamically stable, and his airway is secure with no evidence of inhalational injury. He has sustained deep partial-thickness and full-thickness burns involving his anterior chest, anterior abdomen, entire right arm, and the anterior aspect of his left leg. The remainder of his skin is intact. Intravenous access is obtained. According to current Advanced Trauma Life Support (ATLS) guidelines for adult thermal burns, what should be the initial rate of intravenous lactated Ringer solution administration for this patient? (Enter the value in $\text{mL/hr}$ )

Cevap: 420 mL/hr

Cevap

420

The correct initial fluid resuscitation rate is

420 \text{ mL/hr}

. According to the Advanced Trauma Life Support (ATLS) 10th edition guidelines, adult patients with thermal burns should be resuscitated using

2 \text{ mL}

of lactated Ringer solution per kilogram of body weight per percent of affected Total Body Surface Area (TBSA). First, the Rule of Nines is applied: the anterior chest (

9\%

), anterior abdomen (

9\%

), entire right arm (

9\%

), and anterior left leg (

9\%

) yield a

36\%

TBSA burn. The total 24-hour fluid requirement is

2 \text{ mL} \times 70 \text{ kg} \times 36 = 5,040 \text{ mL}

. Half of this volume (

2,520 \text{ mL}

) must be administered within the first

8 \text{ hours}

from the time of the burn. Because the patient presented

2 \text{ hours}

after the injury, the

2,520 \text{ mL}

must be infused over the remaining

6 \text{ hours}

, resulting in a rate of

2,520 \text{ mL} \div 6 \text{ hours} = 420 \text{ mL/hr}

Adım Adım Çözüm

Calculate the burned Total Body Surface Area (TBSA).

36\%

Using the Rule of Nines, the anterior chest is

9\%

, anterior abdomen is

9\%

, entire right arm is

9\%

, and anterior left leg is

9\%

Calculate the total 24-hour fluid requirement using the ATLS 10th edition formula.

5,040 \text{ mL}

The current guideline for adult thermal burns is

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

. Therefore,

2 \times 70 \times 36 = 5,040 \text{ mL}

Determine the fluid volume required for the first 8-hour block.

2,520 \text{ mL}

Half of the total 24-hour calculated volume is given in the first

8 \text{ hours}

post-injury.

Adjust the infusion time based on the delayed presentation.

6 \text{ hours}

The 8-hour block begins at the time of injury. Since

2 \text{ hours}

have already elapsed, the

2,520 \text{ mL}

must be infused over the remaining

6 \text{ hours}

Calculate the required hourly infusion rate.

420 \text{ mL/hr}

2,520 \text{ mL}

divided by

6 \text{ hours}

equals

420 \text{ mL/hr}

Anahtar Kavram

Management of acute burn fluid resuscitation involves applying the Rule of Nines, utilizing the updated ATLS guidelines (

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

for adult thermal burns), and dynamically adjusting the infusion rate for the time elapsed since the injury.

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