A 45 year old male comes into the resuscitation bay after being found in a house fire. His arms and chest have a leathery gray appearance with patchy red areas and blistering. You recall that burn patients need large volume fluid resuscitations…
How do we calculate the TBSA (total body surface area) affected?
Rule of 9s!
For adults:
Head = 9%
Front Torso = 18%
Back Torso = 18%
Left Upper Extremity = 9%
Right Upper Extremity 9%
Left Lower Extremity = 18%
Right Lower Extremity = 18%
Perineum = 1%
(18 x 4) + (9 x 3) + 1 = 100%
*Does anybody else do this additional calculation every time they use the rule of 9s to make sure they get 100% of the body?*
Note that for children, the surface area of their head comprises a larger percentage of body surface area when compared to an adult, so the rule of 9s needs to be adjusted.
Remember: do NOT include first degree burns in TBSA percentage calculations.
Now what? Calculate the estimate volume of fluid resuscitation required for a burn patient in the next 24 hours with The Parkland Formula = 4 mL x %TBSA x weight (kg).
**Use the % TBSA and not a fraction, e.g. 4mL x 36% x 70kg = 10,080 mL**
Plug in those numbers! Also available at https://www.mdcalc.com/parkland-formula-burns
Give the first half of the total volume calculated in the first 8 hours and the remaining volume over the following 16 hours.
This is an estimation of the volume of fluid resuscitation, so titrate the volume of resuscitation with patient response! Goal is to keep urine output at 0.5mL/kg/hr for adults and 0.5-1mL/kg/hr for children <30kg.
Check out this amazing pdf: http://ameriburn.org/wp-content/uploads/2017/05/burncenterreferralcriteria.pdf
Want to read more?
http://www.emdocs.net/modern-day-burn-resuscitation-moving-beyond-parkland-formula/
https://www.uptodate.com/contents/emergency-care-of-moderate-and-severe-thermal-burns-in-adults