Parkland Formula for Burns
Rule of 9's for Children: 9% for each arm, 14% for each leg, 18% for head, 18% for front torso, 18% for back torso.
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It is important to remember that all resuscitation formulas be used as a guide. Patients should be assessed frequently, with individual adjustments made to maintain adequate organ perfusion.
Resuscitation endpoints and monitoring:
- Urine output: 0.5 mL/kg/hr urine output in adults (50-100cc/hr) and 0.5–1.0 mL/kg/hr in children <30 kg.
- Heart rate: HR<110 in adults usually indicates adequate volume. Narrowed pulse pressure provides an earlier indication of shock than does systolic blood pressure alone.
- Monitoring blood pressure by arterial catheter is superior to cuff pressures because of interference of tissue edema. Radial artery is the first choice, followed by femoral artery.
- Serum lactate is a strong predictor of mortality, and trends can be utilized to determine hemostatic status however, it should not be used as an independent predictor of adequate fluid resuscitation.
Critically ill burn patients are best cared for at a dedicated burn center, particularly those with any of the following:
- >10% TBSA partial thickness burns
- Any size full-thickness burn
- Burns to hands or genitals
- Inhalation injury
- Serious chemical injury
- Serious electrical injuries, including lightning
- David Zodda, MD