Parkland Formula for Burns
Patients with acute burns.
- The Parkland Formula is a validated and effective approach to initial fluid resuscitation in the acutely burned patient.
- Overly aggressive fluid resuscitation, termed “fluid creep”, is well documented in critical care literature. Factors that may lead to fluid creep include lack of physician observation of endpoints (i.e. urine output), increased opioid use and the emergency nature of goal-directed resuscitation.
- Patients with inhalational and electrical burns, as well as children and the elderly, may require more or less fluid resuscitation than is predicted by the formula.
- The Parkland Formula has been endorsed by the American Burn Association.
- It has been shown to appropriately restore intravascular volume and limit the development of hypovolemic shock.
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
Fluid Requirements = TBSA burned(%) x Wt (kg) x 4mL
Give 1/2 of total requirements in 1st 8 hours, then give 2nd half over next 16 hours.
Facts & Figures
Administration of fluids:
- Give 1/2 of total requirements in 1st 8 hours (time from when the burn occurred), then give 2nd half over next 16 hours.
- Rule of 9's for Adults: 9% for each arm, 18% for each leg, 9% for head,18% for front torso, 18% for back torso.
- 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.
Wallace Rule of Nines:
Original/Primary ReferenceBaxter CR. Fluid volume and electrolyte changes in the early post-burn period. Clin Plast Surg 1974;1:693–703.
ValidationCartotto RC, et. al. How Well Does The Parkland Formula Estimate Actual Fluid Resuscitation Volumes? Journal of Burn Care & Rehabilitation. 2002. Volume 23, Number 4. DOI: 10.1097/01.BCR.0000020449.78548.E0.
Other ReferencesBlumetti J, et. al. The Parkland Formula Under Fire: Is the Criticism Justified? J Burn Care Res. 2008 Jan-Feb;29(1):180-6.American Burn Association Guideline. Available at: http://www.ameriburn.org.Ahrns KS. Trends in burn resuscitation: Shifting the focus from fluids to adequate endpoint monitoring, edema control, and adjuvant therapies. Crit Care Nurs Clin N Am 2004; 16:75–98Ahrns KS, Harkins DR. Initial resuscitation after burn injury: Therapies, strategies, and controversies. AACN Clin Issue 1999; 10:46–60Jeng JC, Jablonski K, Bridgeman A, et al. Serum lactate, not base deficit, rapidly predicts survival after major burns. Burns 2002; 28:161–166
About the Creator
Charles R. Baxter, MD, (d. 2005) was the director of the emergency department at Parkland Memorial Hospital in Dallas, Texas. He founded the Parkland Hospital Burn Unit and was an active researcher, making advances in the treatment of burn victims and trauma procedures. Dr. Baxter was also one of the physicians who unsuccessfully tried to save John F. Kennedy after he was shot in 1963.
To view Dr. Charles R. Baxter's publications, visit PubMed
- David Zodda, MD