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    Parkland Formula for Burns

    Calculates fluid requirements for burn patients in a 24-hour period.
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    INSTRUCTIONS

    Use in adult patients with burns. Children have larger TBSA relative to weight and may require larger fluid volumes.
    When to Use
    Pearls/Pitfalls
    Why Use

    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.
    lbs
    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.
    %
    About the Creator
    Dr. Charles R. Baxter
    Content Contributors
    • David Zodda, MD

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    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.

    Management

    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.

    Critical Actions

    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

    Formula

    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.

    Estimation:

    • 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:

    wallace rule of nines

    Evidence Appraisal

    Resuscitation Formula:

    • The Parkland Formula is a validated and effective approach to initial fluid resuscitation in the acutely burned patient (Baxter 1974, Cartotto 2002, Blumetti 2008).
    • It was developed by Dr Charles Baxter at Parkland Memorial Hospital in Dallas, Texas.

    Literature

    Dr. Charles R. Baxter

    About the Creator

    Charles R. Baxter, MD, (d. 2005) was the director of the emergency department at Parkland Memorial Hospital in Dallas, Texas.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

    Content Contributors
    • David Zodda, MD