Parkland Formula for Burn Fluid Management
Additional parameters for fluid management include urine output & systemic blood pressure. The 24 hour formula is: fluids for 24 hours = 4 × kg × % burn (2nd & 3rd added together) with 1st 50% of that total in the first 8 hours and the 2nd 50% over the following 16 hours.
You can estimate the body surface area on an adult that has been burned by using multiples of 9. In an adult who has been burned, the percent of the body involved can be calculated as follows: If both legs (18% x 2 = 36%), the groin (1%) and the front chest and abdomen were burned, this would involve 55% of the body.
The Parkland formula provides an estimate of the additional fluid requirements that a significant burn will require in the first 24 hours. It does not include maintenance fluid requirements.
BSA burned: Affected body surface area. Adult patient (Open Calc) Pediatric patient (Open Calc) Application: 50% over first 8 hrs (from time of burn), crystalloid solution.
The formula recommends 4 milliliters per kilogram of body weight in adults (3 milliliters per kilogram in children) per percentage burn of total body surface area (%TBSA) of crystalloid solution over the first 24 hours of care.
The “rule of palm” is another way to estimate the size of a burn. The palm of the person who is burned (not fingers or wrist area) is about 1% of the body. Use the person’s palm to measure the body surface area burned. It can be hard to estimate the size of a burn.
What are the classifications of burns?
First-degree (superficial) burns. First-degree burns affect only the outer layer of skin, the epidermis. Second-degree (partial thickness) burns. Third-degree (full thickness) burns. Fourth-degree burns.
Burns are now commonly classified as superficial, superficial partial thickness, deep partial thickness and full thickness. A systematic approach to burn care focuses on the six “Cs”: clothing, cooling, cleaning, chemoprophylaxis, covering and comforting (i.e., pain relief).
Hartmann’s (or Lactated Ringer’s) solution is the preferred first-line fluid recommended by the British Burns Association. Its composition and osmolality closely resemble normal bodily physiological fluids and it also contains lactate which may buffer metabolic acidosis in the early post- burn phase.
The Palmer Method of estimating total body surface area (TBSA) is an easy way to get a rough burn size estimate that can be used when calculating a patients fluid resuscitation needs. The patient’s palmar surface including their fingers = 1% TBSA. Courtesy of the American Burn Association.
Doctors group burns into different categories based on how deeply your skin has been harmed. These are called “degrees.” You can have a first-, second-, third-, or fourth-degree burn. The higher the degree, the more severe the burn is. First-degree. These burns only affect the outer layer of your skin.
