Calculating Total Body Surface Area Burned and Fluid Resuscitation Using the Parkland Formula

QUESTION

You are receiving bedside shift report from the dayshift nurse on a burn unit. The nurse tells you that the patient have both of his arms burned, all of this anterior trunk burned and groin, all of anterior legs burned, and no burns on his face and neck, posterior trunk, or posterior legs. What % total body surface area is burned? The patient weighs 185lbs. Using the Parkland Formula, how much fluid resuscitation would you expect to give to the patient?

ANSWER

Calculating Total Body Surface Area Burned and Fluid Resuscitation Using the Parkland Formula

Introduction

Assessing the extent of burn injuries and determining the appropriate fluid resuscitation is crucial in the care of burn patients. In this essay, we will calculate the total body surface area (TBSA) burned and use the Parkland Formula to estimate the required fluid resuscitation for a patient with burns on specific body regions.

Total Body Surface Area Burned Calculation

To calculate the TBSA burned, the Rule of Nines is commonly used, which assigns percentages to different body regions. Based on the information provided:

Both arms (9% each) = 18%
Anterior trunk (18%)
Groin (1%)
Both anterior legs (18% each) = 36%

No burns on:
Face and neck (0%)
Posterior trunk (18%)
Posterior legs (18%)

Now, add the percentages of the affected areas:

18% (anterior trunk) + 1% (groin) + 36% (both anterior legs) = 55%

Therefore, the TBSA burned for this patient is 55%.

Fluid Resuscitation Using the Parkland Formula

The Parkland Formula is commonly used to estimate the fluid resuscitation needs for burn patients within the first 24 hours. The formula is as follows:

4 mL of Lactated Ringer’s solution × TBSA burned (%) × patient’s weight (in kg)

Given that the patient weighs 185 lbs, we need to convert this weight to kilograms. To do this, divide the weight in pounds by 2.205 (since 1 kg = 2.205 lbs):

185 lbs ÷ 2.205 = approximately 83.97 kg (rounded to 84 kg)

Now, plug in the values into the Parkland Formula:

4 mL × 55% (TBSA burned) × 84 kg = 18,480 mL

So, the estimated fluid resuscitation for this patient in the first 24 hours would be 18,480 mL, or approximately 18.5 liters of Lactated Ringer’s solution.

Conclusion

Calculating the TBSA burned and estimating fluid resuscitation using the Parkland Formula are critical steps in managing burn patients effectively. In this case, we determined that the TBSA burned is 55%, and the estimated fluid resuscitation for the patient would be approximately 18.5 liters of Lactated Ringer’s solution within the first 24 hours. Accurate assessment and resuscitation are essential to prevent complications and support the patient’s recovery in the challenging context of burn injuries.