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C3AP1 e Emma Brown 04/03/
PLASTICS
MODIFIED PARKLAND FORMULA
Fluid Loss One of the major complications associated with severe burns is fluid loss, so fluid resuscitation is essential. The amount of resuscitation fluid needed in the first 24 hours after the burn injury is based on the TBSA and the person's body weight. Calculations There are several formulae to calculate fluid requirements; the most commonly used in the UK, based on percentage-burn is the Parkland formula. Half of the fluid needed is infused intravenously over the first 8 hours after the burn injury, and the second half is given over the next 16 hours. Children Children may need additional intravenous background (maintenance) fluids, which also needs to be calculated.
C3AP1 e Emma Brown 04/03/ Requirements? Required in adult > 15%, children >10%. Burn injuries of less than 1 0% are associated with minimal fluid shifts and can generally be resuscitated with oral hydration, except in cases of facial, hand and genital burns, as well as burns in children and the elderly. As the total body surface area (TBSA) involved in the burn approaches 15– 20 %, the systemic inflammatory response syndrome is initiated and massive fluid shifts, which result in burn oedema and burn shock, can be expected. Despite the vast array of experience, there are still controversies regarding the best type of fluid management in major burns in the first 24 hours after injury. Modified Parklands Formula (original Parkland’s formula included colloids)
Adults–4mL/kg/%TBSA
Children – 3 - 4mL/kg/% TBSA ● give 1/2 in first 8h since the time of injury ● give 1/2 in next 16h ● + maintenance fluid for children <30 kg ● aim for urine output of 0.5mL/kg/hr (1ml/kg/hr in children) and normal cardiovascular parameters (HR, BP) ● then albumin after first 24 hours (keep albumin > 20) ● more fluid is typically required if: inhalational injury, electrical burns or delayed resuscitation ● permissive hypovolaemia with non-invasive haemodynamic monitoring is a promising approach ● test for myoglobinuria - > if +ve then rhabdomyolysis is present: Consider ( 1 ) alkalinise urine with 25mmol of HCO3- for each litre of Hartmanns ( 2 ) promote diuresis with 12.5g mannitol to each litre of Hartmanns
