Page 403 - ATP-P 11th Ed

2. Moderate:
a. partial thickness: 15%–25% BSA in adults, 10%-20% BSA in children
b. full thickness: 2%–10% BSA
3. Major:
a. partial thickness: >25% BSA in adults, >20% BSA in children
b. full thickness: >10% BSA
c. burns of hands, face, eyes, ears, feet or perineum
d. associated injuries, such as inhalation injury, fractures, other trauma
e. poor risk patients with underlying disease or suspicion of child abuse

(http://understandingburncare.org/burn-severity.html)
Modified Brooke formula for adults: 2mL/kg/%TBSA. Plan to give ½ of the estimated
fluid in the first 8hr.
In children weighing less than 30kg the infusion rate is estimated at 3mL/kg/≥%TBSA.
Plan to give ½ of the estimated fluid over the first 8hr. Children will also need maintenance
fluids of 5% dextrose in ½ normal saline. This should be given using a rule such as the
4-2-1 rule: 4mL/kg/hr for the first 10kg, 2mL/kg/hr for the next 10kg, and 1mL/kg/hr for
the next 10 kg. If a patient’s resuscitation has been delayed by a few hours, then give fluid
more rapidly.
Adjust the initial fluid infusion rate to the urine output. Failure to monitor and record the
urine output (catheter or bedpan) and adjust the fluid rate hourly may result in death or
severe complications. Adequate urine output is 30–50mL/hr in an adult and 1mL/kg/hr
in a child who weighs less than 30kg. If the output is greater, or less than, the target for 2
consecutive hours, decrease, or increase, the IV rate by 20% respectively until the rate is
satisfactory.
(Special Operations Forces Medical Handbook, 2nd Edition)
Rule of 10 for Fluid Resuscitation of Burn Victims
1. Initial rate is 10mL per %TBSA per hour for a maximum casualty weight of 80kg.
2. Add 100mL/hr to the rate for each 10kg above 80kg. SECTION 5
3. Example: A 90kg casualty with 50% TBSA burn would receive an initial rate of
(10mL × 50)/hr + 100mL/hr or 600mL/hr.

ATP-P Handbook 11th Edition 393