Page 261 - 2023 SMOG Digital

BURN Fluid Resuscitation

Rules of 9 - Burn % Estimation Chart Escharotomy-
Dashed line- preferred
incision lines.
Bold lines- indicate
importance of
extending the incision
over involved major
joints.

ADULTS INFANTS CHILD
Rule of Tens – Fluid Resuscitation Calculations
TBSA >20%, may require acute fluid resuscitation in prehospital
LR(best)>NS(2 best)>Hextend(only to 1L)
nd
Adults (>40kg) - 10mL/hr x %TBSA (estimate to nearest 10%); patients weighing more than 80kg, add 100mL/hr to IV fluid
rate for each 10kg >80kg. Re-evaluate every 1-2 hours. Adjust IV rate to UOP goal 30-50mL (0.5-1mL/kg in Peds). Adjust IV
rate up or down by 20-25%.
Pediatrics (<40kg) - 3 x %TBSA x body weight (kg) gives the volume for initial 24 hours. One half is given in first 8 hours.
Monitor urine output with goal of 0.5 to 1 mL/kg/hr in children.
Example: Pediatric 30kg patient with 50% TBSA 2 nd /3 rd degree (Chemical or Thermal burn ) 3mL LR x 50(%TBSA) x 30(kg) =
4,500mL LR in 1 st 24hr
2,250mL (½ of 4,500) is given over 1 st 8hr
2,250mL/8hr = 281mL/hr for 1 st hr, then titrate by 20-25% to UOP goal
High Voltage Injury: ADULT (>40kg) - 10mL/hr x %TBSA (estimate to nearest 10%); patients weighing more than 80kg, add
100mL/hr to IV fluid rate for each 10kg >80kg. Re-evaluate q1-2hr. Adjust IV rate to UOP goal 75-100mL (1-2mL/kg in Peds).
Adjust IV rate up or down by 20-25%.
Pearls: Both under-resuscitation and over-resuscitation with fluids can precipitate significant adverse clinical events for
the burn patient. Thus, it is both worthwhile and imperative that medical aircrew calculate and administer burn
resuscitation fluids as accurately and fastidiously as possible. Put another way, it is worth your time and effort to
accurately estimate burn surface area, ideal body weight, then calculate and administer appropriate fluids while the
patient is under your care.
• Burns with airway involvement require immediate airway protection with Endotracheal Intubation / surgical airway.
• Burns covering >40% TBSA, will likely require RSI due to airway edema from inflammation/fluid resuscitation.
• Infants and Young Children should also receive LR with 5% Dextrose at a maintenance rate and monitor for
hypoglycemia.
• Burn patients are prone to hypothermia–must protect from environment. Also, never use ice to cool large burn areas.
• All burns require 100% O 2 via NRB unless intubated.
• Never use nitrites for suspected cyanide toxicity in enclosed space fires – can worsen hypoxia. Creates
methemoglobinemia. If cyanide toxicity is a tangible threat, consider IV Hydroxycobalmin (CYANOKIT®)

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