[Sal_B]

Help please -

OK... I am working on my education here and focusing on treating burn victims... If I understand correctly the Parkland Formula is used to calculate flow rate...

4cc x Kg x BSA
1/2 over 1st 8 hours
1/2 over last 16 hours

I keep botching these calculations on tests where I am required to calculate manually. I think I am getting mixed up on the half 8 - half 16 split. Would someone please post a sample calculation -- and slip me an aspirin while you're at it! Thanks in advance.

[Conrad283]

ASA 81mg given 8:30pm ... AC

Pretty simple ... Just remember that half of the total amount is given in the first 8 hours from when the burn initially happened (pt burned at 0800, but gets to the ER 1 hour later, he'll get 8000cc's in 7 hours) and then the rest is over the next 16hrs to make a total of 24hrs.

Pt burned on 50% of body ...
Pt weighs 80kg

4cc/kg/hr = 4 x 50 x 80 = 16000cc total needed to be given

8000cc's given in the first 8hrs and ...
8000cc's given over the following 16hrs ...

[RNREMT-P]

Originally Posted by Sal_B

Help please -

OK... I am working on my education here and focusing on treating burn victims... If I understand correctly the Parkland Formula is used to calculate flow rate...

4cc x Kg x BSA
1/2 over 1st 8 hours
1/2 over last 16 hours

I keep botching these calculations on tests where I am required to calculate manually. I think I am getting mixed up on the half 8 - half 16 split. Would someone please post a sample calculation -- and slip me an aspirin while you're at it! Thanks in advance.

you have an 80kg patient with 40% bsa involved.
That's a total of 12.8L (4x80x40).
you're going to give 6.4L in the 1st 8 hours and 6.4L over the last 16 (which translates to exactly 1/2 the flow rate; e.g. 800mL/hr for the 1st 8 and 400mL/hr for the remainder of the 24 hours).
For prehospital personnel, we worked with our medical director to figure out a "PreHospital Parkland" that was more usable. We decided on .25cc x kg x bsa = minimum amount of fluid to have in upon arrival at the ER. so for the example above...shoot towards at least 800cc infused by arrival time. This was based on the golden hour of trauma and the platinum 10 minutes, thinking urban settings and no longer than 30 minutes from occurence to ER. Of course you'd modify it for a rural setting.
We used to fly patients to a regional burn center fairly often and the first time I delivered a patient with the Parkland all figured out, the receiving nurse told me that was an archaic formula for volume replacement and a more accurate measurement was based on the BMI.
I'd be real interested to hear any ER/burn ICU nurses opinions about this. It's "sparked" a few debates before.

[chare]

There is one major problem many people have calculating fluid replacement with the Parkland Formula. The volume to be infused is calculated from the time of the burn, not the time of arrival at your facility. When you receive the patient you need to calculate how much fluid they have received prior to arrival and adjust the infusion rate accordingly.

For example, the patient in Conrad’s scenario arrives at your facility 2 hours post burn and IV fluid has been infusing 250 mL/hour. To correct this, subtract the 500 mL infused from the 8000 mL calculated, then divide the 7500 mL by the remaining 6 hours.

RNREMT-P, how exactly were they calculating infusion rate using BMI. I’m having a hard time grasping this since BMI is a height/weight ratio. I could easily understand how it would be more accurate if they were using BSA as compared to weight. I did a quick google search and could not find any reference to using BMI to calculate fluid replacement. I did find a few articles at emedicine.com which referenced the Galveston Formula, which BSA was used rather than weight, however the articles stated this was used primarily for pediatric patients who didn’t quite fit the rule of nines.

[gradcare]

Of course that all hinges on the estimation of burned area being correct. Have left burns behind me now but started seeing goal directed fluid strategies with the goal being urine output of approx 1 to 1.5 ml/kg/min with parkland being a starting point. If u/o drops increase the rate... That said I left that area about 18 months ago so much may have changed.

[MORLEIGHRN]

I agree with everything that was said above. In my experience the Parkland Formula is the starting point and it depends on the doc and the condition of the patient where you go from there. I can say that almost 80 percent of the time the Parkland is followed for the first eight hours and then our doc has us keep the output over 30cc per hour. We do keep to the 30cc on the hour very closely and the rate of the fluids is titrated accordingly. We also have done some studies where we infuse Vitamin C for the first 24 hours (it is a pain by the way) and they start on the Parkland but it is adjusted differently this way also. Dont know if that helps, but if you get the opportunity to see a critical burn patient all of this will make a lot more sense. It is hard to imagine why and how, but seeing it helps.