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What is the rule of nines and Parkland formula?

Published in Burn Calculations 2 mins read

The Rule of Nines and the Parkland formula are essential tools used in burn care to estimate the extent of burns and calculate fluid resuscitation needs.

Rule of Nines

The Rule of Nines is a quick method to estimate the Total Body Surface Area (TBSA) affected by burns in adults. It assigns percentage values to different body regions, typically multiples of nine. This method is not as accurate for children, whose body proportions differ considerably from adults.

  • Head and Neck: 9%
  • Anterior Trunk: 18%
  • Posterior Trunk: 18%
  • Each Upper Extremity (Arm): 9%
  • Each Lower Extremity (Leg): 18%
  • Perineum: 1%

Parkland Formula

The Parkland formula is used to calculate the amount of intravenous (IV) fluid needed for burn patients during the first 24 hours after the burn injury. This formula is critical for preventing hypovolemic shock and ensuring adequate tissue perfusion.

The standard Parkland formula is:

4 mL x % TBSA x patient’s weight (kg) = total fluid in 24 hours

  • First Half: The first half of this total fluid volume needs to be administered within the first 8 hours from the burn injury, as outlined in the reference provided by the Youtube video: "And then half of this amount would need to be administered over the first 8 Hours from the burn injury."
  • Second Half: The remaining half of the calculated fluid volume should be administered over the next 16 hours, as outlined in the reference: "And then the remaining half should be administered over the next 16."

Example

Let's say a 70kg patient has a 40% TBSA burn.

  1. Calculate Total Fluid: 4 mL x 40 x 70 kg = 11,200 mL total fluid in 24 hours
  2. First 8 Hours: 11,200 mL / 2 = 5,600 mL. Therefore, 5,600 mL needs to be administered within the first 8 hours.
  3. Next 16 Hours: The remaining 5,600 mL should be administered over the next 16 hours.

Important Considerations

  • The Parkland formula provides an initial estimate of fluid needs.
  • Actual fluid resuscitation is adjusted based on the patient's response, urine output, vital signs, and overall condition.
  • These calculations are a guide, and continuous monitoring and assessment are essential.
  • Electrolyte balance, especially sodium, also needs to be monitored and corrected.

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