The Cincinnati burn formula, specifically the Shriners-Cincinnati formula, provides guidelines for fluid resuscitation in burn patients, adjusting protocols based on age. For older children, the formula is:
Shriners-Cincinnati Burn Formula (Older Children)
Initial Resuscitation Fluid Calculation:
The primary fluid used for resuscitation is lactated Ringer's solution (LR). The formula is:
- 4 mL/kg/%burn + 1,500 mL/m² TBSA (Total Body Surface Area)
Where:
- mL represents milliliters of fluid.
- kg represents the patient's weight in kilograms.
- %burn represents the percentage of total body surface area affected by the burn.
- m² TBSA represents the patient's total body surface area in square meters.
Fluid Administration Schedule
The calculated total volume of fluid needs to be administered over 24 hours:
- First 8 Hours: Administer half of the calculated total volume.
- Next 16 Hours: Administer the remaining half of the calculated total volume.
Example Scenario:
Let's say an older child weighing 40 kg has a 30% total body surface area (TBSA) burn, and a TBSA of 1.3 m².
- Calculate the fluid for %burn: 4 mL/kg/%burn = 4 mL 40 kg 30% = 4800 mL.
- Calculate the fluid for TBSA: 1,500 mL/m² TBSA = 1500 mL * 1.3 m² = 1950 mL
- Calculate the Total Fluid Volume: 4800 mL + 1950 mL = 6750 mL.
- Administration:
- First 8 Hours: 6750 mL / 2 = 3375 mL
- Next 16 Hours: 6750 mL / 2 = 3375 mL
This means that 3375 mL of Lactated Ringers solution would be administered over the first 8 hours, followed by the remaining 3375 mL over the next 16 hours.
Important Notes:
- This formula is specifically designed for older children. Different protocols exist for younger children and infants.
- This formula should be used as a guideline, and healthcare providers should adjust fluid administration based on individual patient response and clinical evaluation.
- The formula is a starting point for fluid resuscitation and does not address the maintenance fluid needs.
- It is important to monitor vital signs and urine output to gauge the effectiveness of the fluid administration.
