The Parkland formula, also known as the Baxter formula, is a burn formula used to calculate the amount of fluid needed for burn patients during the first 24 hours after injury. It was developed by Charles R. Baxter and is considered a well-established protocol for initial fluid resuscitation.
The formula is: 4 mL/kg per %TBSA burn of lactated Ringer's (LR) for the first 24 hours. This means that for every 1% of body surface area burned, you multiply the patient's weight in kilograms by 4 and administer that amount of LR solution over the first 24 hours.
For example, a 70 kg adult with a 20% TBSA burn would require 5600 mL of LR solution in the first 24 hours (70 kg x 4 mL/kg x 20% = 5600 mL).
Here is a breakdown of how to use the formula:
- Step 1: Calculate the total body surface area (TBSA) burned. This can be done using a burn chart or other assessment tools.
- Step 2: Multiply the TBSA by 4 mL/kg. This gives you the total fluid volume needed in mL per kilogram of body weight.
- Step 3: Multiply the result from Step 2 by the patient's weight in kilograms. This gives you the total fluid volume needed in mL.
- Step 4: Administer half of the total fluid volume calculated in Step 3 in the first 8 hours after the burn.
- Step 5: Administer the remaining half of the total fluid volume over the next 16 hours.
The Parkland formula is widely used, but it is important to note that it is just an estimation. Individual patients may require more or less fluid depending on factors such as their age, overall health, and the severity of the burn.
Practical Insights:
- It is crucial to monitor patients closely and adjust fluid administration based on clinical parameters like urine output, heart rate, blood pressure, and capillary refill.
- The Parkland formula is primarily for initial resuscitation and may need to be modified for longer-term fluid management.
- Other factors, like the presence of inhalation injuries, can significantly impact fluid requirements.
- The formula is not applicable to all burns, as it is intended for burns greater than 10% TBSA in children and the elderly, and greater than 20% TBSA in adults.
