Chapter 23

### Chapter 23. Burns

A 45-year-old female presents to the hospital after falling into a fire and suffering 2nd-degree burns to her right hand and entire arm. What is the percent of TBSA burned for this patient?

A. 20%

B. 10

C. 5%

D. 15%

According to the rule of nines, an upper extremity is 9% TBSA. Also, the patient’s hand is considered 1% of TBSA.

A 76-year-old male who weighs 80 kg suffered a 25% TBSA 2nd-degree scald burn when a large pot of boiling water spilled onto his torso and lower extremities. He was immediately transferred to the hospital. He has been given 200 mL of lactated Ringer thus far. What is the amount of fluid needed to resuscitate this patient in the first 8 hours?

A. 5000 mL

B. 4300 mL

C. 3800 mL

D. 3500 mL

The Parkland formula for burn patient fluid resuscitation is: total volume 4 mL/kg/%TBSA, which should be given in the first 24 hours after a burn. Half of this volume should be given in the first 8 hours after the burn injury, which includes prehospital/preadmission time. The remainder is given in the remaining 16 hours. Thus, this 80-kg patient with 25% TBSA 2nd-degree burn should receive a total of 8000 mL of volume in the first 24 hours and 4000 mL in the first 8 hours. He received 200 mL by prehospital personnel, and should receive 3800 mL for a total 4000 mL in the first 8 hours.

A 16-year-old female is admitted to the hospital after suffering a 36% 2nd- and 3rd-degree burns to the face and torso after being involved in a house fire. She is intubated. On the 2nd day of hospitalization, her morning arterial blood gas shows a metabolic acidosis. What is most likely the cause of her lab abnormality?

A. Respiratory rate of 14

B. Silver nitrate