Question 1

What is the Parkland formula for burns?

Accepted Answer

The Parkland formula calculates initial fluid resuscitation for burn patients: Total Fluid (mL) = 4 mL × Body Weight (kg) × %TBSA Burned. Give 50% of the total in the first 8 hours from the time of burn, and the remaining 50% over the next 16 hours. Use Lactated Ringer's solution. Only include 2nd and 3rd degree burns in TBSA.

Question 2

How do you calculate the Parkland formula?

Accepted Answer

Multiply 4 mL × patient weight in kg × percent TBSA burned. For example, a 70 kg patient with 30% TBSA burns: 4 × 70 × 30 = 8,400 mL total. Give 4,200 mL in the first 8 hours (525 mL/hr) and 4,200 mL over the next 16 hours (262.5 mL/hr). Time starts from the burn injury, not hospital arrival.

Question 3

What fluid is used in the Parkland formula?

Accepted Answer

Lactated Ringer's (LR) solution is the preferred crystalloid for Parkland formula resuscitation. LR addresses both hypovolemia and sodium deficits. Normal saline should be avoided in large volumes due to the risk of hyperchloremic metabolic acidosis. After 24 hours, fluids typically transition to D5 half-normal saline at maintenance rates.

Question 4

How much fluid does a burn patient need in the first 8 hours?

Accepted Answer

The first 8 hours receive 50% of the total calculated Parkland volume (2 mL/kg/%TBSA equivalent). Time is measured from the moment of burn injury, NOT from hospital arrival. Any fluids given pre-hospital must be subtracted from this 8-hour allocation. The hourly rate equals the 8-hour volume divided by the remaining hours until the 8-hour mark.

Question 5

What is the rule of nines for burn assessment?

Accepted Answer

The Rule of Nines estimates %TBSA burned. In adults: head/neck = 9%, each arm = 9%, anterior trunk = 18%, posterior trunk = 18%, each leg = 18%, perineum = 1%. In children: head = 18%, each arm = 9%, anterior trunk = 18%, posterior trunk = 18%, each leg = 14%, perineum = 1%. Only 2nd and 3rd degree burns are counted.

Question 6

What is the difference between the Parkland and Brooke formula?

Accepted Answer

The Parkland formula uses 4 mL/kg/%TBSA while the Modified Brooke formula uses 2 mL/kg/%TBSA. Both use Lactated Ringer's with the same 50/50 timing split. Studies show no significant clinical outcome differences, but Parkland patients receive 15–28% more total fluid. Recent evidence and ABLS courses recommend starting with 2 mL (Brooke) and titrating upward.

Question 7

What urine output do you target in burn resuscitation?

Accepted Answer

Target urine output is 0.5–1.0 mL/kg/hr (typically 30–50 mL/hr) in adults, 1.0–1.5 mL/kg/hr in children <30 kg, and 0.5 mL/kg/hr in children >30 kg. For electrical burns with rhabdomyolysis, target 1.0 mL/kg/hr. Urine output is the most commonly used endpoint but should not be relied upon in isolation.

Question 8

What is fluid creep in burn patients?

Accepted Answer

Fluid creep is the administration of IV fluid volumes significantly exceeding formula-predicted needs. It occurs in up to 90% of patients with ≥10% TBSA burns. Causes include overestimated TBSA, pre-hospital over-resuscitation, reluctance to titrate down, and opioid-related hemodynamic effects. Complications include pulmonary edema, abdominal compartment syndrome, and extremity compartment syndrome.

Question 9

What burns are included in TBSA calculation?

Accepted Answer

Only 2nd degree (partial thickness) and 3rd degree (full thickness) burns are included in TBSA calculation for fluid resuscitation. 1st degree (superficial) burns — like sunburn — do NOT cause significant fluid shifts and are excluded. 4th degree burns (involving muscle/bone) are included as full thickness.

Question 10

When do you start the Parkland formula from — time of burn or arrival?

Accepted Answer

Time starts from the time of BURN INJURY, NOT from hospital arrival. This is critical: if a patient was burned at 14:00, the first 8-hour window ends at 22:00 regardless of when they reach the hospital. Any fluids given pre-hospital must be subtracted from the first 8-hour allocation, and the remaining volume is given over the remaining hours in that window.

Question 11

What are the complications of over-resuscitation in burns?

Accepted Answer

Over-resuscitation complications include: pulmonary edema/ARDS, abdominal compartment syndrome (which can cause oliguria that triggers further inappropriate fluid administration), extremity compartment syndrome (in burned AND unburned limbs), cerebral edema, worsening burn wound edema that deepens injury, pneumonia, and multiple organ dysfunction syndrome.

Question 12

When should you transfer a burn patient to a burn center?

Accepted Answer

ABA criteria include: partial thickness burns >10% TBSA, any full thickness burn, burns to face/hands/feet/genitalia/major joints, chemical burns, electrical burns (including lightning), inhalation injury, burns with concomitant trauma, burns in patients with significant comorbidities, all pediatric burns, and burns with poorly controlled pain.

Range	Classification	Recommendation
<-9	Minor Burn	Oral fluids may suffice. Consider IV access. Assess for burn center referral criteria.
10-19	Moderate Burn	IV resuscitation indicated for children ≥10% TBSA. Adults: consider IV if 15–20% TBSA. Consult burn center.
20-39	Major Burn	Initiate Parkland formula. Foley catheter for hourly UOP monitoring. Consult/transfer to burn center.
40-59	Severe Burn	Aggressive fluid resuscitation. Consider albumin at 8–12h if crystalloid needs escalating. Transfer to verified burn center.
60-100	Critical Burn	Maximum resuscitation. High risk for fluid creep and compartment syndrome. Monitor for abdominal compartment syndrome. Burn center transfer essential.

Parkland Burn Formula Calculator - Fluid Resuscitation