Burns — SAQ

Stem

A 70 kg man is extricated from a house fire. Injury time was 1 hour ago. He has partial- and full-thickness burns involving the entire anterior trunk and the entire right upper limb. He is hoarse with carbonaceous sputum. Distal pulses in the right hand are weak and the forearm compartments feel tense.^[1]

Questions

a) Estimate %TBSA (Rule of Nines) and state what you exclude from Parkland calculations. (3 marks)

Anterior trunk 18% + one entire arm 9% = 27% TBSA (Wallace teaching chart; EMS StatPearls: Rule of Nines assigns each part usually 9% or a multiple of 9).
Include partial- and full-thickness (second- and third-degree) only; exclude simple erythema from the %TBSA used for formula-based resuscitation.^[3]

b) Calculate Parkland volume for 24 h and for the first 8 h; how you titrate. (5 marks)

ABA range (Bodnar): 2–4 mL × BSA × weight in the first 24 h, half in the first eight hours from the time of burn. Parkland (StatPearls) sits at the 4 mL end with lactated Ringer.
4 × 70 × 27 = 7,560 mL / 24 h. Half in the first 8 hours from injury = 3,780 mL (credit fluids already given). Remaining 3,780 mL over the next 16 hours.
Guilabert: crystalloid first because capillary permeability is increased for 24 h. Peeters: give the least fluid that maintains organ perfusion — urine-output-led “fluid creep” causes respiratory failure and compartment syndromes. Do not quote an unsourced 0.5 mL/kg/h adult UO as ABA from these papers.^[1][2][4][5]

c) Airway and carbon monoxide priorities. (3 marks)

Closed-space fire + hoarseness + carbonaceous sputum = inhalational injury until proven otherwise. Give 100% oxygen, early senior airway assessment — intubate before progressive oedema obstructs. Measure carboxyhaemoglobin. Do not quote unsourced COHb percentage or half-life recipes. Consider burn-centre transfer (ABA criteria exist).^[1]

d) Limb threat management and suxamethonium. (4 marks)

Weak pulses/tense compartments after circumferential deep burn → urgent escharotomy (mid-axial lines) and reassess perfusion; involve burns/plastics; elevate limb; adequate analgesia.
Avoid suxamethonium after a major burn because extrajunctional acetylcholine-receptor upregulation risks life-threatening hyperkalaemia. Do not quote an unsourced 24-hour-to-1-year window.^[1]

References5ShowHide

1. [1]Bodnar D, Parker L, Rashford S, et al. The Pre-Hospital Initial Fluid Therapy Estimate in Early Nasty Burns (PHIFTEEN B, 15-B) Guideline applied to a retrospective cohort of Intensive Care Unit patients with major burns Burns, 2020.PMID 33183830
2. [2]Mehta M, Tudor GJ Parkland Formula StatPearls, 2026.PMID 30725875
3. [3]Oboli VN, Waseem M EMS Burn Rule of Tens StatPearls, 2026.PMID 37983357
4. [4]Guilabert P, Usúa G, Martín N, et al. Fluid resuscitation management in patients with burns: update Br J Anaesth, 2016.PMID 27543523
5. [5]Peeters Y, Lebeer M, Wise R, et al. An overview on fluid resuscitation and resuscitation endpoints in burns: Past, present and future. Part 2 - avoiding complications by using the right endpoints with a new personalized protocolized approach Anaesthesiol Intensive Ther, 2015.PMID 26480868