A 70 kg patient comes to the emergency department with a 40% TBSA burn injury. According to the Parkland formula, what will be the expected fluid to be given in the first 8 hours to this patient?

1. A

   5800 ml

2. B

   11200 ml

3. C

   5600 ml

4. D

   6000 ml

Appeared in: NORCET 8 Prelims-2025

Explanation

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• The Parkland formula is a standard guideline for calculating intravenous fluid requirements for burn patients during the initial 24 hours.
• The formula is: Total Fluid (mL) = 4 mL × Body Weight (kg) × Total Body Surface Area (% TBSA).
• For this patient, the calculation is: 4 mL × 70 kg × 40 = 11,200 mL total fluid over 24 hours.
• The protocol specifies that half of this total volume must be administered in the first 8 hours following the burn injury.
• Therefore, the fluid volume for the first 8 hours is calculated as 11,200 mL / 2 = 5,600 mL.

Why Other Options Were Wrong

• Option A: This value is a result of an incorrect calculation and does not align with the standard Parkland formula protocol.
• Option B: This is the total fluid volume required for the entire 24-hour period, not the amount for the first 8 hours. The question specifically asks for the volume in the first 8-hour interval.
• Option D: This value is a result of an incorrect calculation. It might arise from miscalculation or rounding errors.

Related Visual

• Visual 1: Flowchart - A step-by-step flowchart showing the Parkland formula calculation: Start with patient weight and %TBSA, calculate total 24-hour fluid, then divide to find the volume for the first 8 hours and the next 16 hours.
• Visual 2: Diagram - The 'Rule of Nines' diagram for adults, illustrating how to estimate the percentage of Total Body Surface Area (TBSA) affected by burns.

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Parkland (Baxter) Formula for Burn Fluid Resuscitation in acute care settings.
• Accurate fluid resuscitation is critical to prevent 'burn shock,' a life-threatening complication caused by massive fluid shifts and hypovolemia.
• Nurses must meticulously monitor urine output (goal: 0.5-1 mL/kg/hr for adults) as the primary indicator of adequate organ perfusion and adjust infusion rates accordingly.
• What if? If the patient's arrival was delayed by 2 hours after the burn occurred, the 5600 mL would need to be infused over the remaining 6 hours (rate of 933 mL/hr) instead of 8 hours (rate of 700 mL/hr), as the clock starts at the time of injury.

How to Approach the Question

• Identify the question type: This is a calculation-based question requiring the application of a specific formula (Parkland).
• Extract the key data from the stem: Patient weight (70 kg) and %TBSA (40%).
• Recall the Parkland formula: Total fluid = 4 mL × kg × %TBSA.
• Perform the first calculation: 4 × 70 × 40 = 11,200 mL. This is the total volume for 24 hours.
• Recall the administration schedule: 50% of the total volume is given in the first 8 hours.
• Perform the final calculation: 11,200 mL / 2 = 5,600 mL.

Concept Tested & Keywords

• Concept Tested: Parkland (Baxter) Formula for Burn Fluid Resuscitation
• Stem keywords: 70 kg, 40% TBSA burn, Parkland formula, first 8 hours
• Lead-in keywords: what will be the expected fluid
• Clinical cues: Patient weight: 70 kg (key input for formula)
• Clinical cues: Burn size: 40% TBSA (critical for calculating fluid volume)

Question ID

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