NORCET -4 , 2023
Medical & Surgical Nursing
Easy
Parkland formula for fluid calculation in burn patients should be calculated by?
Appeared in: NORCET -4 , 2023
Explanation
- The Parkland (or Baxter) formula is a standard method for calculating fluid needs in burn patients for the first 24 hours post-injury.
- The formula is specifically defined as: 4 mL of Lactated Ringer's solution × Body Weight (in kg) × Percentage of Total Body Surface Area (%TBSA) burned.
- Lactated Ringer's is the preferred fluid as it is an isotonic crystalloid that helps buffer the metabolic acidosis common in severe burns.
- The administration schedule is critical: half of the total volume is given in the first 8 hours from the time of the burn, and the remaining half over the next 16 hours.
Why Other Options Were Wrong
- Option B: This value is not the standard Parkland formula. While it falls within the range of the Consensus formula (2-4 mL), the Parkland formula specifically uses a multiplier of 4 mL.
- Option C: This value represents the Modified Brooke formula, not the Parkland formula. Using 2 mL/kg/%TBSA would deliver only half the fluid calculated by the Parkland formula, risking under-resuscitation.
- Option D: This value is far too low for initial adult burn resuscitation and is not part of any standard formula. It would lead to severe hypovolemia and burn shock.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Parkland formula for burn fluid resuscitation as background academic context rather than a clinical decision trigger.
- Accurate fluid resuscitation is the cornerstone of early burn management to prevent burn shock, a life-threatening complication caused by massive fluid shifts from the intravascular to the extravascular space.
- Nurses must understand that the Parkland formula is a guideline. The patient's response, primarily urine output (target 0.5-1 mL/kg/hr for adults or 30-50 mL/hr), is the most important factor for titrating fluid rates.
- What if? If the patient has an electrical burn, the Parkland formula may underestimate fluid needs due to deep, unapparent muscle damage. These patients often require significantly more fluid, and monitoring for myoglobinuria (dark urine) is crucial.
How to Approach the Question
- This is a factual recall question testing knowledge of a specific medical formula.
- Identify the core concept being asked: the 'Parkland formula'.
- Recall the components of this formula: a constant volume (in mL), patient weight (in kg), and the percentage of Total Body Surface Area (%TBSA) burn.
- The options differ only by the constant volume multiplier. Focus on recalling this specific number.
- Select the option that correctly states the constant used in the Parkland formula, which is 4 mL.
Concept Tested & Keywords
- Concept Tested: Parkland formula for burn fluid resuscitation
- Stem keywords: Parkland formula, fluid calculation, burn patients
- Lead-in keywords: calculated by
- Negative lead-in flag: false
Question ID
QfjWFqBipRSWalR1Kdzazq
Reference Book
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 694-696
E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 748-750
Practise the full NORCET -4 , 2023
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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