Burns Management: Parkland Formula and Initial Care

Burns management appears in surgery, emergency medicine and plastic surgery exams. The questions are practical: how deep is the burn, how large is it and what do you do first? A calm, stepwise method makes the topic easy to score.

Step 1: Stop the burning and assess safety

Remove the patient from the source, take off burned clothing and jewelry, and cool the burn with running water for about twenty minutes when appropriate. Avoid ice, and prevent hypothermia in large burns. Follow the standard trauma approach: airway, breathing and circulation.

Step 2: Airway and inhalation injury

Suspect inhalation injury with facial burns, singed nasal hair, soot in the mouth or nose, hoarseness, stridor or a history of an enclosed space fire. Airway swelling can progress quickly, so consider early intubation. Give high-flow oxygen if carbon monoxide poisoning is suspected.

Step 3: Estimate depth

• Superficial: red, dry and painful, without blisters
• Superficial partial thickness: blisters, moist and very painful
• Deep partial thickness: pale or mottled and less painful
• Full thickness: leathery and painless, as nerve endings are destroyed

Step 4: Estimate burned area

Use the rule of nines in adults or a chart for children. Count only partial and full-thickness burns when calculating the area for fluid planning.

Step 5: Fluid resuscitation

The Parkland formula estimates fluid for the first 24 hours: 4 mL multiplied by body weight in kilograms and by the percentage of body surface burned, using a balanced crystalloid solution. Give half in the first eight hours counted from the time of injury, and the other half over the next sixteen hours. Adjust the rate to urine output rather than treating the number as fixed.

Step 6: Other care

Provide effective analgesia, give tetanus prophylaxis as needed, cover wounds with clean dressings and monitor for complications. Circumferential burns of a limb or chest may need escharotomy.

Referral to a burn center

Consider referral for large burns, burns of the face, hands, feet, genitalia or major joints, full-thickness burns, chemical or electrical burns, inhalation injury and burns in children or patients with serious comorbidities.

A classic exam pattern

A 70 kg adult has partial and full-thickness burns over 20 percent of the body. The 24-hour estimate is 4 multiplied by 70 multiplied by 20, which is 5,600 mL, with half in the first eight hours.

Study tips

• Memorize the formula and what time the first eight hours start
• Learn the signs of inhalation injury
• Review each wrong answer for the missing safety step

This article is for exam revision and does not replace current clinical guidelines. Practice surgical cases in the Namazj free trial.