Case of the Month #46 A Major Burn Injury: Taming the Flames

Published 13/02/2024

You move on to assess circulation. What points are specific to burns?


  • Hypotension should not be attributed to early burn injury 

    • Evaluate for bleeding in concurrent trauma 
    • Also consider comorbid conditions 
  • Volume resuscitation 

    • Use the Parkland formula for burns >15% TBSA 
      • 2-4ml/kg/%TBSA burned 
      • Calculated from the time of injury 
      • Give half in the first 8 hours, then half in the subsequent 16 hours 
    • Use balanced crystalloid, delivered through a fluid warmer 
  • Cyanide toxicity 

    • Inhalational injury 
    • Cardiovascular instability 
    • Elevated blood lactate levels 
    • If suspected, give high-dose hydroxocobalamin 

IV access is obtained through non-burned skin. You begin volume resuscitation according to the Parkland formula. The initial blood lactate level is 7mmol/L, and you ask for a blood gas to be rechecked in an hour to ensure this is falling. Your colleague will insert an arterial line. You move on in your assessment.