Burns Fluid Resuscitation: Parkland Formula & Rule of 9s

PARKLAND

RULE

Standardized estimation of total body surface area (TBSA) burned and initial 24-hour crystalloid fluid resuscitation formula.

Severe thermal burns cause massive capillary leak and systemic inflammatory response. Fluid resuscitation replaces plasma fluid lost into the interstitial third space to prevent hypovolemic burn shock.

Systematic Breakdown

Head & Neck

9% TBSA (4.5% anterior, 4.5% posterior)

Entire head and neck represents 9% of adult surface area.

Upper Limbs

9% each (4.5% anterior, 4.5% posterior per arm)

Both arms combined represent 18% total body surface area.

Trunk

36% TBSA (18% anterior chest/abdomen, 18% back)

Anterior torso = 18%, Posterior torso = 18%.

Lower Limbs

18% each (9% anterior, 9% posterior per leg)

Both legs combined represent 36% total body surface area.

Perineum

1% TBSA

Genitalia and perineum represent 1%.

Parkland

4 mL x Body Weight (kg) x % TBSA Burned

Total Lactated Ringer's volume for first 24 hours: 50% given over first 8 hours (from time of burn!), and remaining 50% over the next 16 hours.

High-Yield Clinical Pearls & Exam Tips

Titrate fluids to target Urine Output of 0.5 - 1.0 mL/kg/hour in adults (1-2 mL/kg/h in pediatric burns).
Superficial 1st-degree burns (sunburns) are NOT included in the % TBSA calculation.

Related Pharmaceuticals

Lactated Ringer's Solution Silver Sulfadiazine Morphine

Related Clinical Conditions

Thermal Burns Inhalation Injury Hypovolemic Shock

Authoritative Sources: American Burn Association Practice Guidelines · ATLS 10e

Burns Fluid Resuscitation: Parkland Formula & Rule of 9s

Systematic Breakdown

9% TBSA (4.5% anterior, 4.5% posterior)

9% each (4.5% anterior, 4.5% posterior per arm)

36% TBSA (18% anterior chest/abdomen, 18% back)

18% each (9% anterior, 9% posterior per leg)

1% TBSA

4 mL x Body Weight (kg) x % TBSA Burned

More Emergency Medicine Mnemonics

Trauma Rapid History: AMPLE

Reversible Causes of Cardiac Arrest: 5 H's & 5 T's

Glasgow Coma Scale: Breakdown & Scoring

System Notice

Confirm Action