Burned Bella — Burns & Fluid Resuscitation
Deep partial-thickness burns over 40% TBSA — the Parkland formula tells you how much fluid, but urine output tells you if it's working
Bella is pulled from a house fire with singed nasal hair and soot around her mouth, and deep partial-thickness burns cover both legs and her torso. Her voice is hoarse and she cannot stop coughing.
Bella suffers a major thermal burn, and capillaries throughout her body become leaky within minutes as inflammatory mediators flood her bloodstream. Massive fluid shifts from the vascular space into the interstitium, causing burn shock if resuscitation is delayed. The Parkland formula guides the first 24 hours of crystalloid replacement, but the true measure of adequate resuscitation is urine output, not the calculated number. Airway burns and circumferential chest or limb burns can kill faster than the fluid shift itself.
Read Burned Bella's full story →The story arc
The setup
Bella's clothing catches fire in a kitchen accident, and she sustains deep partial and full-thickness burns across 42% of her body surface area.
The turn
In the emergency department her voice grows hoarse, she has facial soot and singed nasal hairs, and she cannot stop coughing.
The crisis
Within hours her legs feel tight and pulseless below a circumferential burn, and her urine output falls to 15 mL/hr despite ongoing IV fluids.
The save
The nurse secures the airway early before swelling closes it, titrates lactated Ringer's using the Parkland formula while trending hourly urine output, and calls for an emergency escharotomy on the constricted limb.
NCLEX study section — Burns & Fluid Resuscitation
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Critical Care
Take this chapter into practice questions on the same topic.