1. You have a 20 kg child that comes in with 30% TBSA burns. What is your initial fluid rate per the Parkland formula?
a) 2400 ml/hr
b) 100 ml/hr
c) 150 ml/hr
d) 210 ml/hr
2. What is the gold standard for diagnosis of inhalational injury?
a) Clinical exam
b) PaO2/FiO2 ratio
c) CXR findings
d) Bronchoscopy findings
3. Which is not a common treatment for the patient with significant burns from a house fire?
a) Fluid Bolus
b) 100% Oxygen
4. What is the factor most associated with mortality in pediatric burns?
a) Inhalational injury
c) Other associated injuries
d) %TBSA involved
ANSWERS & EXPLANATIONS
1. D. The Parkland formula is Total fluids in first 24 hours=4(Wt in Kg)(%TBSA Burn) with the first half given in the first 8 hours and the other half given in the second 8 hours. Hence, the total fluid to be given in the first 24 hours= 4(20kg)(30)= 2400 ml. 1200 ml should be given in the first 8 hours. Hence 1200/8=150 ml/hr. However, you also have to add the basic maintenance rate which is 60 ml/hr leading to an initial fluid rate of 150+60 =210 ml/hr. This can then be titrated based on urine output and hemodynamic parameters.
2. D. Bronchoscopy findings are the gold standard for diagnosis of inhalational injury and can also be therapeutic.
3. A Fluid bolus therapy has little/no role in the initial treatment of burn therapies, with titration of fluid infusion rates serving as the main method for adjusting volume infusions. 100% oxygen is used to treat carbon monoxide poisoning which would be common with a house fire. Metoprolol and oxandrelone are used to reduce the hypermetabolic state.
4. A Inhalational injury has been found to be the single most important factor associated with mortality for pediatric burns.