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Burns: Initial
Resuscitation Priorities

Master the first life-saving steps for a burn patient: airway, breathing, circulation, and fluid resuscitation using the Parkland formula.

NCLEX-RN

Why Burns Are a True Emergency

A major burn is far more than a skin injury. The body loses its protective barrier, causing massive fluid shifts out of the bloodstream, risk of airway swelling, and the threat of shock. The first hour determines survival.

Key Terms to Know

TBSA
Total Body Surface Area burned, expressed as a percent. Drives fluid calculations.
Fluid Shift
Plasma leaks from vessels into tissues, causing edema and low blood volume.
Resuscitation
Restoring airway, breathing, and circulating volume to prevent shock.

Estimating Burn Size: Rule of Nines

9% Front 18% Back 18% 9% 9% 18% 18% Perineum 1%

The Core Rule: Parkland Formula

This gives the total lactated Ringer's volume to give in the first 24 hours. Half is given in the first 8 hours, the remaining half over the next 16 hours. Time starts at the moment of injury — not arrival.

Splitting the Fluid Over 24 Hours

½ Volume First 8 hours ½ Volume Next 16 hours Injury 24 hr

ABCs vs. Fluids: What Comes First?

Airway First
Face, neck, or inhalation burns can swell shut. Secure the airway before swelling makes it impossible.
Fluids Second
Once airway and breathing are safe, large-bore IV access and Parkland fluids treat circulation.

Step-by-Step Approach

1
Airway: Assess for inhalation injury; prepare for early intubation if needed.
2
Breathing: Apply 100% oxygen; watch for carbon monoxide poisoning.
3
Circulation: Establish two large-bore IVs; begin lactated Ringer's.
4
Calculate: Estimate %TBSA, then apply the Parkland formula.
5
Monitor: Titrate fluids to urine output of \( 0.5\text{–}1\ \text{mL/kg/hr} \).

Worked Example One

A 70 kg adult has burns to the entire front torso (18%) and both full arms (18%), for a total of 36% TBSA. Calculate the 24-hour Parkland volume.

Worked Example Two

An 80 kg man has 50% TBSA burns. Find the infusion rate in mL/hr for the first 8 hours.

Worked Example Three

A 60 kg woman with 40% TBSA burns arrives 2 hours after injury. The first 8-hour half is 4,800 mL. What is the corrected rate for the remaining time?

Common Mistakes

✕ Fluids Before Airway
Starting IVs while ignoring a swelling airway. Airway always comes first.
✕ Clock from Arrival
Timing fluids from ER arrival instead of the actual moment of injury.
✕ Wrong Fluid
Using normal saline or dextrose instead of lactated Ringer's for resuscitation.

Resuscitation Summary

Priority Action
Airway1stIntubate early if inhalation injury
Breathing2nd100% oxygen; watch for CO
Circulation3rdTwo large-bore IVs, LR fluids
Fluid VolumeCalculate\( 4 \times kg \times \%TBSA \)
MonitorOngoingUrine \( 0.5\text{–}1\ \text{mL/kg/hr} \)

Question 1 of 5

A burn patient arrives with singed nasal hairs, a hoarse voice, and soot in the mouth. What is the nurse's first priority?

Question 2 of 5

Which IV fluid is the standard choice for initial burn resuscitation?

Question 3 of 5

A 50 kg patient has 20% TBSA burns. Using the Parkland formula, what is the total 24-hour fluid volume?

Question 4 of 5

For the Parkland formula, the 24-hour clock for fluid resuscitation begins at:

Question 5 of 5

Which finding best indicates that fluid resuscitation is adequate in an adult burn patient?

Key Takeaways

1
ABCs first. Airway always outranks fluids, especially with inhalation signs.
2
Lactated Ringer's is the resuscitation fluid of choice.
3
Parkland: \( 4 \times kg \times \%TBSA \); half in 8 hr, half in 16 hr.
4
Time from injury, and titrate to urine output.

You're Ready to Resuscitate

Lead with the ABCs, calculate fluids with Parkland, and titrate to urine output. These priorities save lives.

``` I've generated the complete 20-slide deck for "Burns: Initial Resuscitation Priorities" following the design system exactly. Key features: - **20 slides**: title, concept intro, key terms, Rule of Nines diagram, Parkland formula, fluid timing visual, ABC vs. fluids distinction, step-by-step approach, three worked examples (increasing difficulty), common mistakes, summary table, 5 MCQ assessments, takeaways, and closing. - **KaTeX** for all math (Parkland formula `$$ V = 4 \times kg \times \%TBSA $$`, all calculations, choice buttons, and feedback). - **Exact CSS template** with all design tokens, accessible navigation, accordion support, swipe/keyboard controls, and assessment logic with "✓ Correct!" prepending. - **No emojis, no grey body text**, all SVGs sized generously with literal Unicode characters.