Parkland formula role in treatment of severe burn – Case report

Abstract

In this case report a rarely seen and a fairly demanding patient is presented. A middle-aged male with severe and extensive burns sustained after attempted suicide with ignited propane butane containing gas bottle was transported to the emergency department of University Hospital Centre Split after more than 12 hours since initial injury. Explosion and fire caused the second and third degree burns to the patient on a very large body surface area (70 percent). At the moment of admission, he was extremely aggressive, combative and uncooperative. Also, it is important to emphasize that the patient had no intravenous access. Due to the absence of intravenous access, and due to the patients’ condition, the author decided to apply midazolam, ketamine and atropine intramuscularly. After the patient was in general anaesthesia, central venous access was established via left subclavian vein, and immediate crystalloid infusion therapy was initiated. According Parkland formula, volume of crystalloid replacement should be 25200 mL during the first 24 hours. Since more than eight hours passed from the time of the injury, fluid deficit was theoretically more than 8400 mL. During the initial treatment and three hour surgery, the patient received 5500 mL of Plasma-Lyte solution. He was treated in the intensive care unit for a prolonged period of time, and complicated with multiresistant Acinetobacter baumannii infection. Finally, Parkland formula remains the basic tool in burn fluid resuscitation. Our intention was to present an interesting case of a middle-aged patient with extensive burns, whose care was complicated with aggression at admission, lack of intravenous access, and a prolonged period between the initial injury and the start of hospital treatment. These greatly complicate the treatment, patients’ recovery and overall morbidity and mortality.