Which burns require a fluid bolus of 1000 mL NS for adults or 20 mL/kg for pediatrics?

Which burns require a fluid bolus of 1000 mL NS for adults or 20 mL/kg for pediatrics?

• A. First-degree burns >5%
• B. All burns require fluid bolus
• C. 2nd or 3rd degree burns >9% or signs of hypovolemia
• D. Only burns with inhalation injury

Answer: (C)

When burns are severe enough to cause fluid shifts, giving IV crystalloid helps restore circulating volume and improve tissue perfusion. The key factor is burn depth and extent: deeper burns that damage the dermis (second or third degree) and/or a larger total body surface area increase the risk of hypovolemia, so a fluid bolus is used to support circulation. The threshold used here is burns that are second- or third-degree and exceed about 9% of body surface area, or any burn with signs of hypovolemia such as tachycardia, low blood pressure, cool clammy skin, or reduced urine output. In these cases, administer a 1000 mL normal saline bolus to an adult, or 20 mL/kg to a pediatric patient. Smaller, superficial burns or burns without evidence of hypovolemia typically do not require this bolus. Inhalation injury can complicate management, but the need for a bolus is driven by depth and TBSA and the presence of hypovolemia, not inhalation alone.

When burns are severe enough to cause fluid shifts, giving IV crystalloid helps restore circulating volume and improve tissue perfusion. The key factor is burn depth and extent: deeper burns that damage the dermis (second or third degree) and/or a larger total body surface area increase the risk of hypovolemia, so a fluid bolus is used to support circulation. The threshold used here is burns that are second- or third-degree and exceed about 9% of body surface area, or any burn with signs of hypovolemia such as tachycardia, low blood pressure, cool clammy skin, or reduced urine output. In these cases, administer a 1000 mL normal saline bolus to an adult, or 20 mL/kg to a pediatric patient. Smaller, superficial burns or burns without evidence of hypovolemia typically do not require this bolus. Inhalation injury can complicate management, but the need for a bolus is driven by depth and TBSA and the presence of hypovolemia, not inhalation alone.