Date of Graduation

8-2008

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Dr. Mark Pedemonte, MD

Second Advisor

Jonathon W Gietzen MS PA-C

Abstract

Background: Information for immediate burn resuscitation and treatment has been available in many forms, most of which requires starting with the Parkland formula. Research in the last ten years has called that formula into question and has recommended either using it only as initial guidance or using another method all together.

Purpose: To present a summary, in an unbiased format, of the information available for immediate burn fluid resuscitation especially that which has been published in the past 25 years. The primary focus is on the Parkland formula and its validity either as initial guidance or as a method for immediate treatment.

Methods: An exhaustive search of available medical literature using CINHAL, Medline-OVID, Medline-plus and UpToDate. Of those articles highlighted, 20 were found to have information pertaining only to general guidelines, to particular types of burns or to a specific pediatric or geriatric population. The final 12 articles were found to have pertinent and current information regarding the immediate fluid resuscitation of new onset burns and the value of the Parkland or other formula in doing so. All tables and data analyses were directly transferred from annotated sources.

Results: The sum total of burn victims evaluated was over 1100 patients using various testing formats ranging from well-randomized to retrospective studies. The validity of each article is discussed and with the amount of available information, some are presented as supporting evidence only. Given the advances in knowledge of burn treatment and resuscitation, the author recommends additional studies comparing purposeful dehydration versus the Parkland formula, with emphasis on the means for monitoring the Parkland formula results.

Conclusion: Literature evidence has supported the Parkland formula in the past as a starting point for resuscitation, with the onus on the Provider for calculating appropriate amounts and adjusting based on careful monitoring. Recent studies have shown that the numbers from the Parkland formula are not reproducible. Therefore, the author recommends a larger study evaluating the Parkland formula as compared with Permissive Hypovolemia and other methods of resuscitation.

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