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Old 15 June 2018, 15:49
FlightMedicine FlightMedicine is offline
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Rule of 10's for burns

So I saw a recent post on a FB site for medics about burns. There were some people saying how they would like to use a different formula than Parkland's but weren't comfortable. I figured I'd share some of the recent research on fluid resuscitation for burns.

Overall the trend, especially in pre-hospital, is actually fluid overloading. While it may not be apparent at pre-hospital time of treatment but can lead to serious complications later on. This phenomena is known as "fluid creep."

One of the newer one's that has become accepted is the Rule of Ten's. It is used generally for patients with >= 20% TBSA. For adults its just 10mL/hr x TBSA. For patients greater than 80kg add 100mL for every 10kg over 80.

I was wondering if anyone had heard anything better than this or if they had any practice with this formula?
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Old 15 June 2018, 16:02
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I am curious if this is a regional issue or other.

We do not have that issue in our region.

Do you have a link to the article/study I would like to read more.
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Old 17 June 2018, 01:51
FlightMedicine FlightMedicine is offline
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This article just breaks that fluid creep is happening:

https://www.ncbi.nlm.nih.gov/pubmed/17438489


This article links Parkland to fluid creep (found it on my schools library page so can't link it):

Saffle, J. R. (2007). The Phenomenon of “Fluid Creep” in Acute Burn Resuscitation. Journal of Burn Care & Research, 28(3), 382-395.

I know that the Army's SMOG for MEDEVAC has the rule of 10's as their go to. I also think it's easier for that "3am" math
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Old 17 June 2018, 07:36
Doctor_Doom Doctor_Doom is offline
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The rule of 10's was developed to address a problem other than fluid creep. Even the term "fluid creep" means deviation from the Parkland formula. When I was at the USAISR, we used the "classic" Parkland, with colloid. The rule of 10's was developed to easily achieve resuscitation between Brooke and Parkland in battlefield/austere environments, but has not been validated as being "better" than Parkland. The distinction is important.
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Old 17 June 2018, 10:59
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We use a modified Parkland at my Trauma Center... -> but not the "Rule of 10's" thing. While not a burn center, I do have aa "Burn Guy" on service who spent 11 yrs doing nothing but burn response / intervention / resuscitation.
That joker is pretty freakin smart - he's been a modified Parkland guy for years.
I tend to follow his lead whenever I am in his company
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Old 17 June 2018, 15:14
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At my air agency we utilize the consensus formula. Never even heard of Rule of Tens.
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Old 18 June 2018, 03:54
FlightMedicine FlightMedicine is offline
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Quote:
Originally Posted by Doctor_Doom View Post
The rule of 10's was developed to address a problem other than fluid creep. Even the term "fluid creep" means deviation from the Parkland formula. When I was at the USAISR, we used the "classic" Parkland, with colloid. The rule of 10's was developed to easily achieve resuscitation between Brooke and Parkland in battlefield/austere environments, but has not been validated as being "better" than Parkland. The distinction is important.
Thanks for the info!
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Old 18 June 2018, 23:04
Jakers Jakers is offline
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Problem that I've seen with the Parkland formula is that it can be to complicated to do on the fly under pressure; calculating the total fluid to be given in 24 hours and then the rate can be a pain.

Easier way is to change the equation: (%burned x weight in kg)/4. Gives you the ml/hour for the first 8 hours, then give half that rate for the next 16.

It gives the same volume as the Parkland; it IS the Parkland formula, just given in a different format.

As an aside, I've only ever seen this taught once; anyone else do it like this?
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