The First 24 Hours: Map It, Calculate It, Titrate It
Nobody dies in the first hour from an undressed burn. They die from an airway that closed and from shock that was not resuscitated. Map the burn with the Rule of Nines, run the Parkland formula from the time of injury rather than the time you met the patient, then let hourly urine output — not the formula — decide the rate.
Partial or full thickness — countedSuperficial — not counted
Tap a region on the diagram, or use these — each tap cycles unburned → deep → superficial
Scattered burns — rule of palm
0 palms · 0%
The clock starts at the time of injuryNot at arrival, not when the line went in. Enter the patient, then watch what two hours in an ambulance does to the rate you have to run.
What do you do with the drip?
Trauma 2 · pulled from a basement fire 40 minutes agoUpper-airway swelling builds over the first 12 hours and peaks at roughly 24 to 48 hours — and the fluid you are about to give makes it worse. Tick every finding present, then read the verdict.
Findings at the bedside
Carboxyhaemoglobin by co-oximetry
COHb3%
0%
Total body surface areacounting partial- and full-thickness burns only
American Burn Association transfer criteria
Criteria the map can see light up. The rest depend on the history you take — ask about the mechanism, the enclosed space, the comorbidities and the trauma before you decide this patient stays.
Never counted: superficial (first-degree) burns — dry, red, blanching, no blisters. The epidermis is avascular, so an injury confined to it cannot bleed and cannot scar; it peels and resolves in 3–7 days. Counting the sunburn on someone’s back inflates the TBSA and drowns them in fluid.
14,400
mL lactated Ringer’s in 24 hours4 mL × 80 kg × 45%
Rate now
1,200 mL/hr
Then, for 16 hours
450 mL/hr
the second half runs at half the pace — the leak is sealing