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# Parkland Formula Calculator

Rule of ninesBurn percentage estimation in childrenHow to use the Parkland formula calculator?Parkland formula exampleBurns gradation – when to use Parkland burn formulaHow to treat a burn?

This Parkland formula calculator is the perfect tool to manage the amount of IV fluids that your patient needs to get in the initial 24 hours of burn treatment. The Parkland burn formula uses a simple burn percentage assessment based on the so-called rule of nines – there is no need to run complex calculations while in an emergency. Ensuring a patient gets a sufficient amount of fluid is a crucial factor when it comes to how to treat a burn of a major degree. We also provide a Parkland formula example which will hopefully give you a good grasp of how to apply the rule of nines in real life.

We try our best to make our Omni Calculators as precise and reliable as possible. However, this tool can never replace a professional doctor's assessment. Before administering any drugs, fluids, or treatment to your patient, make sure you know the dose and the method.

## Rule of nines

The rule of nines, or the Wallace rule of nines (after surgeon Alexander Wallace), is used to quickly assess what percentage of the body's total surface area (BSA) has been afflicted by burns (if you're curious what is your BSA, use the BSA calculator). It assigns a value of either 9 or a multiple of 9 (18, 36) to every body region and thus enables you to estimate the burn area with just a visual examination. The only exception is the groin, which has a value of 1%. It is good to remember that only 2nd and 3rd-degree burns are taken into account – redness of the skin often isn't severe enough to warrant IV administration of fluids.

The rule goes:

• Front/ back of the torso is 18%. Abdomen or chest only is 9%;
• Entire arm is 9%, and one side of the arm (front/ back) is 4.5%;
• Entire leg is 18%; and
• Groin area is 1%.

The rule of nines only applies to an adult person – for a child's assessment, scroll down – and, together with the Parkland formula, helps guide the treatment decisions regarding fluid resuscitation and whether a patient should be transferred to a specialized burn center.

## Burn percentage estimation in children

Children have different body proportions, so the basic rule of 9s cannot be used. Their heads are bigger and their legs shorter – so the traditional rule of nines wouldn't be appropriate. Instead, we use a modified rule of nines (differences with the adult version are in bold):

• Entire torso is 36%, anterior or posterior trunk is only 18%;
• Entire arm is 9%;
• Entire leg is 14%; and
• You typically don't assess the groin area in children. However, there are rule modifications that assign 13.5% to each leg and thus leave 1% for the groin.

## How to use the Parkland formula calculator?

Proper fluid resuscitation is one of the most critical aspects of treating patients with burns. It replaces the amount of water lost through the burned areas (even though we have a rather large amount of water in our bodies, burns can lead to massive loss of it) and prevents organ failure.

1. First, choose if you're assessing an adult or a child.

2. Determine their weight and put it into the appropriate field.

3. Inspect the person carefully. Remember to assess every region of the body. Pay attention to 2nd and 3rd-degree burns.

4. Fill in the field for each affected body area. You can also input additional arm and leg areas to address smaller parts of limbs for a more accurate calculation.

5. The Parkland formula calculator will do the math on its own. Here we assume the amount of fluids (most commonly Ringer's lactate) needed is 4 ml/kg/% (milliliter per kilogram of body weight per percentage of body area burnt).

Total fluids needed = Weight × Body surface area burnt × 4

6. Half of the fluids are to be given in the first 8 hours of treatment. Typically, it's spread evenly over 8 hours, so dividing the result by eight will give you the IV flow rate.

7. The other half is to be given over the next 16 hours. It is also spread evenly over these 16 hours.

These calculations do not include the standard daily need for water. This is especially important in pediatric patients. Be aware of it and estimate the daily water need using water intake calculator.

## Parkland formula example

Let's try to use the Parkland burn formula in a real-life situation.

A patient, a 38-years old male (82 kg), is admitted to your Emergency Unit after pouring hot fluids onto himself at work. The whole front of his left leg and half of the frontal part of his left arm is reddened, swollen, and blistered. He's complaining about the pain. How much fluid you should you administer to this patient, and over how much time would you spread it?

1. The patient's weight is 82 kg, and he is an adult, so we can apply the regular rule of nines.

2. The front of the leg is about 9% of the TBSA (Total Body Surface Area), and half of the frontal part of the arm is about 2.3%. The total percentage of body area burned is, therefore, 9% + 2.3% = 11.3%.

3. Now, we multiply 4 ml/kg/% by the burn percentage and by the patient's weight.

82 × 11.3 × 4 = 3690

We should give our patient 3690 ml of fluid over the first 24 hours of treatment. Now, let's see how to administer it properly.

For the first 8 hours: half of the total amount:

3690 ml / 2 = 1845 ml

With the IV flow of:

1845 ml / 8h = 231 ml/h

The next 16 hours require the other half of the total amount and also need an even IV flow rate:

1845 ml / 16h = 115 ml/h

Done!

## Burns gradation – when to use Parkland burn formula

• First-degree (superficial) burns – only affects the outer layer of the skin or epidermis. The skin is reddened, dry, and moderately painful; no blisters occur. A common example is a mild sunburn when you don't apply a sufficient amount of sunscreen on your skin. The Parkland burn formula doesn't apply to this degree of burn.

• Second-degree (partial thickness) burns – affect not only the epidermis but also a part of the layer underneath – the dermis. The injured area is red, swollen, blistered, and very painful.

• Third-degree (full thickness) burns – both layers, the epidermis, and dermis, are destroyed, and the subcutaneous tissue may even be affected. The burn site can be pearly-white or blackened, charred.

• Fourth-degree burns – the epidermis, dermis, and subcutaneous tissue are destroyed, perhaps along with the muscle and bone beneath. This degree of burns can be painless, as the nerve endings may be burnt away.

Not all types of burns require hospital admission and IV fluids. Click here to read how to treat a burn at home – for example, minor sunburn.

## How to treat a burn?

Note: this applies only to small, minor burns, e.g., mild sunburns. If you have burns or strong ailments and feel unwell, seek medical help as soon as possible.

Fortunately, not all burns require hospitalization and the administration of IV fluids. You can deal with minor burns at home using a few tips to help you recover quickly:

1. The first thing to do is cool the burn. Apply a huge amount of cool running water or make a cold compress until the pain eases (this should take 5-15 minutes). Don't use ice directly on the injured area.

2. Remove any pieces of jewelry, especially rings – when the skin swells, it may be impossible to get them off.

3. Once the burn area is completely cooled, you may apply some mild moisturizing lotion – e.g., aloe vera or petroleum jelly. Avoid thick ointments and food items (like butter). Repeat the application about 2-3 times a day.

4. Don't pop blisters. It may cause an infection.

5. Bandage the burn with sterile, nonstick dressing.

6. Consider taking over-the-counter pain medication – like paracetamol or ibuprofen – if needed. To make sure you take the proper dose, consult our paracetamol dosage calculator.

7. Protect the burn from the sun and other irritating factors. That's why you should cover the wound.

8. Consider getting a tetanus shot – if you got your last tetanus vaccination over ten years ago, consider repeating it, as burns are a gateway to infections.