Is the Parkland formula (total body surface area burned calculation) used in the treatment of electrical injuries?

Parkland Formula in Electrical Injuries

The Parkland formula is not specifically recommended for fluid resuscitation in electrical injuries, but is primarily used for thermal burns with adjustments based on clinical response and hemodynamic parameters. 1, 2

Fluid Resuscitation in Burns vs. Electrical Injuries

Thermal Burns Fluid Resuscitation

• The Parkland formula (4 mL/kg/%TBSA over first 24 hours) is a standard approach for thermal burns 1
• For adults with ≥15% TBSA burns and children with ≥10% TBSA burns, initial fluid resuscitation is recommended at 20 mL/kg of balanced crystalloid solution in the first hour 1, 2
• After initial bolus, ongoing fluid requirements are calculated using formulas like Parkland, which estimate 2-4 mL/kg/%TBSA for the first 24 hours 1

Key Differences for Electrical Injuries

• Electrical injuries cause damage that may not be visible on the skin surface
• The extent of tissue damage is often underestimated by visual TBSA assessment
• Fluid requirements may be higher than predicted by standard burn formulas due to extensive deep tissue damage and myoglobinuria

Clinical Management Approach

Initial Assessment

• Assess for visible thermal burns (if present)
• Evaluate for signs of deep tissue injury (compartment syndrome)
• Monitor for myoglobinuria (dark urine) indicating muscle breakdown
• Check cardiac function (ECG monitoring) due to risk of arrhythmias

Fluid Management in Electrical Injuries

1. Initial Resuscitation:

   • Administer 20 mL/kg balanced crystalloid solution in first hour regardless of visible burn area 2
   • Establish IV access in unburned areas when possible 1

2. Ongoing Fluid Management:

   • Adjust fluid rates based on clinical response rather than rigid formula calculations 1
   • Target urine output of 0.5-1 mL/kg/hour in adults 1
   • In electrical injuries with myoglobinuria, target higher urine output (1-2 mL/kg/hour) to prevent renal injury

3. Monitoring Parameters:

   • Hourly urine output is the primary parameter for assessing adequacy of resuscitation 2
   • Additional monitoring may include arterial lactate concentration, echocardiography, and hemodynamic parameters 1
   • Avoid both under-resuscitation and "fluid creep" (excessive fluid administration) 1

Important Considerations

Pitfalls to Avoid

• Do not rely solely on visible burn area: Electrical injuries cause deep tissue damage not reflected in surface burns
• Do not rigidly adhere to formula calculations: Fluid requirements should be adjusted based on clinical response 1
• Avoid delayed recognition of compartment syndrome: Monitor for signs of compartment syndrome requiring escharotomy 2

Special Populations

• Children require higher fluid volumes (approximately 6 mL/kg/%TBSA) due to higher body surface area/weight ratio 1, 2
• For children, consider adding basal fluid requirements using Holliday-Segar formula (4-2-1 rule) to burn formula calculations 1

Evidence Quality

The recommendations are based primarily on expert consensus and observational studies, as the formulae for fluid resuscitation in burns (including Parkland) have never been rigorously validated in randomized controlled trials 1. Current guidelines emphasize that these formulae should serve as starting points, with adjustments based on clinical response rather than rigid adherence to calculated volumes 1, 2.