ALTERNATIVE STRATEGY: PLASMA

Plasma is likely a superior resuscitation fluid because of protective effects on the endothelial glycocalyx. 18 Additionally burn shock is a plasma deficit, so early plasma resuscitation will result in less fluid shifts. For burns larger than 20% TBSA, consider utilizing plasma early if available, in combination with balanced crystalloid, using one of the following formulas:19,20

- Original Brooke Formula: estimated plasma dose for the first 24 hours is 0.5 ml/kg/TBSA. Estimated crystalloid dose is 1.5 ml/kg/TBSA. Example: 100 kg with 50% TBSA: initial plasma rate is 156 ml/hr; initial crystalloid rate is 468 ml/hr.
- Evans Formula: estimated plasma infusion dose for the first 24 hours is 1 mL/kg/TBSA. Estimated crystalloid dose is the same.
- When using these formulas, it is recommended to adjust the crystalloid dose hourly while keeping the plasma dose constant.