A 32-year-old man presents to the emergency department after a house fire. He has partial-thickness (second-degree) burns on his anterior chest, left arm, and the entirety of his right leg. He is awake, oriented, and in moderate pain. Vitals: heart rate 118, blood pressure 104/66, respiratory rate 22, SpO2 97% on room air, temperature 36.8°C. Weight: 80 kg. On examination there are bullae on the chest and arm, with moist, painful wounds and intact capillary refill. There is no evidence of inhalation injury (no soot, normal voice, no stridor). Using the rule of nines, total body surface area (TBSA) burned is calculated as: anterior chest = 9%, left arm (entire) = 9%, right leg (entire) = 18%, for a total of 36% TBSA. You need to begin initial fluid resuscitation.
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What is the most appropriate initial fluid resuscitation plan for this patient?
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