In the burns protocol, what is the recommended fluid bolus for adults 13 years and older?

• A. For adults 13 years and older: NS or LR 1000 mL bolus if signs of hypoperfusion; OR burn present; contact burn center for drip rates
• B. NS or LR 1000 mL bolus regardless of signs
• C. D5W bolus 250 mL
• D. No IV fluids

Answer: (D)

In this burns protocol, the field approach for adults 13 and older is to avoid giving a routine IV fluid bolus. The emphasis is on rapid transport to a burn center and close monitoring, with fluids not started as a fixed bolus unless there are clear signs of hypoperfusion that require escalation and guidance from the burn center. Giving a large bolus in the field can lead to fluid overload, edema, and complicate subsequent hospital-based resuscitation, so it’s not the default in this scenario. Dextrose-containing fluids are not appropriate for resuscitation in burns, and a small, fixed bolus is not recommended unless perfusion concerns are established and managed per protocol. If perfusion becomes compromised, follow the burn center guidance for fluid management rather than administering a standard bolus upfront.