• Stop the burning process
• Remove all clothing and jewelry
• Keep patient warm
• Obtain complete history and evaluate for associated injuries

Administer 100% oxygen

Suspect inhalation injury if:

• Injury occurred in enclosed space
• Presence of facial burns singed nasal hairs, carbonaceous sputum, soot on teeth or tongue, inflamed oral or nasal mucosa

Assess for airway distress

• Rapid respiratory rate, agitation, hoarse voice, stridor, cyanosis

Tip: If inhalation injury is suspected, consider early intubation

• <15% rarely symptomatic
• 15% - 40% associated with CNS changes
• 40% - 60% associated with obtundation

STEP 1

Place 2 large bore IV's

• Attempt in nonburn extremity (may place through burned skin if necessary)

STEP 2

Calculate body surface area burned

Tip: To estimate scattered burns: patient's palm surface = 1% total body surface area

STEP 3

Calculate fluid resuscitation

• Adults
• Age >15 years
• Ringers Lactate 2-4cc X kilogram body weight X percent burn.
• Infants and children
• Ringers Lactate 3-4cc X kilogram body weight X percent burn.
• For infants < 4 years old add maintenance fluid of D5LR
• For the 1st 10 Kg of body weight: 100cc/Kg/ 24 hrs
• For the 2nd 10 Kg of body weight: 50cc/Kg/24 hrs
• For each Kg of body weight above 20 Kg: 20cc/Kg/24 hrs

Tip: Monitor glucose for infants and young children

STEP 4

Administer fluid

• Infuse 1/2 estimated resuscitation volume over first 8 hrs
• Infuse 1/2 estimated resuscitation over next 16 hrs

Tip: Fluid resuscitation begins at time of injury

STEP 5

Monitor urine output

Insert foley and titrate IV fluid to goal of:

• Adults: 30-50cc/hour
• Children: 1cc/Kg/hour

• Insert NG for body surface area burned >20% or helicopter transport
• Administer pain medication IV
• Initial laboratory studies
• CXR, hematocrit, electrolytes, blood urea nitrogen, carboxyhemoglobin, arterial blood gas
• Administer Tetanus toxoid IM if necessary
• Elevate head if spine cleared
• Consider spine precautions
• Monitor pulses for third degree circumferential extremity burns. If diminished or absent call burn center.

• Record and report
• History of incident and associated injuries
• Allergies
• Medications
• Past medical/surgical history
• Last meal
• History of drug or alcohol use
• Maintain adequate airway protection
• Keep patient warm
• Transport in dry sheet or blanket, do not apply topical ointment or ice to wound

• 
  2nd degree burns >10% body surface area
• 3rd degree burns
• Burns to face, hands, feet, genitalia, perineum
• Electrical burns (including lightning injury)
• Chemical burns
• Inhalation injury
• Patients with pre-existing conditions
• Circumferential third degree burns to extremity or chest
• Hospitals without qualified personnel or equipment for care of burn injured children