- Burns of the airway with facial swelling or signs of inhalation injury should necessitate immediate rapid sequence intubation.
- Remove involved clothing and jewelry.
- Consider treating for carbon monoxide and/or cyanide toxicity, if appropriate.
- Assess burns for percent of body surface burned and depth.
- Refer to the Fluid Management Protocol and the Parkland formula.
- Attempt to maintain urine output 0.5-1 mL/kg/hr in children.
Cover burns with clean dry dressing
- Leave bullae intact.
Consider escharotomies for circumferential burns after consulting with burn center:
- Chest: bilateral, midaxillary incisions for severe respiratory compromise.
- Extremities: for compromised neurovascular status.
- Irrigate with copious amounts of water or sterile saline.
- For eye exposure, consider prochlorperazine drops and continuous irrigation
- Consider calcium preparations for hydrofluoric acid burns
- Monitor urine for signs of myoglobinuria (dark urine, urine myoglobin, or positive dipstick for blood).
- These patients will require aggressive fluid therapy
- Consider Sodium Bicarbonate (1-2 mEq/kg in 1 liter D5W) to alkalinize urine
- Stewart C. Emergency care of pediatric burns. Emerg Med Rep. October 2000;5(10):101–111.
- Passaretti D, Billmire DA. Management of pediatric burns. J Craniofac Surg. September 2003;14(5):713–718