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Burns

Thermal

  • 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.

Chemical

  • 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

Electrical

  • 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

Citations/References:

  1. Stewart C. Emergency care of pediatric burns. Emerg Med Rep. October 2000;5(10):101–111.
  2. Passaretti D, Billmire DA. Management of pediatric burns. J Craniofac Surg. September 2003;14(5):713–718