Burn injuries that are frequently seen in our burn unit:

1. Partial thickness burns greater than 10% total body surface area (TBSA)
2. Burns that involve the face, hands, feet, genitalia, perineum or major joints
3. Any third-degree burn
4. Electrical burns, including lightning injuries
5. Chemical burns
6. Inhalation injury
7. Burn injury in patients with pre-existing medical disorders that could complicate management, prolong recovery or affect mortality
8. Any patients with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality

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1. Treat according to CPR protocol
2. Use airway and C-spine precautions
3. Stop the burning process

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1. Stop the burning process with water
2. Remove all clothing and jewelry
3. Monitor pulses in circumferentially burned extremity
4. Keep patient warm

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1. Turn off power source or remove source before rescue
2. Monitor for cardiac arrhythmias
3. Start CPR if needed
4. Remove clothing and jewelry
5. Document pulses of affected extremities
6. Keep patient warm

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1. Flush for one hour at the scene if no other trauma and the patient’s vital signs are stable
2. Remove all clothing, shoes and jewelry (they can trap chemicals)
3. Brush powder off before flushing with water; flush with copious water by shower or hose for an additional hour at the local ER
4. Keep patient warm

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1. Administer high flow 100% oxygen to all burn patients
2. Be prepared to suction and support ventilation if necessary
3. If you suspect an inhalation injury, intubate immediately

You can detect an inhalation injury by observing the following:

• Burned in an enclosed space
• Dark or reddened oral and/or nasal mucosa
• Burns to the face, lips, nares, singed eye brows or singed nasal hairs
• Carbon or soot on teeth, tongue or oral pharynx
• Raspy, hoarse voice or cough
• Stridor or inability to clear secretions may indicate impending airway occlusion

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Fluid needs are related to the extent of the burn and body size. Use the Rule of Nines for adults and children to estimate the body surface area of second and third degree burns. Fluid resuscitation is needed to supplement circulating volume and to treat hypovolemic shock.

For large injuries, place two large bore IVs in a non-burned extremity (through burned tissue if there is no alternative) and use femoral approach if a central line is the only option.

Calculate the fluid using the Parkland formula:

-Adults: 2-4 ml/Ringers Lactate x Kg body weight x % burn. Give the first half over the first eight hours and the remainder over the next 16 hours.

-Children over age 10: Use the same formula for adults and consult a Burn Center Surgeon.

-Children under age 10: Start with 3-4 ml/Ringers Lactate x Kg body weight x % burned, and consult a Burn Center Surgeon.

Place foley to accurately measure urine, that’s output is an indication of the progression and treatment of hypovolemic shock, or burn shock. Discard initial urine in the bladder.

Titrate Ringers Lactate based on urine output:

• Adult or young adolescent: 30 to 50 cc/hr
• High voltage electrical injury: 75-100cc/hr
• Children under 30 kg: 1cc/Kg/hr

If there is no urine output, increase the rate of fluids by 1/3. If there is only a scant amount of dark or concentrated urine, pigments, myoglobin and/or hemoglobin may be blocking the kidney – especially in a high voltage electrical burn. If urine output and pigment clearing do not respond to increased fluid administration, promptly consult a Burn Center Surgeon.

High Dose vitamin C for burn injuries = 30% TBSA 66Mg/Kg/hr. Contact Burn Center Surgeon for further instructions.

Burn situations that require special fluid management are:

• Electrical injury
• Inhalation injury
• Patients whose fluid resuscitation is delayed
• Patients burned while intoxicated
• Children and infants

Monitor lung sounds during fluid resuscitation for overload. Elevate head and burned extremities ASAP.

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Give all pain medication via IV. Provide Morphine Sulfate (if not contraindicated) in the following proportions:

• Adults: 3-5 mg IV q 10 minutes or prn
• Children: Titrate IV Morphine Sulfate by weight (0.1 Mg/Kg/dose) or consult a Burn Center Surgeon
• Do not use ice or iced normal saline as a comfort measure

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• Wrap patient in clean or sterile, dry sheet
• Place blankets over patient to ensure warmth
• Cover heat with an extra layer
• Provide warm fluids, if possible

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• Current Issue (PDF - 3.9 MB)

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• Learn about burns (PDF - 4.42 MB)
• Tips about burns (PDF - 1.94 MB)

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Our burn surgeons are always available to answer your transfer or other questions.

• Referrals: (877) 863-9595
• Mobile: (706) 830-7511
• Pager: (888) 259-0971

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