Primary Survey

Airway and breathing

• 100% O2 via NRB
• Pulse oximetry and consider ABG, co-oximetry
• Consider early intubation with burns >20% TBSA
• In patients with burned faces, secure ETT with ties, not tape
• NG/OG inserted on all intubated patients
• If swelling is progressive, consider early intubation in patients with larger burns, burns to the head and face, and those receiving large volumes of fluid resuscitation (inc. edema)
• Consider monitoring patients with a possible inhalation injury for 24 hours
• Monitor chest expansion in circumferential torso burns (→ possible escharotomy)

Circulation

• Large bore IV or I/O
• Do not place IV bolus unless there is associated trauma
• Elevate burned extremities and ensure adequate pulses
• If burn >20% TBSA, administer IV fluid (LR is fluid of choice, but NS can be used if LR is not available).
  • Pre-hospital/triage fluids:
    • ≤ 5 years: 125 mL/hr
    • 6-12 years: 250 mL/hr
    • ≥13 years: 500 mL/hr

Disability and environment

• Monitor GCS: Typically awake, alert and oriented
• Remove all clothing and jewelry
• Keep warm and dry
• Do not use wet dressings, wet blankets or ice

Secondary Survey

Hospital management

• Evaluate wound and calculate TBSA%
• Consider a virtual consult with a burn center
• Check tetanus status
• Pain management: Small, frequent doses with reassessment
• Hospital fluids:
  • Adults and children (≥13 yrs):
    • 2 mL x kg x TBSA% divided by 16
    • U/O 0.5 mL/kg/hr or 30-50 mL/hr
  • Infants and children (≤12 years):
    • 3 mL x kg x TBSA% divided by 16 plus D5LR at maintenance rate
    • U/O 0.5-1 mL/kg/hr or 30 mL if over 30 kg
  • Electrical injury:
    • 4 mL x kg x TBSA% divided by 16
    • Adults with pigment in urine: U/O 75-100 mL/hr

<aside> 💡

For educational use only. Double check important info. If you have feedback or corrections, submit here.

</aside>