Airway Stabilization (see trauma/RSI)
- 100% humidified 02 for all pts with possible inhalational injury.
- All patients with large burns or closed-space burns should be assumed to have carbon monoxide (CO) poisoning until further evaluation is obtained.
- Measure carboxyhemoglobin (to evaluate for carbon monoxide exposure) and obtain an ABG with concerns for respiratory compromise.
- Intubate for evidence of inhalational injury.
- Evaluate for carbonaceous material in nares and mouth. If present, obtain airway stabilization early as edema and airway compromise develop rapidly.
Aggressive fluid resuscitation based on BSA burned (see below) on infants with >10% BSA and children with >15% BSA.
Calculate body surface area (BSA) burned based on second and third degree burns only. Please see references to the Parkwood Formula in Harriet Lane and Peds ED texts in the department. The calculation of burn percentages, and therefore fluids to be administered, varies significantly by age. In general, the formula for fluid resuscitation according to the Parkwood formula is: 4cc/kg x wt (kg) x percent of body with second or third degree burns. Give half of total fluids in first 8 hours and the rest in the next 16 hours. Remember to always add maintenance fluids to total calculation for pediatric patients. Monitor urine output with a Foley catheter to ensure 2-3cc/kg/hr of urine.
IV analgesia is necessary for pain for moderate to severe burns. Give po pain meds for milder burns. Remember tetanus prophylaxis.
Pediatric Surgery/ Burn Team
Many of the burn patients are sedated in the Peds ED for debridement of their wounds in conjunction with the Pediatric Surgery/Burn team. The Peds ED residents and attending are responsible in those circumstances for providing pain control and sedation while the Surgery team performs the skin care, often with placement of a synthetic material called Biobrane that aids in wound healing and pain relief. If patients are discharged after debridement, they are followed very closely in Burn clinic for dressing changes and to determine need for grafting etc.
- First degree/ superficial
- Painful and erythematous; only epidermis
- Second degree/ partial thickness
- Any blistering, painful, may progress to third degree;
- Epidermis and dermis involved
- Third degree/ full thickness
- Leathery, white and painless;
- Epidermis, all of dermis