If it’s an emergent transport, use a moist, saline dressing.

If you’re sending a patient to follow-up in our clinic in the next 24-48 hours, use a polysporn, xeroform or dry-sterile dressing.

Airway Management

  • Administer highflow 100% oxygen to all burn patients.
  • Be prepared to suction and support ventilation if necessary.
    • Signs of a possible inhalation injury:
      • Burned in an enclosed area
      • Dark or reddened oral or nasal mucosa
      • Burns to the face, lips, nose, including singed eyebrows and 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.
  • If you suspect an inhalation injury, consider intubation.

No. The majority of early burn wounds can be treated with topical, antimicrobial agents because the risk of early burn wound infection is low.  The goal is to prevent early colonization.

The anatomy of a child places them at higher risk for airway obstruction following a thermal injury. A child’s airway is relatively small; thus, less swelling is needed to cause a clinically significant airway obstruction. Practitioners or caregivers should be aware of these anatomical differences and the potential risk for airway compromise. Soot about the nose and mouth, carbonaceous sputum and facial involvement following a thermal injury should alert the physician or caregivers to potential future airway issues.  The decision to intubate is based on good clinical judgment with the goal of securing an airway being an elective event versus emergent one.


Pre-Hospital Fluids:

  • <5 years…………. 125 mL/hr
  • 6-13 years………. 250 mL/hr
  • ≥14 years……….. 500 mL/hr

Fluids in the Emergency Department:

  • 2-4 mL Ringer’s Lactate x kg bodyweight x percent burn.
  • Give half over the first eight hours and remainder over next 16 hours.
  • Calculate fluids from time of accident.

A Adult ≥14 2 mL
C Child <14 3 mL
E Electrical 4 mL

For TBSA >20%, consider placing Foley catheter to accurately measure urine output.

Titrate Ringer’s Lactate based on urine output:

  • Adult or young adolescent >30kg ... 30-50 mL/hr
  • Children <30kg ... 1 mL/kg/hr
  • High-voltage electrical injury ...75-100 mL/hr

> Consult Burn Center if urine is black/brown/red or <1 mL/kg/hr.

Burn situations that require special fluid management are:

  • Electrical injuries.
  • Inhalation injuries.
  • Patients in which fluid resuscitation is delayed.
  • Patients burned while intoxicated.
  • Children and infants.

If you have questions or concerns about fluid resuscitation, contact the Burn Center at (855) 863-9595.

  1. If child abuse/neglect is suspected, please contact the local county Child Protective Services Office as soon as possible.
  2. Notify law enforcement
  3. Rule out other significant injuries (Head CT, Skeletal Survey if able)
  4. Document other injuries/findings
  5. Document history provided by caregivers using exact quotes when possible