ED Pathway for Evaluation/Treatment of the Child with a Burn Injury

MD/CRNP/RN Brief Rapid Assessment

General Assess VS, administer O2
Assess for inhalation injury
Assess severity of burns
Cover patient with dry sheet
C spine collar
Airway/Breathing Consider early intubation if signs of inhalation injury:
  • Hoarseness, facial/oral soot, stridor, singed nasal hair, facial burn
IV Access/
Fluid Resuscitation
NS bolus 20 cc/kg immediately
Parkland Formula to estimate fluid requirements in the first 24 hours following a burn injury:
  • 4 mL/kg/% TBSA of crystalloid (NS)
  • Add maintenance D5NS for children < 5 yrs of age
  • Include volume of pre-hospital fluids
  • Administer half of the volume in the first 8 hrs
  • Administer second half over next 16 hrs
Lab Studies CBC, CMP, PT/PTT, VBG with co-oximetry as indicated
Urine pregnancy for post-pubertal females
Analgesia IV/oral pain medication per ED Burn Care Order Set
Temperature Regulation Warm blankets
Warmed IV fluids
CO Poisoning Administer 100% O2
Elevated carboxyhemoglobin
Indications for hyperbaric oxygen therapy (Consider PCC Consult, phone: 215-590-2100)
  • LOC at the scene
  • Persistent neurologic symptoms in the ED
  • Seizure
  • Evidence of cardiac injury
  • Carboxyhemoglobin levels > 25-40%

Consult hyperbaric physician at HUP
Hyperbaric Physician Contact: 215-662-7785
8am-5pm; otherwise call PCC

Cyanide Poisoning Indications for hydroxocobalamin (consider PCC consult)
  • History of CPR
  • Abnormal VS, intubation, other evidence of hypoxic injury
  • Severe metabolic and /or lactic acidosis
Electrical Burns UA, CK, EKG
Strict monitoring of urine output (75 – 100 cc/hr if myoglobinuria)
Chemical Burns
  • Consider need for decontamination room
  • Remove clothing/jewerly
  • Copious irrigation
    • if eye involved, consider topical analgesic (proparacaine)
    • use morgan lense for irrigation
    • goal pH 6.5-7.5 & immeditate ophtomology consult
  • Consult PCC as needed