| 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
|
| Fluid Resuscitation |
- Pre-Hospital/Early Hospital Prior to TBSA estimation:
- < 5 yrs: LR at 125 mL/hr (may use D5LR in infants)
- 6-13 yrs: LR at 250 mL/hr
- ≥ 14 yrs: LR at 500 mL/hr
- After Estimation of TBSA, 3 mL/kg/% TBSA of Crystalloid (LR):
- Administer half of the volume in the first 8 hrs
- Administer second half over next 16 hrs
- Add maintenance D5LR for children < 5 yrs of age
- Include volume of pre-hospital fluids in calculations
|
| 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 |
- Ensure dry sheet, warm blankets
- Warmed IV fluids
|
| CO Poisoning |
- Administer 100% O2
- Elevated carboxyhemoglobin
- Indications for hyperbaric oxygen therapy (Consider PCC Consult, 215-590-2100):
- LOC at the scene
- Persistent neurologic symptoms in the ED
- Seizure
- Evidence of cardiac injury
- Carboxyhemoglobin levels > 25-40%
- Consult HUP Hyperbaric Physician
|
| 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/jewelry
- Copious irrigation
- If eye involved, consider topical analgesic (proparacaine)
- Use morgan lens for irrigation
- Goal pH 6.5-7.5 and immediate ophthalmology consult
- Consult PCC as needed
|