Burn Injury/Thermal Burn — Physical Care — Clinical Pathway: Inpatient

Burn Injury Clinical Pathway — Inpatient

Physical Care

Pain Control
  • Acetaminophen and/or ibuprofen around the clock
  • Oral opioid prn and before dressing changes
  • IV opioid prn before dressing changes
  • Procedural sedation prn for debridement or dressing changes
  • Pain Team and Child Life consults prn
Temperature Control
Nutrition
Fluid Management
  • Continue fluid resuscitation (utilizing the Parkland Formula) if this was initiated in the ED
  • Begin immediately for burns > 15% TBSA
  • Patients ≤ 13 yrs:
    • 3 mL /kg/% TBSA/24 hrs of crystalloid (LR)
  • Patients ≥ 14 yrs (includes adults):
    • 2 mL/kg/% TBSA/24 hrs of crystalloid (LR)
  • Add maintenance D5NS for children and infants ≤ 30 kg
  • Administer half of the volume in the first 8 hrs
  • Administer the second half over the next 16 hrs
  • Foley catheter with goal urine output:
    • Young children ≤ 30 kg: 1 mL/kg/hr
    • Children > 30 kg and ≤ 17 yrs: 0.5 mL/kg/hr
    • Adults: 0.5 mL/kg/hr or 30-50 mL/hr
  • Record intake and output every 4 hours
  • Adjust fluids based on urinary output and clinical response
Vital Signs
Labs
  • For burns > 15% TBSA, fluid resuscitation, smoke inhalation, or PICU admission, assure the following labs are obtained
    • CBC, BMP, ABG, PT/PTT
    • Add carboxy-hemoglobin level for smoke inhalation
  • Repeat as needed if abnormal:
  • BMP if ongoing fluid resuscitation
  • ABG, carboxy-hemoglobin for hemodynamic instability or respiratory failure