Physicians or staff are encouraged to call the Burn Center at (1-888-744-4791 or
206-744-5735) ) with questions or concerns about these recommendations or any other treatment issues.
1. Remove any sources of heat. Remove any clothing that may be burned, covered with chemicals or are constricting.
2. Initiate Fluid Resuscitation.
- Estimate the burn size based on the rule of nines or based on patient palm size(1%) TBSA) to calculate the resuscitation fluid volume.
- Lactated ringer solution at 3cc/kg/%TBSA burn
- In children <20Kg also administer D51/2NS solution @ maintenance rate
- Do not give dextrose solutions (except for maintenance fluids in children)- they may cause an osmotic diuresis and confuse adequacy of resuscitation assessment.
3. Assess Urine Output. Insert Foley catheter in patients with burns >15 percent TBSA.Adequate urine output is 30 mL/hr in adults and 1.5 mL/kg / hr in a child less than 20 kg.
- Observe urine for burgundy color (seen with massive injuries or electrical burns).There is a high incidence of renal failure associated with these injuries, therefore, prompt and aggressive intervention is required.
Reminder: If the urine is red or brown, please consult Burn Center staff 1-888-744-4791.).
4.Insert Nasogastric Tube.
- Give an IV Proton blocker if the patient will not be transported within 12 hours.
5. Escharotomies. If transfer will be completed within 12 hours, escharotomies will not be needed.
- Elevate burned extremities.
6. Medications
- After fluid resuscitation has been started, pain medications may be titrated in small doses.
- No antibiotics should be given.
- A tetanus shot should be given
7. Wound Care. Debridement and application of topical antimicrobials is usually unnecessary. Transport patient in dry sheet and blanket, keeping patient warm.
8. Special Considerations for Chemical Burns.
- Remove ALL clothing.
- Brush powered chemicals off wound: then flush burns for a minimum of 30 minutes with running water. Be careful to protect yourself.
- Irrigate burned eyes with a gentle stream of saline. Follow with an ophthalmology consult if transport is not imminent.
9. Special Considerations for Electrical Injuries
- Elevate burned extremities above the level of the heart on pillows.
- Monitor distal pulses.