For Referring Physicians

Patient Transport Number: 1-800-822-2233

Initial Management

  • Stop the burning process
  • Remove all clothing and jewelry
  • Keep patient warm
  • Obtain complete history and evaluate for associated injuries

Airway Management

Administer 100% oxygen

Suspect inhalation injury if:

  • Injury occurred in enclosed space
  • Presence of facial burns singed nasal hairs, carbonaceous sputum, soot on teeth or tongue, inflamed oral or nasal mucosa

Assess for airway distress

  • Rapid respiratory rate, agitation, hoarse voice, stridor, cyanosis

Tip: If inhalation injury is suspected, consider early intubation

Monitor carboxyhemoglobin levels

  • <15% rarely symptomatic
  • 15% - 40% associated with CNS changes
  • 40% - 60% associated with obtundation

Fluid Resuscitation


Place 2 large bore IV's

  • Attempt in nonburn extremity (may place through burned skin if necessary)


Calculate body surface area burned

Calculate body surface area burned image

Tip: To estimate scattered burns: patient's palm surface = 1% total body surface area


Calculate fluid resuscitation

  • Adults
    • Age >15 years
    • Ringers Lactate 2-4cc X kilogram body weight X percent burn.
  • Infants and children
    • Ringers Lactate 3-4cc X kilogram body weight X percent burn.
  • For infants < 4 years old add maintenance fluid of D5LR
    • For the 1st 10 Kg of body weight: 100cc/Kg/ 24 hrs
    • For the 2nd 10 Kg of body weight: 50cc/Kg/24 hrs
    • For each Kg of body weight above 20 Kg: 20cc/Kg/24 hrs

Tip: Monitor glucose for infants and young children


Administer fluid

  • Infuse 1/2 estimated resuscitation volume over first 8 hrs
  • Infuse 1/2 estimated resuscitation over next 16 hrs

Tip: Fluid resuscitation begins at time of injury


Monitor urine output

Insert foley and titrate IV fluid to goal of:

  • Adults: 30-50cc/hour
  • Children: 1cc/Kg/hour


  • Insert NG for body surface area burned >20% or helicopter transport
  • Administer pain medication IV
  • Initial laboratory studies
    • CXR, hematocrit, electrolytes, blood urea nitrogen, carboxyhemoglobin, arterial blood gas
  • Administer Tetanus toxoid IM if necessary
  • Elevate head if spine cleared
  • Consider spine precautions
  • Monitor pulses for third degree circumferential extremity burns. If diminished or absent call burn center.

Transport to Burn Center

  • Record and report
    • History of incident and associated injuries
    • Allergies
    • Medications
    • Past medical/surgical history
    • Last meal
    • History of drug or alcohol use
  • Maintain adequate airway protection
  • Keep patient warm
  • Transport in dry sheet or blanket, do not apply topical ointment or ice to wound

ABA Criteria for Transfer

  • American Burn Association Criteria For Transfer
    2nd degree burns >10% body surface area
  • 3rd degree burns
  • Burns to face, hands, feet, genitalia, perineum
  • Electrical burns (including lightning injury)
  • Chemical burns
  • Inhalation injury
  • Patients with pre-existing conditions
  • Circumferential third degree burns to extremity or chest
  • Hospitals without qualified personnel or equipment for care of burn injured children