Regions Direct – Burn Center

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Checklist for severe burns

  • Airway and breathing
    • Assess airway immediately.
    • For carbon monoxide or smoke inhalation, provide high flow O2 at 15 liters/min (100 percent) using a non-rebreathing mask.
    • Intubate for circumferential neck burns, sooty sputum, hoarseness, dry cough, stridor or other significant respiratory distress.
  • Circulation
    • Assess circulation of involved extremities; escharotomies may be required, but generally not within the first four hours after a burn.
  • C–spine immobilization
    • Immobilize if involved in blunt trauma or high voltage electrical injury (> 1,000 volts).
  • Disability
    • Assess neuro status using AVPU Method:
      • Alert
        Responds to Verbal stimuli
        Responds to Painful stimuli
  • Expose and examine
    • Remove all clothing, jewelry and contact lenses.
  • Fluid resuscitation (use Lactated Ringers)
    • Start two large bore IV’s
    • Adult and Child > 20 kg: 4cc per kg per percent burn (Give half of the fluid over first eight hours, the other half over the next 16 hours.)
    • A child less than 20 kg: 3 cc per kg per percent burn (Give half of the fluid over the first eight hours, the other half over the next 16 hours. Add maintenance rate using D5LR and divide evenly over 24 hours.)
    • Maintenance formula:
      • 100 cc per kg for first 10 kg of body weight
      • 50 cc per kg for second 10 kg of body weight
  • Foley catheter
    • Adjust IV rate to maintain urine at 30–50 cc per hour in adults and one cc per kg in children. For electrical burns with myoglobin (dark urine), maintain urine at 100 cc per hour.
  • Nasogastric tube
    • Use for BSA > 25 percent burns or intubated patients.
  • Pain management
    • Use IV morphine.
  • Chemical burns
    • Remove clothing, dust off powdered chemicals then flush all areas with water for at least 30 minutes.
  • Wound care
    • Cover with a clean, dry sheet and keep patient warm.
    • Exercise caution if using wet compresses — may result in hypothermia.
    • Elevate upper extremities if burned.
  • History
    • Obtain history of mechanism of injury and pertinent past medical history.
    • Obtain laboratory studies as indicated.
    • Immunize for tetanus if indicated.