Burn 

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
□ Pediatric hypotension is defined as SBP < 70 + (age in years x 2) mmHg

□ Rule of 9’s is different for adults and children

□ Rapid heat loss from burns is common		□ Burns, pain, swelling 
□ Dizziness 
□ Loss of consciousness 
□ Hypotension / shock 
□ Airway compromise / distress, singed facial or nasal hair, hoarseness / wheezing / stridor		□ Superficial (1°) – red and painful 
□ Partial thickness (2°) – blistering and painful 
□ Full thickness (3°) – painless and charred or leathery skin 
□ Chemical 
□ Thermal 
□ Electrical 
□ Radiation

Clinical Management Options

EMT-B
• Oxygen target SpO2 92% – 96%  
• Basic Airway Management as needed 
• Remove rings, bracelets, or other constricting items 
• If thermal burn: < 10% body surface area, then cool down the wound with Isotonic Crystalloid or sterile water 
• If thermal burn: After cooling cover burn with a dry sheet or dressings 
• If chemical burn: Remove clothing or expose area, brush off any dry chemicals or powder, then flush area with large amount of water or Isotonic Crystalloid 
• Establish BSA, location(s), and type of burn 
Paramedic
• Partial/Full Thickness burn area > 10% BSA then: 
• Isotonic solution infusion
• 1L NS for adults
• 20cc/kg for children
• Pain Management Guideline  
• Continuous ETCO2 and ECG monitoring 
• If airway burn: Nebulized Epinephrine for Respiratory Distress and prepare to secure the airway
Cricothyrotomy for Airway Obstruction 
• Calcium Chloride for hydrofluoric acid burns with unstable vital signs, such as hypotension, tachy/bradycardia, ectopic beats, and/or ECG changes 
Consult Online Medical Control as Needed

Pearls

  • Consider nebulized epinephrine for respiratory distress early in airway burns when horsed/muffled voice, stridor, etc. are presenting. It can cause bronchodilation and reduce the airway edema.
  • Evaluate BSA: Use chart or use palm side of patient’s hand = 1% BSA 
  • Critical Burns: 
    • >20% 2° and 3° body surface area (BSA) age > 10. 
    • >10% BSA age < 10 or > 50. 
    • 3° burns >5% BSA. 
    • 2° and 3° burns to face, eyes, hands or feet or genitalia; electrical burns; respiratory burns; deep chemical burns. 
    • Burns with extremes of age or chronic disease; and burns with associated major traumatic injury. 
  • Non-critical burns (< 5% BSA 2nd and 3rd) not complicated by airway compromise or trauma do not require transport to a trauma center. 
  • Potential CO exposure should be treated with 100% oxygen. 
  • Circumferential burns to extremities are dangerous due to potential vascular compromise 2° to soft tissue swelling. 
  • Burn patients are prone to hypothermia – Never apply ice or cool burns that involve >10% body surface area. 
  • Do not overlook the possibility of multiple system trauma or child abuse with burn injuries. 
  • Hydrofluoric acid burns of 3% BSA may be fatal and may have little to no external signs