1. Burns of the airway with facial swelling or signs of inhalation injury should necessitate immediate rapid sequence intubation.
  2. Remove involved clothing and jewelry.
  3. Consider treating for carbon monoxide and/or cyanide toxicity, if appropriate.
  4. Assess burns for percent of body surface burned and depth.
  5. Refer to the Fluid Management Protocol and the Parkland formula.
    1. Attempt to maintain urine output 0.5-1 mL/kg/hr in children.

Cover burns with clean dry dressing

  1. Leave bullae intact.

Consider escharotomies for circumferential burns after consulting with burn center:

  1. Chest: bilateral, midaxillary incisions for severe respiratory compromise.
  2. Extremities: for compromised neurovascular status.


  1. Irrigate with copious amounts of water or sterile saline.
  2. For eye exposure, consider prochlorperacaine drops and continuous irrigation
  3. Consider calcium preparations for hydrofluoric acid burns


  1. Monitor urine for signs of myoglobinuria (dark urine, urine myoglobin, or positive dipstick for blood).
  2. These patients will require aggressive fluid therapy
  3. Consider Sodium Bicarbonate (1-2 mEq/kg in 1 liter D5W) to alkalinize urine


  1. Stewart C. Emergency care of pediatric burns. Emerg Med Rep. October 2000;5(10):101–111.
  2. Passaretti D, Billmire DA. Management of pediatric burns. J Craniofac Surg. September 2003;14(5):713–718

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