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CHAPTER 104 ■ BURNS
ANGELA M. ELLISON, MARGARET EMILY SAMUELS-KALOW

GOALS OF EMERGENCY CARE
As with any acute situation, the goals of emergency care for the burned
patient include the protection of the airway, and maintenance of breathing
and circulation. For the burned patient in particular, this will include
attention to the potential for inhalational injury and airway edema,
consideration of burn location and need for escharotomy to allow effective
chest wall movement, and early careful fluid resuscitation of burn shock.
Beyond immediate resuscitative interventions, appropriate wound care can
significantly improve both mortality and functional outcomes. Concomitant
control of pain is also an important aspect of care for the burned patient,
both to prevent unnecessary discomfort and to facilitate required
procedures. Finally, burn management aims at decreasing the risk of
infection created by disruption of barrier function of the skin, and

promoting healing and optimal cosmetic outcomes.
KEY POINTS
Burns should be described by estimated depth (superficial, partial
thickness, or full thickness) and total-body surface area (TBSA)
involved.
Significant burns are often accompanied by other injuries
(including ocular, inhalational, or traumatic) that may require
emergent assessment and treatment.
Full-thickness burns will be insensate due to destruction of the
cutaneous nerves of the dermis.
Severe burn injury requires intravenous fluid resuscitation, often
calculated using the Parkland formula: IV fluid volume (mL) =
(weight in kg) × (% TBSA burned) × 4. Half of this volume is given
in the first 8 hours and the remaining half during the subsequent
16 hours, in addition to maintenance fluids.


RELATED CHAPTERS
Resuscitation and Stabilization
Airway: Chapter 8
Shock: Chapter 10
Signs and Symptoms
Pain: Dysphagia: Chapter 56
Respiratory Distress: Chapter 71
Stridor: Chapter 75
Wheezing: Chapter 84
Medical, Surgical, and Trauma Emergencies
Child Abuse/Assault: Chapter 87
Toxicologic Emergencies: Chapter 102
The Children’s Hospital of Philadelphia Clinical Pathway

ED Pathway for Evaluation/Treatment of the Child With a Burn
Injury
URL: />Authors: M. Lavoie, MD; B. Koza, RN; D. Perks, CRNP; E.
Szydlowski, MD; J. Lavelle, MD
Posted: February 2012, last revised April 2018

INITIAL ASSESSMENT AND RESUSCITATION
CLINICAL PEARLS AND PITFALLS