Emergency Burn Care

1. Stop Burning Process

  • Remove all clothing and jewelry
  • Irrigate chemical burns with copious amounts of water for 15 minutes

2. Breathing

  • Administer O2
  • Examine airway for potential inhalation injury

3. Bleeding

  • Burns do not bleed, so check for other injuries

4. Shock

  • Insert large bore IV catheter & secure
  • Formula for fluid resuscitation for the first 24-hours:
  • Adult: (weight in kg) x (% burn) x (4cc Ringer’s Lactate)
  • Administer 1/2 of volume in first 8 hours post-burn
  • Child under 3 yrs: (weight in kg) x (% burn) x (3cc Ringer’s Lactate) + (maintenance fluid of D51/2NS based on weight)

5. Insert Foley Catheter in Burns > 30%

  • Monitor output every hour:
  • 30-50ml/hour 20kg plus
  • 1ml/hr/kg/wt in patients under 20kg

6. History

  • Circumstances of injury
  • Pre-existing illnesses
  • Medications
  • Allergies
  • Tetanus Toxoid – Administer if indicated

7. Physical Exam

  • Estimate extent & depth of burn (Rule of 9’s)
  • First degree burns are NOT included in burn estimation
  • Weigh the patient
  • Check for associated injuries

8. Nasogastric Tube

  • Insert & evacuate stomach to prevent aspiration or emesis if intubated
  • Keep NPO

9. Comfort Measures

  • Keep warm & sedate patient intravenously using small doses until pain relief is obtained

10. Lab & X-ray

  • CBC, Lytes, ABG, PCXR & Carboxyhemoglobin
  • Trauma workup with c-spine clearance when indicated

11. Initial Burn Wound Care

  • Wipe off debris & loose skin
  • Cover wounds with dry dressing or sheet

12. Determine Depth of Burn Injury

  • First degree: pink in color, no blisters, minor to moderate pain
  • Second degree: bright pink to red, blisters present, wet & weepy, blanches with capillary refill present, strong pain
  • Third degree: may initially appear to be second degree, no blisters, dry/tight/leathery, brown/tan/waxy or pearly white, no blanching or capillary refill, pain free

13. Treat Minor Burn Wounds

  • Medicate for pain prior to wound care
  • Remove all blisters & devitalized tissue
  • Clean the wound with antibacterial soap & water
  • Apply antibacterial ointment
  • Wrap wound with light gauze
  • Cleanse wound each day, removing all previous ointments before reapplying

14. Triage Criteria for Consultation/Referral

  • Total burn size is 15%+
  • Third degree burn is 10%+
  • Patient is under age 6 or over age 60
  • Has airway or inhalation injury
  • Has electrical injury
  • Has significant associated injury or pre-existing disease
  • Has deep burns on face, hands, feet, or perineum
  • Is a suspected child abuse case

Rule of 9's


 For inpatient transfers or outpatient appointments, call (800) 743-7718 or (225) 387-7717.