Back to Protocols

Burns Protocol

HIGH PRIORITY

Comprehensive burn assessment and management including TBSA calculation and fluid resuscitation

Initial Management

Stop the Burning Process

Remove clothing, jewelry, irrigate chemical burns

Cool the Burn

Room temp water for 10-20 min (not ice)

Cover the Burn

Clean, dry sheets or dressings

Prevent Hypothermia

Keep patient warm, monitor temperature

Rule of 9s Calculator

Parkland Formula

Burn Depth Classification

First Degree

Appearance

Red, dry, painful

Healing

3-7 days

Treatment

Cool water, aloe, NSAIDs

Scarring

None

Second Degree (Superficial)

Appearance

Blisters, red, wet, very painful

Healing

2-3 weeks

Treatment

Clean, dress, pain control

Scarring

Minimal

Second Degree (Deep)

Appearance

White/red, less painful, may blister

Healing

3-8 weeks

Treatment

May need grafting

Scarring

Significant

Third Degree

Appearance

White, leathery, painless

Healing

Requires grafting

Treatment

Surgical debridement and grafting

Scarring

Severe

Fourth Degree

Appearance

Black, charred, involves bone/muscle

Healing

Requires surgery

Treatment

Amputation may be needed

Scarring

Severe/loss of function

Special Burns

Electrical Burns

  • • Cardiac monitoring mandatory
  • • Check CK, myoglobin for rhabdomyolysis
  • • More extensive than appears
  • • May need fasciotomy

Chemical Burns

  • • Copious irrigation (30-60 min)
  • • Remove contaminated clothing
  • • Identify chemical if possible
  • • Special: HF acid needs calcium gluconate

Inhalation Injury

  • • 100% oxygen immediately
  • • Consider early intubation
  • • Check CO/cyanide levels
  • • Bronchoscopy if available

Pain Management & Wound Care

Analgesia

  • • IV opioids for moderate-severe pain
  • • Ketamine for dressing changes
  • • Multimodal approach preferred
  • • Regional blocks if appropriate

Wound Care

  • • Clean with mild soap and water
  • • Debride loose tissue only
  • • Leave blisters intact initially
  • • Silver sulfadiazine or alternatives
  • • Update tetanus prophylaxis

Complications

  • • Compartment syndrome
  • • Infection/sepsis
  • • Hypothermia
  • • Acute kidney injury