Browse categories and answer follow-up questions to refine your symptom profile.
History
Mechanism and exposure
Mechanism details
Thermal scald
Thermal flame
Contact burn
Chemical exposure
Electrical exposure
Radiation exposure
Explosion
Confined space fire
Clothing ignition
Assault concern
Occupational exposure
Time of injury
Time from injury to cooling
First aid applied
Cooling with running water duration
Ice exposure
Home remedies applied
Chemical agent name if known
Chemical form
Chemical concentration if known
Chemical contact duration
Decontamination performed
Electrical voltage category
Alternating current
Direct current
Contact time
Loss of consciousness
Fall or trauma after shock
Lightning exposure
Smoke exposure
Soot exposure
Inhaled irritants
Enclosed space exposure duration
Burn symptoms and progression
Symptom pattern
Pain severity
Pain trajectory
Numbness or decreased sensation
Tightness with swelling
Increasing blistering
Worsening redness
Drainage
Fever onset timing
Associated symptoms
Associated symptoms list
Dyspnea
Cough
Hoarseness
Stridor
Wheeze
Chest tightness
Sore throat
Dysphagia
Facial swelling
Headache
Confusion
Syncope
Nausea
Vomiting
Muscle cramps
Weakness
Dark urine
Eye pain
Vision change
Extremity pain out of proportion
Paresthesia
Alarm Features
Airway and inhalation injury red flags
High risk inhalation features
Stridor
Progressive hoarseness
Respiratory distress
Hypoxemia
Facial burns
Oropharyngeal burns
Soot in mouth
Carbonaceous sputum
Singed nasal hairs
Enclosed space exposure
Circumferential neck burns
Altered mental status after smoke exposure
Shock and systemic toxicity red flags
Immediate escalation triggers
Systolic blood pressure under 90 mmHg
Mean arterial pressure under 65 mmHg
Lactate 4 mmol/L or higher
Persistent tachycardia with cool extremities
Hypothermia
Severe metabolic acidosis
Suspected cyanide toxicity
Refractory hypoxemia on 100 percent oxygen
Limb threat and compartment red flags
High risk extremity findings
Circumferential full thickness burn
Increasing pain with passive stretch
Paresthesia
Pallor
Pulselessness
Poikilothermia
Tense swelling
Capillary refill delay
High risk locations and special populations
High risk context
Burns to face
Burns to hands
Burns to feet
Burns to genitalia
Burns to perineum
Burns over major joints
Age under 5 years
Age 65 years or older
Pregnancy
Immunocompromised state
Diabetes mellitus (E11.9)
Anticoagulation
Suspected non accidental injury
Inability to ensure safe wound care at home
Medications
Current medications affecting burn care
Medication profile
Anticoagulants
Antiplatelets
Insulin
Oral hypoglycemics
Chronic opioids
Benzodiazepines
Immunosuppressants
Systemic corticosteroids
Beta blockers
ACE inhibitors
Diuretics
Allergies and contraindications relevant to burn therapy
Therapy limitations
Sulfonamide allergy
Local anesthetic allergy
Opioid allergy
NSAID intolerance
Adhesive allergy
Latex allergy
ED analgesia and sedation history
Analgesia history
Prehospital opioids dose and route
Prehospital ketamine dose and route
Recent acetaminophen dose
Recent NSAID dose
Substance use affecting sedation risk
Diet
Intake and aspiration risk
Intake status
Last oral intake time
Nausea or vomiting
Dysphagia
Planned procedural sedation risk
Hydration and heat loss
Hydration context
Poor oral intake today
Diuretic use
Heat exposure
Excess sweating
Alcohol exposure
Baseline dehydration risk
Review of Systems
Cardiopulmonary
Cardiopulmonary symptoms
Chest pain
Palpitations
Dyspnea
Cough
Wheeze
Hemoptysis
Neurologic
Neurologic symptoms
Headache
Confusion
Weakness
Paresthesia
Seizure
Syncope
GI and renal
GI and renal symptoms
Abdominal pain
Nausea
Vomiting
Diarrhea
Decreased urine output
Dark urine
Eye and ENT
Eye and ENT symptoms
Eye pain
Photophobia
Vision change
Sore throat
Hoarseness
Dysphagia
Collateral History and Family History
Collateral source and reliability
Collateral inputs
EMS report
Family witness
Workplace witness
Photo or video of scene
Chemical safety data sheet availability
Family history relevant to complications
Familial conditions
Malignant hyperthermia history
Bleeding disorders
Early cardiovascular disease
Inherited arrhythmia syndromes
Risk Factors
Comorbid and host risk
Host risk factors
Diabetes mellitus (E11.9)
Peripheral vascular disease (I73.9)
Chronic kidney disease (N18.9)
Chronic liver disease
COPD (J44.9)
Heart failure (I50.9)
Frailty
Malnutrition
Immunocompromised state
Smoking
Exposure and injury pattern risk
High risk exposures
Confined space fire
Synthetic material combustion
Industrial chemical exposure
High voltage electrical exposure
Arc flash exposure
Delayed presentation
Contaminated water exposure
Treatment complicating risk
Care barriers
Limited ability to do dressing changes
Limited access to follow up
Unsafe home environment
Cognitive impairment
Substance use disorder
Differential Diagnosis
Life threatening
Life threatening causes and complications
Inhalation injury with airway edema
Enclosed space fire
Facial or oropharyngeal burns
Carbon monoxide poisoning (T58)
Headache
Altered mental status
Cyanide toxicity (T65.0)
Severe lactic acidosis
Cardiovascular collapse
Necrotizing soft tissue infection (M72.6)
Pain out of proportion
Rapid progression
Compartment syndrome (T79.A)
Pain with passive stretch
Tense compartments
Rhabdomyolysis (M62.82)
Electrical injury
Dark urine
Hypovolemic shock (R57.1)
Large TBSA burn
Hypotension
Common
Common diagnoses
Superficial burn
Erythema
Blanching
Superficial partial thickness burn
Blistering
Moist pink wound bed
Deep partial thickness burn
Mottled wound bed
Reduced sensation
Full thickness burn
Leathery eschar
Painless center
Chemical burn
Ongoing pain after exposure
Unknown agent
Electrical burn
Small entry wound
Deep tissue injury concern
Less common and mimics
Less common and mimics
Stevens Johnson syndrome or toxic epidermal necrolysis (L51.1)
Mucosal involvement
Medication exposure
Staphylococcal scalded skin syndrome (L00)
Diffuse tenderness
Positive Nikolsky sign
Cellulitis (L03.90)
Progressive erythema after days
Fever
Contact dermatitis (L23.9)
Pruritus
Vesicles in exposure pattern
Frostbite (T33)
Cold exposure
Pallor then blistering
Past Medical History
Conditions affecting resuscitation and healing
Relevant conditions
Diabetes mellitus (E11.9)
Heart failure (I50.9)
Chronic kidney disease (N18.9)
Chronic liver disease
COPD (J44.9)
Peripheral vascular disease (I73.9)
Immunocompromised state
Seizure disorder
Prior procedures and baseline function
Baseline status
Prior skin grafts
Prior burn injury
Implanted cardiac device
Baseline mobility limitations
Baseline cognition limitations
Physical Exam
Initial appearance and vitals pattern
Initial assessment
Toxic appearance
Work of breathing
Voice quality
Temperature trend
Heart rate trend
Blood pressure trend
Oxygen saturation trend
Airway and pulmonary exam
Airway and respiratory findings
Oropharyngeal edema
Soot in oropharynx
Facial burns distribution
Singed nasal hairs
Stridor
Wheeze
Crackles
Accessory muscle use
Skin and burn mapping
Burn characterization
Burn depth by region
TBSA estimate method used
Circumferential extremity involvement
Circumferential chest involvement
Circumferential neck involvement
Capillary refill distal to burns
Distal pulses
Sensation distal to burns
Motor function distal to burns
Eschar firmness
Blister characteristics
Contamination or foreign material
Neurovascular and musculoskeletal
Extremity evaluation
Pain with passive stretch
Compartment firmness
Range of motion limitations
Concomitant trauma survey
Eye and ENT
Eye and ENT exam
Periorbital burns
Conjunctival injection
Corneal clarity
Visual acuity
Tympanic membrane injury concern
Lab Studies
Core labs for moderate to severe burns
Core laboratory set
CBC
Electrolytes
Glucose
Creatinine
Urea
Venous blood gas
Lactate
Coagulation studies if large TBSA
Type and screen if large TBSA
Inhalation and toxic exposure labs
Smoke exposure testing
Carboxyhemoglobin
Arterial blood gas if hypoxemia
Lactate for cyanide toxicity screening
Electrical and crush complication labs
Rhabdomyolysis evaluation
Creatine kinase
Urinalysis for heme with few RBC
Potassium
Phosphate
Calcium
Infection and delayed presentation labs
Infection evaluation
C reactive protein
Blood cultures if systemic toxicity
Wound culture if purulence
Imaging
Scoring Systems
Burn size and severity tools
TBSA estimation
Rule of nines for adults
Lund and Browder chart for children
Palmar method
Patient palm including fingers about 1 percent TBSA
Use for small scattered burns
Burn depth categories
Superficial
Superficial partial thickness
Deep partial thickness
Full thickness
Burn center referral criteria
Partial thickness over 10 percent TBSA
Burns involving face
Burns involving hands
Burns involving feet
Burns involving genitalia
Burns involving perineum
Burns involving major joints
Full thickness burns any size
Electrical burns
Lightning injury
Chemical burns
Inhalation injury
Significant comorbidities
Concomitant trauma
Children in hospitals without pediatric burn capability
Need for special social support
MRI
MRI role
Not routine for acute burn depth
Consider for occult deep soft tissue injury when CT limited
CT
CT indications
Concomitant trauma evaluation
Suspected inhalation injury complications
Suspected deep tissue necrosis when diagnosis unclear
Ultrasound
Ultrasound applications
FAST if associated trauma
Lung ultrasound for pulmonary edema during resuscitation
Vascular ultrasound if limb ischemia concern
Special Tests
Airway and inhalation evaluation
Inhalation injury diagnostics
Flexible nasolaryngoscopy local protocol dependent
Bronchoscopy local protocol dependent
Soot and edema grading for risk stratification
Eye evaluation
Ocular burn testing
Ocular pH testing for chemical exposure
Fluorescein staining for corneal injury
Morgan lens irrigation local protocol dependent
Wound evaluation adjuncts
Depth and perfusion adjuncts
Capillary refill and blanching assessment
Pinprick sensation assessment
Doppler pulses distal to circumferential burns
ECG
Indications and high risk patterns
ECG indications
Electrical injury
Lightning injury
Syncope
Chest pain
Palpitations
Significant electrolyte abnormalities
High risk findings
Ventricular arrhythmia
New conduction block
Ischemic ST segment changes
Prolonged QT interval
Assessment
Burn severity summary
Working assessment elements
Burn depth category by region
TBSA estimate percentage
Inhalation injury probability
Chemical exposure severity
Electrical exposure severity
Circumferential burn risk for perfusion compromise
Pain control adequacy
Tetanus immunization status
Complications to rule out
Immediate complications checklist
Airway edema progression risk
Carbon monoxide toxicity
Cyanide toxicity
Hypovolemia
Hypothermia
Compartment syndrome
Rhabdomyolysis
Acute kidney injury
Associated trauma
Plan
First 5 minutes workflow
Time critical priorities
Cardiac monitoring for moderate to severe burns
Pulse oximetry
Noninvasive blood pressure cycling
Two large bore IV lines for large TBSA
IO access if IV access failure
Active warming measures
Remove constrictive clothing and jewelry
Stop burning process
Chemical decontamination
Remove dry chemical with brushing
Copious irrigation after brushing
Cool thermal burns
Cool running water
Avoid ice
100 percent oxygen for smoke exposure until CO excluded
Early airway control if progressive airway risk
Analgesia and anxiolysis
Pain control regimen
Fentanyl IV 25 mcg
Repeat every 5 minutes as needed
Typical total 50 to 200 mcg adult
Morphine IV 0.05 mg per kg
Repeat every 10 minutes as needed
Hydromorphone IV 0.2 mg
Repeat every 10 minutes as needed
Ketamine IV 0.2 mg per kg
For opioid sparing analgesia
Acetaminophen PO 1000 mg
Maximum 4000 mg per day adult
Ibuprofen PO 400 mg
Avoid in significant renal disease
Antiemetic
Ondansetron IV 4 mg
Repeat every 8 hours as needed
Fluids and resuscitation
Fluid strategy by burn size
Oral fluids for small burns with normal vitals
IV fluids for
Adults with TBSA 15 percent or higher
Children with TBSA 10 percent or higher
Any burn with shock
Lactated Ringers preferred
Parkland formula
4 mL per kg per percent TBSA
Half in first 8 hours from time of burn
Half over next 16 hours
Urine output targets
Adults 0.5 mL per kg per hour
Children 1 mL per kg per hour
Electrical injury 1 mL per kg per hour
Avoid over resuscitation
Rising airway pressures
Worsening extremity edema
Wound care and topical therapy
Local care steps
Gentle cleansing with soap and water
Remove loose devitalized tissue
Blister management local protocol dependent
Nonadherent dressing
Moist wound environment
Elevation of burned extremities
Topical agents for minor burns
Bacitracin ointment
Face friendly option
Daily dressing changes
Mupirocin ointment
MRSA risk option
Daily dressing changes
Silver sulfadiazine
Avoid on face
Avoid in pregnancy near term
Avoid in infants
Avoid in sulfonamide allergy
Systemic antibiotics
Not routine for uncomplicated burns
Use for clear cellulitis or sepsis
Tetanus and infection prevention
Tetanus prophylaxis
Tdap if immunization unknown or not up to date
Tetanus immune globulin for incomplete primary series with dirty wound
Toxic smoke exposure management
Carbon monoxide management
100 percent oxygen via nonrebreather
Consider hyperbaric oxygen local protocol dependent
Loss of consciousness
Neurologic deficits
Pregnancy with elevated carboxyhemoglobin
Cyanide toxicity management
Hydroxocobalamin IV 5 g adult
Repeat 5 g if refractory shock
Circumferential burn escalation
Perfusion rescue
Frequent neurovascular checks
Doppler if pulses difficult
Escharotomy local protocol dependent for
Loss of Doppler signal
Increasing pain with passive stretch
Compartment pressure concern
Reassessment loop
Reassessment timing
Repeat vitals every 15 to 30 minutes for moderate to severe burns
Repeat airway exam every 15 to 30 minutes if inhalation concern
Repeat neurovascular checks every 30 minutes for circumferential burns
Repeat urine output hourly during resuscitation
Disposition
Burn center and transfer criteria
Burn center transfer indicators
Partial thickness over 10 percent TBSA
Full thickness burns any size
Burns involving face
Burns involving hands
Burns involving feet
Burns involving genitalia
Burns involving perineum
Burns over major joints
Chemical burns
Electrical burns
Lightning injury
Inhalation injury
Significant comorbidities
Concomitant trauma
Social barriers to outpatient wound care
ICU and inpatient admission criteria
Higher level care indicators
Need for intubation
Persistent hypoxemia
Hemodynamic instability
Large TBSA requiring ongoing IV resuscitation
Rhabdomyolysis with rising creatine kinase
Acute kidney injury
Circumferential burns with perfusion threat
Observation and discharge criteria
Observation pathway considerations
Moderate TBSA with stable vitals after initial period
Pain control requiring parenteral opioids
Discharge suitability
Small superficial or superficial partial thickness burn
No inhalation concern
Pain controlled on oral meds
Reliable follow up within 24 to 72 hours
Safe home wound care plan
Discharge Instructions
Copy discharge instructions
Burn care at home
Keep dressing clean and dry
Change dressing as instructed
Wash hands before dressing changes
Apply thin layer of ointment if prescribed
Elevate the burned area when possible
Avoid sun exposure on healing skin
Pain control
Use acetaminophen as directed on label
Use ibuprofen as directed on label if safe for you
Avoid driving if taking sedating medications
Follow up
Recheck in 24 to 72 hours
Earlier follow up for worsening pain or swelling
Return to emergency care now for
Trouble breathing
Hoarseness or noisy breathing
New confusion
Fainting
Worsening swelling of a burned limb
Numbness or blue fingers or toes
Fever
Spreading redness
Pus drainage
Uncontrolled pain
Decreased urination
Dark urine
Burn on face
Burn on hands
Burn on feet
Burn on genitals
Burn crossing a joint
References
Guidelines and core sources
Evidence based sources
American Burn Association burn center referral criteria
American Burn Association practice guidance on burn resuscitation
International Society for Burn Injuries practice guidelines
Advanced Trauma Life Support guidance on burns and inhalation injury
UpToDate burn evaluation and management topic review local protocol dependent
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.