BurnMANAGEMENT

TRAUMA PRESENTATIONS · 12 SECTIONS

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532 items

☷ Legend

01Approach to the Critical Patient/attcp60

Immediate priorities

›Time critical stabilization

›Scene safety

›Ongoing exposure removed

›Smoldering clothing removed

›Airway risk

›Facial burns

›Soot in mouth or nares

›Hoarseness

›Stridor

›Enclosed space exposure

›Breathing risk

›Circumferential chest burns with restricted excursion

›Suspected inhalation injury

›Circulation risk

›Hypotension not explained by burn alone

›Concomitant trauma or hemorrhage

›Cooling and hypothermia prevention

›Cool running water 20 minutes if within 3 hours

›Ice and iced water avoided

›Warm environment and blankets during cooling

Burn classification and triage snapshot

›Depth and urgency map

›Superficial burn

›Erythema

›Dry

›Blanching present

›Superficial partial thickness burn

›Blisters

›Moist

›Blanching present

›Marked pain

›Deep partial thickness burn

›Pale or mottled

›Decreased blanching

›Diminished sensation

›Full thickness burn

›White brown or charred

›Leathery texture

›Insensate central area

›Fourth degree burn

›Extension into fascia muscle or bone

›High amputation risk

Initial actions that change outcome

›Early system decisions

›Total body surface area estimate

›Adult rule of nines for rapid estimate

›Pediatric Lund and Browder preferred

›Immediate burn center consultation triggers

›Any full thickness burn

›Partial thickness 10 percent TBSA or more

›Deep partial or full thickness involving face hands feet genitalia perineum or major joints

›Inhalation injury

›Electrical burns including lightning

›Chemical burns

›Concomitant trauma

›Poorly controlled pain

›Fluid resuscitation trigger

›Consider when TBSA exceeds 15 percent

›Avoid routine boluses without shock physiology

›Transfer planning

›Early transport coordination before edema progression

›Analgesia and thermoregulation plan during transport

02History/hx49

Burn mechanism and timeline

›Injury story

›Mechanism category

›Scald

›Flame

›Contact

›Chemical

›Electrical

›Radiation

›Cold injury frostbite overlap

›Time since injury

›Cooling already performed

›Duration of exposure

›Environment

›Enclosed space

›Explosion or blast

›Smoke exposure duration

›Associated symptoms

›Dyspnea

›Cough

›Sputum with soot

›Voice change

Patient risk modifiers

›Host factors

›Age extremes

›Infant or toddler

›Older adult

›Comorbidities

›Diabetes

›Peripheral vascular disease

›Chronic lung disease

›Heart failure

›Chronic kidney disease

›Immunocompromise

›Steroid use

›Chemotherapy

›HIV

›Medications

›Anticoagulants

›Beta blockers masking shock

›Allergy history

›Topical agents

›Opioids

Tetanus and wound context

›Immunization context

›Tetanus vaccine series completion

›Unknown or incomplete series

›Completed primary series

›Time since last booster

›Less than 5 years

›5 to 10 years

›More than 10 years

03Physical Exam/exam48

Primary survey focused findings

›ABC focused exam

›Airway and upper airway

›Soot in oropharynx

›Carbonaceous sputum

›Edema of tongue or uvula

›Singed nasal hairs

›Lung exam

›Wheeze

›Stridor

›Hypoxia

›Circulation

›Tachycardia

›Hypotension

›Delayed capillary refill in burned limb

Burn mapping and depth assessment

›Burn description set

›Location map

›Face

›Neck

›Hands

›Feet

›Perineum

›Over joints

›TBSA estimate

›Percent partial thickness and deeper only

›Superficial excluded from resuscitation calculations

›Depth estimation

›Blanching

›Moisture

›Sensation

›Color

›Eschar presence

›Circumferential injury

›Limb circumferential band

›Chest circumferential restriction

Perfusion and compartment risk

›Limb threat evaluation

›Distal pulses

›Palpable

›Doppler only

›Absent

›Distal neurologic function

›Two point discrimination change

›Paresthesia

›Capillary refill and temperature

›Cool distal extremity

›Delayed refill

›Escalation triggers

›If progressive pain with tense compartments then escharotomy or fasciotomy consult

›If ventilation limited by chest eschar then escharotomy consult

04Differential Diagnosis/ddx32

Burn mimics and overlapping emergencies

›Alternate or concurrent diagnoses

›Dermatologic mimics

›Toxic epidermal necrolysis ICD-10 L51.2

›Stevens Johnson syndrome ICD-10 L51.1

›Staphylococcal scalded skin syndrome ICD-10 L00

›Chemical injury masquerade

›Alkali exposure with minimal early pain

›Hydrofluoric acid toxicity

›Electrical injury complications

›Dysrhythmia

›Rhabdomyolysis

›Inhalation and poisoning

›Carbon monoxide poisoning ICD-10 T58

›Cyanide toxicity

›Concomitant trauma

›Blunt trauma from explosion

›Falls during fire escape

Coding aligned burn categories

›Burn and corrosion codes

›Site specific burn ICD-10 T20 to T25

›Head and neck T20

›Trunk T21

›Shoulder and upper limb T22

›Wrist and hand T23

›Hip and lower limb T24

›Ankle and foot T25

›Burn extent ICD-10 T31

›Percent TBSA bands

›Full thickness percent included

›Corrosions ICD-10 T26 to T28 and T32

›Eye adnexa T26

›Respiratory tract T27

›Other internal organs T28

05Laboratory Tests/lt34

Baseline labs for significant burns

›Resuscitation labs

›Complete blood count for baseline and hemoconcentration

›Leukocytosis as stress response

›Hemoconcentration suggesting hypovolemia

›Electrolytes and renal function for fluid plan

›Sodium and potassium shifts with capillary leak

›Creatinine trend for resuscitation adequacy

›Venous blood gas with lactate for shock physiology

›Elevated lactate suggesting hypoperfusion

›Metabolic acidosis severity

Inhalation and toxin labs

›Smoke exposure evaluation

›Co ox oximetry with carboxyhemoglobin

›Pulse oximetry may be falsely normal

›Treatment guided by symptoms and level

›Lactate for cyanide concern

›Markedly elevated lactate supporting cyanide toxicity

›Consider antidote pathway if high suspicion

Electrical and crush related labs

›High voltage or deep tissue injury set

›Creatine kinase for rhabdomyolysis

›High values correlate with muscle injury

›Trend for ongoing necrosis

›Urinalysis for heme with few RBC

›Myoglobinuria indicator

›Risk for acute kidney injury

›Potassium and calcium for dysrhythmia risk

›Hyperkalemia from cell lysis

›Hypocalcemia possible in rhabdo

Special circumstance labs

›Chemical burn adjuncts

›Serum calcium and magnesium for hydrofluoric acid

›Hypocalcemia risk

›Ventricular dysrhythmia risk

›Glucose for large burns and stress hyperglycemia

›Hyperglycemia associated with infection risk

›Insulin plan in ICU settings

06Diagnostic Tests/dt37

Scoring Systems

›Classification tools

›TBSA estimation systems

›Rule of nines for adults

›Lund and Browder for children

›Inhalation injury screening features

›Enclosed space exposure

›Facial burns

›Oropharyngeal soot

›Severity and prognosis tools

›Baux score concept

›Revised Baux age plus TBSA plus inhalation component

MRI

›Advanced imaging niche roles

›Deep tissue viability questions

›Suspected deep muscle necrosis after electrical injury

›Compartment syndromes with unclear extent

›Limitations

›Not time critical for initial triage

›Transport and monitoring constraints in unstable patients

›Cross sectional imaging use cases

›Inhalation injury and airway complications

›CT chest when diagnosis unclear and clinical deterioration

›Alternative diagnoses in smoke exposure

›Trauma coexistence

›CT head spine chest abdomen pelvis per trauma mechanism

›Contrast considerations

›Acute kidney injury risk in severe burns

›Benefit risk balance in polytrauma

Ultrasound

›Point of care ultrasound applications

›Hemodynamic guidance

›IVC assessment as adjunct to volume status

›Cardiac function if shock unclear

›Procedural guidance

›Peripheral IV and central access guidance

›Arterial line placement assistance

›Soft tissue assessment

›Abscess or cellulitis under dressings in delayed presentations

›Compartment syndrome adjuncts with limited evidence

07Disposition/dispo27

Burn center referral and transfer

›Referral criteria framework

›Immediate consultation with consideration for transfer

›Any full thickness burn

›Partial thickness 10 percent TBSA or more

›Deep partial or full thickness involving face hands feet genitalia perineum or major joints

›Inhalation injury

›Electrical burns including lightning

›Chemical burns

›Concomitant trauma

›Significant comorbidities affecting recovery

›Poorly controlled pain

›Pediatric nuance

›Any burn when pediatric expertise not available

›Higher hypothermia and fluid risk

Admission level of care

›Hospitalization criteria

›ICU level care

›Airway concern or inhalation injury

›Large TBSA requiring formal resuscitation

›Electrical injury with rhabdomyolysis risk

›Circumferential burns with perfusion threat

›Ward level care

›Moderate TBSA without shock

›Need for serial debridement and pain control

›Discharge suitability

›Small superficial or superficial partial thickness

›Pain controlled with oral regimen

›Reliable follow up within 24 to 72 hours

08Treatment/t144

First aid and wound protection

›Immediate care bundle

›Cooling and protection

›Cool running water 20 minutes if appropriate

›Window within 3 hours associated with improved outcomes

›Hypothermia prevention during cooling

›Remove rings watches tight clothing unless adherent

›Constriction risk with edema

›Adherent material left in place

›Cover with clean dry non adherent dressing

›Plastic wrap for large areas when appropriate

›Avoid fluffy cotton directly on wound

›Chemical burns specific

›Copious irrigation

›Dry powders brushed off before irrigation

›Prolonged irrigation for alkali exposures

›Hydrofluoric acid protocol

›Topical calcium gluconate gel

›Regional anesthesia often required for pain

Airway and inhalation injury management

›Airway strategy

›Early intubation pathway

›Progressive hoarseness or stridor

›If airway edema progressing then early intubation before loss of landmarks

›Smaller endotracheal tube size anticipated

›Significant facial or neck burns

›Difficult airway preparation

›Surgical airway backup readiness

›Oxygen and toxins

›High flow oxygen for smoke exposure

›Carboxyhemoglobin elimination accelerated with oxygen

›Hyperbaric discussion per local protocol when severe

›Cyanide antidote consideration

›Enclosed space fire with altered mental status

›Markedly elevated lactate supporting suspicion

Fluid resuscitation and hemodynamic targets

›Resuscitation principles

›Indications

›Partial thickness and deeper exceeding 15 percent TBSA

›Capillary leak peak within first 24 hours

›Ongoing reassessment with urine output targets

›Children with lower TBSA thresholds per local burn center guidance

›Maintenance fluids required in addition to resuscitation

›Hypoglycemia risk in small children

›Initial formula starting points

›Lactated Ringer starting estimate

›2 mL per kg per percent TBSA for adults as conservative start

›Half in first 8 hours from time of burn

›Remaining over next 16 hours

›3 mL per kg per percent TBSA for children as starting estimate

›Separate maintenance dextrose containing fluids if indicated

›Frequent glucose monitoring in young children

›4 mL per kg per percent TBSA for electrical injury consideration

›Higher risk of deep tissue necrosis

›Higher urine output targets often used

›Titration targets

›Urine output goals

›Adults 0.5 mL per kg per hour

›Foley catheter for major burns

›Adjust fluids hourly to goal

›Children 1 mL per kg per hour

›Consider 2 mL per kg per hour in infants

›Avoid over resuscitation with lung exam and ultrasound adjuncts

›Electrical injury 1 mL per kg per hour or higher per burn center

›Myoglobinuria clearance goal

›Urine alkalinization per consult if severe rhabdo

Analgesia and sedation

›Pain control ladder

›Non opioid baseline for minor burns

›Acetaminophen oral dosing per weight and age

›Max daily dose per local formulary

›Hepatic disease adjustment

›Ibuprofen oral dosing per weight and age

›Avoid in renal hypoperfusion

›Avoid in bleeding risk settings

›Opioid first line for moderate to severe burns

›Morphine IV titration

›Small incremental dosing

›Monitor respiratory status

›Fentanyl IV titration

›Useful for short procedures

›Hemodynamic stability advantage

›Dissociative analgesia for severe pain or procedures

›Ketamine IV

›Titrated doses for analgesia versus sedation

›Emergence reaction mitigation per protocol

›Regional anesthesia options

›Digital block for finger burns

›Avoid epinephrine in end artery concerns per local protocol

›Sensory exam documented before block when possible

Local wound care by burn depth

›Superficial burns

›Supportive care

›Cool compresses after initial cooling period

›Ongoing cold exposure avoided to prevent vasoconstriction injury

›Hydration and sun protection advice

›Moisturizer and aloe once skin intact

›Avoid occlusive greasy products on acute thermal burn

›Pruritus control plan

›Superficial partial thickness burns

›Blister and dressing approach

›Non adherent dressing with topical antimicrobial when indicated

›Bacitracin for small areas

›Avoid routine silver sulfadiazine for minor outpatient burns due to delayed healing risk

›Blister management individualized

›Large tense blisters impairing motion may be de roofed in sterile fashion

›Small intact blisters often left intact

›Deep partial thickness burns

›Early specialist involvement

›Burn center consultation

›High risk of conversion and scarring

›Excision and grafting consideration

›Elevation and splinting when over joints

›Contracture prevention

›Early occupational therapy planning

›Full thickness burns

›Definitive care pathway

›Burn center management

›Early excision and grafting typical

›Escharotomy readiness if circumferential

›Dry sterile dressings during stabilization

›Avoid topical agents that obscure depth assessment during transfer

›Temperature maintenance priority

Infection prevention and tetanus

›Infection and immunization bundle

›Wound cleansing and debridement

›Gentle cleansing with soap and water

›Foreign material removal

›Necrotic tissue debridement as indicated

›Systemic prophylactic antibiotics avoided for uncomplicated burns

›Antibiotics reserved for clinical infection

›Sepsis evaluation if systemic signs

›Tetanus prophylaxis

›Clean minor wounds guidance

›Vaccine if unknown or fewer than 3 doses

›Booster if 10 years or more since last dose

›All other wounds guidance

›Vaccine if 5 years or more since last dose

›Tetanus immune globulin if unknown or fewer than 3 doses

Escharotomy and surgical escalation

›Limb and chest decompression

›Indications

›Circumferential full thickness with distal ischemia

›Absent Doppler signals

›Worsening pain and paresthesia

›Circumferential chest with ventilatory compromise

›Rising airway pressures on ventilation

›Limited chest wall expansion

›Consultation triggers

›Immediate burn surgery or trauma surgery involvement

›Transfer if capability not available

09Special Populations/sp31

Pregnancy

›Pregnancy specific considerations

›Maternal first approach

›Standard resuscitation priorities

›Left lateral uterine displacement in late pregnancy if hypotensive

›Fetal considerations

›Viable gestation fetal monitoring after stabilization

›Rh status and trauma overlap evaluation if indicated

›Medication considerations

›Opioids short term acceptable with monitoring

›NSAID avoidance in later pregnancy per obstetric guidance

Geriatric

›Older adult risk profile

›Higher mortality for same TBSA

›Lower physiologic reserve

›Higher comorbidity burden

›Resuscitation caution

›Heart failure risk with over resuscitation

›Early invasive monitoring consideration

›Social and function context

›Home support reliability

›Delirium risk with opioids

Pediatrics

›Pediatric specific elements

›TBSA estimation

›Lund and Browder mandatory for accuracy

›Larger head and smaller legs proportions

›Fluids and glucose

›Maintenance fluids required in addition to resuscitation

›Dextrose containing fluids in young children as indicated

›Non accidental trauma consideration

›Pattern burns

›Inconsistent history

›Delay in seeking care

10Background/b30

Epidemiology

›Population level context

›Burn mechanisms distribution varies by age

›Scalds predominant in young children

›Flame burns more common in adolescents and adults

›Outcome drivers

›TBSA and depth as primary predictors

›Inhalation injury as major mortality multiplier

Pathophysiology

›Burn physiology fundamentals

›Local tissue injury

›Coagulation zone necrosis

›Stasis zone with conversion risk

›Hyperemia zone recovery potential

›Systemic response in major burns

›Capillary leak and third spacing

›Inflammatory mediator surge

›Hypovolemia and burn shock

›Inhalation injury mechanisms

›Upper airway edema

›Lower airway chemical pneumonitis

›Carbon monoxide impaired oxygen delivery

Therapeutic Considerations

›Why treatments work

›Cooling rationale

›Heat removal limits depth progression

›Early cooling associated with improved healing

›Fluid titration rationale

›Under resuscitation increases organ failure risk

›Over resuscitation increases edema and compartment syndromes

›Early excision and grafting rationale

›Reduced infection risk and hospital length of stay

›Improved functional outcomes in deep burns

11Patient Discharge Instructions/pdi24

copy discharge instructions

›Home care plan

›Dressing care

›Keep dressing clean and dry

›Change dressing as instructed

›Pain control

›Acetaminophen or ibuprofen as directed if safe

›Avoid exceeding labeled daily maximums

›Wound protection

›Sun protection over healing skin

›Avoid popping blisters

›Return to emergency care now

›Trouble breathing

›Burn on face eyes hands feet genitals or across a joint

›Increasing redness warmth swelling or pus

›Fever or chills

›Worsening pain not controlled

›Numbness or blue fingers or toes distal to burn

›Large burn area or spreading blistering

›Follow up

›Recheck within 24 to 72 hours for partial thickness burns

›Burn clinic follow up if referred

›Safety

›Keep water heater temperature safe

›Smoke detector and fire escape plan

12References/r16

Guidelines and high quality sources

›Core references

›American Burn Association guidelines for burn patient referral

›Partial thickness 10 percent TBSA or more referral criterion

›Any full thickness burn referral criterion

›CDC clinical guidance for tetanus wound management

›Antibiotics not recommended solely to prevent tetanus

›Wound cleaning and necrotic tissue removal emphasized

›NHS guidance for burns and scalds treatment

›Cool or lukewarm running water for 20 minutes

›Ice and greasy substances avoided

›ACEP thermal blast injuries fact sheet

›Fluid resuscitation required when burns exceed 15 percent TBSA

›Early initiation emphasized

›HHS CHEMM burn triage and treatment resource

›Burn center referral criteria summary

›Chemical and inhalation injury considerations

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.