The burn protocol is to ensure survival, minimize shock, prevent infection, and begin fluid resuscitation.
Following the right protocol helps to prevent huge losses.
Primary: ABCDE
A – Airway
- Early intubation if:
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Facial burns
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Soot in the mouth or nose
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Singed nasal hairs
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Hoarseness, stridor
B – Breathing
- Administer 100% oxygen by non-rebreather mask
- Look for signs of carbon monoxide poisoning
C – Circulation
- Monitor BP, HR, capillary refill, urine output
D – Disability
- Check neurological status (Glasgow Coma Scale)
E – Exposure & Environment
- Fully expose the patient to assess burn extent
- Prevent hypothermia: cover with warm, clean sheets
Burn Severity Assessment
1. Total Body Surface Area (TBSA) burned:
- Use the Rule of Nines in adults
- Use the Lund and Browder chart for children
2. Depth of Burn:
- Superficial (1st degree): only epidermis
- Partial-thickness (2nd degree): epidermis + dermis
- Full-thickness (3rd degree): extends through dermis
- 4th degree: extends into muscle and bone
Fluid Resuscitation: Parkland Formula
FLUID
F – Fluid resuscitation is crucial
L – Use Lactated Ringer’s solution
U – Use formula (4 mL × body weight (kg) × %TBSA burned)
I – Infuse: Half in the first 8 hours and remainder over the next 16 hours
D – Don’t delay fluids; time starts from burn injury, not hospital arrival
Monitor:
- Urine output: Goal: 0.5–1 mL/kg/hr in adults and 1–2 mL/kg/hr in children
- Vital signs and perfusion indicators
Other Immediate Measures
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Pain control: IV opioids (morphine/fentanyl)
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Tetanus prophylaxis
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Wound care:
- Cover with a clean sheet dressing
- Don’t apply ice directly
Referral to Burn Center
BURNS
B – Burns >10% TBSA
U – Unusual locations (face, hands, feet, genitalia, perineum)
R – Respiratory involvement (inhalation injury)
N – Non-accidental (suspected abuse)
S – Special types (electrical, chemical, lightning)
