Burn Management
Standardize resuscitation and transfer of adult and pediatric burn patients.
Updated: 06/24/2025
BurnsModified BrookeTransferCOCyanideOn this page5 sectionsHide sections
⚠️ Fluid formula updated 06/24/2025 — adults are now 2 mL/kg/%TBSA, NOT the classic Parkland 4 mL/kg.
⚠️ Confirm burn center transfer contacts are current before use.
🏥Transfer Criteria
▼- Full thickness burns
- >10% TBSA partial thickness
- Deep burns: face, hands, genitalia, feet, perineum, joints
- Burns + trauma or complex comorbidities
- Inhalational injury suspected
- Pediatric burns
- All chemical, high-voltage (>1000V), lightning injuries
📞
Confirm contacts before use: ICU / polytrauma / pregnant → Santa Clara Medical Center via the Transfer Center. Non-ICU, low-risk → St. Francis Medical Center by attending-to-attending call.
💧Adult Resuscitation (>20% TBSA)
▼⚠️
Formula changed 06/24/2025: the CPG now uses 2 mL/kg/%TBSA for adults (Modified Brooke), not the classic Parkland 4 mL/kg. Use the Modified Brooke calculator.
- Use Lactated Ringer's
- Total first 24h = 2 mL × weight(kg) × %TBSA
- Give first half over the first 8h from injury
- After the first 8h, titrate rate to urine output — do not bolus
- Foley — UOP goal 30–50 mL/hr, check hourly until transfer
🧒Pediatric Resuscitation (<12yo, >20% TBSA)
▼- 3 mL/kg/%TBSA ÷ 16 = starting hourly LR rate
- PLUS D5LR at maintenance rate (children need glucose-containing maintenance in addition to burn resuscitation)
- Place foley
- UOP goal 0.5 mL/kg/hr, or 30 mL/hr if over 30 kg
ℹ️
Dividing by 16 gives the initial hourly rate because half the 24h volume is delivered over the first 8 hours.
⚡Electrical Injury
▼- 4 mL/kg/%TBSA ÷ 16 = starting hourly rate
- Pigmented (myoglobinuric) urine → target UOP 75–100 mL/hr in adults
🌬️CO & Cyanide
▼1
CO: COHb venous co-oximetry
If >3% in nonsmoker → 100% NRB O₂
2
Cyanide: elevated lactate + metabolic acidosis
Get ALL labs BEFORE hydroxocobalamin — affects all results including UA and ABG.
3
Hydroxocobalamin 70 mg/kg IV
Low threshold with inhalation injury or respiratory failure.
- Status
- AHS Official Protocol
- Source
- sites.google.com/view/hghtrauma/burn-management
- Last reviewed / updated
- 06/24/2025