Pediatric Terrorism and Disaster Preparedness: Table 7.4

Table 7.4. Principles of Advanced Burn Life Support®

*Primary Survey*
Airway	Rapid upper airway closure may occur following inhalation injury and require early intubation
Breathing	Circumferential full thickness burns of the trunk may impair ventilation and require escharotomy
Circulation	Circulation in a limb with full thickness burns may be impaired and require escharotomy
Disability	Consider carbon monoxide poisoning if the patient is not initially alert and oriented
Exposure and environment	Remove all jewelry to avoid constriction of digits
*Adjuncts*
Foley catheter	Needed to titrate fluid replacement against urine output
Gastric tube	Needed to decompress stomach due to burn ileus
*Resuscitation*
Stop the burning process
Fluid resuscitation	Parkland formula: 3-4 mL Ringer's lactate × body weight in kg × total body surface area (BSA) burned; administer half the amount during the first 8 hr after injury, half over the next 16 hr. Modification for pediatric patients: Add maintenance fluid to Parkland formula for children and infants; 100 mL/kg for first 10 kg + 50 mL/kg for next 10 kg + 20 mL/kg for each additional kg
*Secondary Survey*
History and physical
Obtain as much information as possible regarding the circumstances of injury	*Flame* How did the burn occur? Did the burn occur outside or inside? Did the clothes catch on fire? How long did it take to extinguish the flames? How were the flames extinguished? Was gasoline or another fuel involved? Was there an explosion? Was there a house fire? Was the patient found in a smoke-filled room? How did the patient escape? If the patient jumped out a window, from what floor? Were others killed at the scene? Was there a motor vehicle crash? How badly was the car damaged? Was there a car fire? Are there other injuries? Are the purported circumstances of the injury consistent with the burn characteristics? *Scald* How did the burn occur? What was the temperature of the liquid? What was the liquid? How much liquid was involved? What was the temperature setting of the water heater? Was the patient wearing clothes? How quickly were the patient's clothes removed? Was the burned area cooled? Who was with the patient when the burn took place? How quickly was care sought? Where did the burn occur? Are the purported circumstances of the injury consistent with the burn characteristics? *Chemical* What was the agent? How did the exposure occur? What was the duration of contact? What decontamination occurred? Was there an explosion? *Electrical* What kind of electricity was involved? What was the duration of contact? Did the patient fall? What was the estimated voltage? Was there loss of consciousness? Was cardiopulmonary resuscitation administered at the scene?
Determine the severity of the burn	*Extent of burn* Rule of nines for adolescents Lund-Browder chart for children and infants (Table 6.5) *Depth of burn*
*Adjuncts*
Imaging and laboratory studies	Carboxyhemoglobin
*Reevaluation*
Continued assessment of ventilatory effort Continued assessment of extremity perfusion Pain management Psychosocial assessment
*Burn Wound Care*
Thermal burns	Cover the area with a clean, dry sheet Ice applications are appropriate only in small burns
Chemical burns	Flush the chemical agent from the body surface with copious amounts of water Powdered chemicals should be brushed from the skin prior to flushing the involved area Remove all contaminated clothing Chemical eye injuries require continuous irrigation until otherwise instructed by an expert
Electrical burns	Continuous cardiac monitoring may be necessary during the first 24 hr after injury Maintain urine output at twice normal target volumes if myoglobinuria
*Burn Center Referral*
Partial thickness burns >10% total BSA Burns that involve face, hands, feet, genitalia, perineum, or major joints Full-thickness burns Chemical burns Electrical burns, including lightning injury Inhalation injury Burn injury in patients with significant comorbidities; concomitant trauma; or who require special social, emotional, or rehabilitative intervention Burned children in hospitals without qualified personnel or equipment for care of children

Note: The principles of Advanced Burn Life Support are identical to the principles of Advanced Trauma Life Support® (Table 7.3), with additional caveats pertinent to Advanced Burn Life Support.

Source: Courtesy American Burn Association. Used with permission.

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