Step away from your MDCalc – we’re going to calm that scorching stress-induced acid reflux with an update on the emergency department management of burns - Mary Ellen Billington MD


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Burn and Inhalation Injuries: ED Wound Care, Resuscitation and Airway Management

One of the most important principles to remember with any burn patient is that they are a trauma and toxicology patient first. Don’t get distracted by the burns. Perform your primary and secondary survey as you normally would with a trauma patient and address the burns later...

The Parkland Formula is passé... Modified Brooke/Parkland Formula is recommended as a starting point for fluid resuscitation for burns >15% BSA in children and >20% BSA in adults. Patients with inhalation injuries generally require more fluid resuscitation (closer to 4mL x %BSA x kg) however the extent of injury is impossible to quantify accurately...

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 Burn and Inhalation Injuries: ED Wound Care, Resuscitation and Airway Management

Burns in the ED are not easily classifiable on the initial assessment and they may convert to deeper burns over the next few days. Use caution when classifying burns and counseling patients and families about prognosis. Patients require close follow up of the wound for reassessment and ongoing care.

BC Emergency Medicine Network

In light of changing perspectives on burn pathophysiology, the BC Provincial Major Burns Working Group recommends a resuscitation formula of 3 mL/kg/%Total Body Surface Area (TBSA). In addition to new concepts in fluid resuscitation for burns, novel therapies such as high dose vitamin C, early colloid administration, and selective use of vasoactive agents to improve perfusion pressures are also gaining traction in complex burn care.

Washington University Emergency Medicine Journal Club- November 2020

Circumferential burns, as well as those involving the face, ears, eyes, perineum, joints, or in those with renal failure or diabetes, are not considered minor burns.


Whichever formula is used, the critical point to remember is the fluid amount calculated is just a guideline. The patient’s vital signs, mental status, capillary refill, and urine output must be monitored and fluid rates adjusted accordingly.

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