· ABC: if there is evidence of inhalation then pulmonary toilet with endotracheal intubation may be needed.
· Assume that there is carbon monoxide poisoning and measure carboxyhaemoglobin level and PaO2. Give humidified 100% oxygen until results are available.
· Follow serial arterial blood gases and CXRs.
· Consider cyanide exposure and poisoning if the breath smells of almonds, or if the accident is fire-related, or if there is metabolic acidosis with raised anion-gap.
· In infants with burns >10% of body surface area, or children with >15% burns, consider an IV bolus of normal saline (10–20mL/kg). Further fluid resuscitation should be directed toward maintaining a urine output of 0.5–2mL/kg/h. In patients with >25% burns use the Parkland’s formula.
· Analgesia: pain must be treated. First ensure that ventilation, oxygenation, and perfusion are adequate. Use IV analgesics if required.
· Other injuries: do a secondary survey of associated traumatic injuries. Assess for cardiac and skeletal muscle injury in electrical accidents. In chemical burn, wash and neutralize the chemical.
· Place a nasogastric tube (NGT) and urinary catheter. Follow outputs.
· Pulse oximetry and cardiac monitoring are useful, but remember their limitations in carbon monoxide poisoning.
· Eyes: examine the eyes for burn or abrasion, and treat with topical antibiotics if required.
· Give tetanus immunoprophylaxis if required.
· 4mL/kg per 1% burn
· Use 50% of this volume in the first 8hr
Crystalloid + colloid
· Use 50–75% of fluid requirements on day 1
· Add albumin (1g/kg/day) to maintain serum level above 2g/dL