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CEN and TCRN Burns

Updated: Dec 29, 2019


1. Burn Fluid Resuscitation

· Fluids prior to calculation as starting point:

o 500 ml/hour for 14 and older

o 250 ml/hour for 6-13 years of age

o 125 ml/hour for 5 years and younger

· Based on partial, deep, and full-thickness burns (not superficial).

· LR is fluid of choice, half of total amount in first 8 hours from time of burn.

· ABA guidelines (Modified Parkland)

o Adult thermal = 2ml x kg x BSA for 24-hour calculation

o Child thermal = 3ml x kg x BSA for 24-hour calculation

o Electrical = 4ml x kg x BSA for 24-hour calculation

· Adjust fluid based on urinary output, need 0.5-1.0 ml/kg/hour adult, 1-2ml/kg/hour in pediatrics.


2. Electrical Burns

· Do not document entrance and exit wound.

· Hand-to-hand – increased risk of heart damage (across the heart).

· Risk of rhabdomyolysis (increased K+), so increase IVF’s to get UO of 75-100 ml/hr.

· Lightening – lace or feathering appearance (Lichtenberg figures).


3. Chemical Burns – first goal is to reduce exposure to others, Don PPE.

· Decontaminate – Hot zone only for suited, warm for decontamination, cold for treatment.

· Brush off dry chemicals (lime powder).

· Hydrofluoric acid – calcium to inactivate fluoride.

· Asphalt (tar) – apply fat emollient and cool immediately.

· Phenols (carbolic acid) – irrigate with 50% PEG (Miralax) to neutralize.


4. Radiation exposure – decontaminate ASAP. S/S: nausea, vomiting, diarrhea, malaise, anorexia, GI bleed; skin red, but without blisters.


Burn Resources

· Emergency Nurses Association. Trauma Nursing Core Curriculum, 8th ed., 2019.

· Kent, Kendra. Trauma Certified Registered Nurse Examination Review. Springer, 2017.

· Sheehy, S. Sheehy’s Manual of Emergency Care, 7th ed. Elsevier, 2013.

· http://www.emdocs.net/hydrofluoric-acid-burn-keeps-burning/

· https://litfl.com/trauma-major-burns/

· https://www.aliem.com/2012/09/tricks-of-trade-calcium-gel-for/

· http://www.emdocs.net/em3am-electrical-injuries/

· http://www.emdocs.net/modern-day-burn-resuscitation-moving-beyond-parkland-formula/


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