Emergency Management of Pediatric Burn Patients

Initial Resuscitation and Assessment

Administer 20 mL/kg of balanced crystalloid solution intravenously within the first hour, regardless of burn size, to address early hypovolemic shock, as recommended by the American Society of Anesthesiologists 1, 2, 3
Establish IV access immediately, preferably in unburned areas, according to the American College of Surgeons 2, 3
Use Ringer's Lactate or Hartmann's solution as first-line fluid, avoiding 0.9% NaCl due to risk of hyperchloremic acidosis and acute kidney injury, as suggested by the American Academy of Pediatrics 1, 3, 4

Use the Lund-Browder chart (pediatric version) to measure Total Body Surface Area (TBSA), as recommended by the American Burn Association 5
Children with burns ≥10% TBSA require formal fluid resuscitation, according to the American College of Emergency Physicians 1, 4, 6
Calculate total 24-hour fluid requirement using the Modified Parkland Formula: 3-4 mL/kg/% TBSA, as suggested by the American Society of Anesthesiologists 4, 6

Give half of the calculated 24-hour fluid requirement in the first 8 hours, and the remaining half over the next 16 hours, as recommended by the American College of Surgeons 1, 4, 6
Monitor urine output, aiming for 0.5-1 mL/kg/hour, and adjust fluid rate accordingly, according to the American Academy of Pediatrics 4, 6
Avoid "fluid creep" (over-resuscitation) which increases morbidity, as suggested by the American Burn Association 4, 6

Assess for inhalation injury, which significantly increases mortality, according to the American College of Emergency Physicians 4
Monitor for circumferential burns causing circulatory compromise, and consider escharotomy if necessary, as recommended by the American Society of Anesthesiologists 3, 4, 5
Contact a burn specialist to determine the need for transfer to a burn center, according to the American Burn Association 5

Over-resuscitation leads to complications including compartment syndrome, pulmonary edema, and intestinal edema, with studies showing 76% of resuscitations receive more than the upper Parkland limit, averaging 6.3 mL/kg/%TBSA, according to the British Journal of Dermatology 7
Full thickness burns increase the risk of wound conversion and delayed healing, and may require volumes at the higher end of the range (4 mL/kg/%TBSA), as noted in the British Journal of Dermatology 7