FIELD REFERENCE
Full criteria & treatment guidance
Key cautions & base contact
- SpO₂ may look reassuring despite significant CO exposure.
- Burn size alone does not determine destination: location, depth, mechanism, and comorbidities also matter.
Initial care
- For enclosed-space or heavy-smoke exposure, give high-flow oxygen by mask as tolerated. Pulse oximetry may be misleading with carbon-monoxide exposure.
- Use cooling measures for a burn that remains symptomatic. For wheeze or suspected smoke inhalation, give albuterol 5 mg in 6 mL by continuous nebulization as tolerated.
Pain & circulation
- Do not inject analgesics or place IV access through burned skin. With systolic BP above 90, options include morphine 5 mg (or 4 mg carpuject) IV/IM, or fentanyl 50 mcg IV/IM or 100 mcg IN; one repeat after 3 minutes is permitted as specified. Morphine IO use is limited to already-established access for saline.
- For systolic BP at or below 90 or shock signs, establish access through unburned skin and give 250 mL saline boluses up to 1 L to maintain perfusion.
Burn-center contact
- Contact base for suspected inhalation injury, electrical/lightning injury, or chemical burns; burns involving face, hands, feet, genitalia, or perineum; circumferential burns; or relevant complicating disease.
- Burn-center criteria also include second-degree burns above 10% TBSA and any third-degree burn. Base coordinates the burn-unit destination.
Chemical & electrical injuries
- Brush away residual dry chemical. Irrigate continuously with copious water or saline unless the substance reacts dangerously with water; identify the chemical and use the appropriate hazard guidance.
- Small electrical wounds can conceal major deep injury and rhythm risk. High-voltage exposure requires cardiac monitoring and ALS escort.
- For suspected cyanide exposure, use PR-130/base-directed hydroxocobalamin rather than assuming every smoke exposure needs an antidote.
UNDERSTAND THE CARE
Why mechanism and location change the burn assessment
The visible skin injury is only part of a burn presentation. Enclosed-space smoke, electrical exposure and chemicals introduce different concerns. Describe the exposure and associated respiratory or circulatory findings, not just the surface appearance. The destination criteria also consider depth, anatomical location, circumferential injury and complicating disease.
Applying the guidance
Follow the mechanism-specific instructions while treating pain and poor perfusion. Chemical care requires identifying whether water is appropriate after dry material is removed. Electrical wounds may underestimate deeper injury and rhythm risk. Keep access and injections away from burned skin as directed, and reassess breathing and pressure after treatment.
Putting it together
Teaching example: a patient from an enclosed-space fire has limited skin burns but concerning respiratory findings. Report the exposure and suspected inhalation injury early; the burn percentage alone should not determine the destination discussion.
Diagram text & teaching checkpoints
- Mechanism
- Thermal, chemical, electrical or smoke.
- Airway and perfusion
- Assess risks beyond the skin.
- Extent and location
- Describe depth and affected regions.
- Destination
- Apply the complete referral criteria with base.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
Estimate extent without losing the referral decision
The burn estimate is one part of the destination discussion. Report the areas involved, apparent depth, mechanism and inhalation findings alongside the estimated percentage. The OCEMS estimation procedure excludes first-degree burns from its TBSA calculation; uncertainty in the estimate should be communicated rather than hidden by an overly precise number.
Source wording differs at the boundary: SO-E-005 describes second-degree burns above 10% TBSA, while PR-003 says 10% or more. An estimate at or near that boundary should be reported explicitly to base for destination direction rather than treated as a rule-out. Other burn-center criteria can apply regardless of the percentage.
Use PR-003: body-surface-area estimation and disposition alongside the burn standing order. This source comparison preserves the difference instead of inventing a harmonized threshold.