FIELD REFERENCE
Full criteria & treatment guidance
Key cautions & base contact
- A normal SpO₂ does not exclude carbon monoxide toxicity.
- Do not give fluids blindly to water-reactive chemicals; scene/exposure identification matters.
First actions
- For enclosed-space burns or smoke exposure, provide high-flow oxygen as tolerated. Pulse oximetry can be misleading with carbon monoxide exposure.
- Cool a burn that remains symptomatic. For wheeze or suspected smoke inhalation, give albuterol 5 mg in 6 mL by continuous nebulization as tolerated.
Pain and circulation
- For pain with systolic BP above 80: morphine 0.1 mg/kg IV/IM (maximum 5 mg), OR fentanyl 2 mcg/kg IN/IV/IM (maximum 50 mcg). Each may repeat once after 3 minutes, with total limits of 10 mg morphine or 100 mcg fentanyl.
- Base contact is required at age 2 or younger. Avoid medication injections and IV/IO placement through burned skin.
- For BP at or below 80 or signs of shock, use non-burned access and saline 20 mL/kg IV/IO, maximum 250 mL, with base contact. May repeat twice for three total boluses.
Burn-center criteria
- Contact base, pediatric-capable preferred, for suspected inhalation injury, electrical/lightning injury, or chemical burns.
- Other triggers include face/hands/feet/genitalia/perineum involvement, circumferential burns, complicating disease, second-degree burns above 10% TBSA, or any third-degree burn.
Chemical and electrical injuries
- Brush off residual dry chemical before irrigation. Use copious continuous water/saline when appropriate, but identify water-reactive chemicals before applying fluids.
- Small electrical skin wounds can conceal deep injury. High-voltage exposure requires ALS escort and cardiac rhythm monitoring. Report mechanism, TBSA/depth, airway findings, pain treatment, and fluid response.
UNDERSTAND THE CARE
Why pediatric burn decisions need more than a size estimate
The mechanism and affected structures can create serious risk even with a small surface injury. Assess inhalation exposure, chemical identity, electrical mechanism and the location and depth of the burn. Record the child’s weight and distinguish airway concerns from the visible skin findings.
Applying the guidance
Pain treatment and perfusion support use the pediatric instructions and their maximums. Check the age-specific opioid contact requirement and account for each prior dose. Chemical irrigation depends on the substance, while electrical exposure requires attention to deeper injury and rhythm. Report the treatment response alongside the destination criteria.
Putting it together
Teaching example: a small hand burn follows an electrical exposure. Describe the mechanism and systemic findings in the base report; the external wound size does not capture the complete risk.
Diagram text & teaching checkpoints
- Mechanism
- Smoke, thermal, chemical or electrical.
- Child-specific care
- Weight, age and medication limits.
- Perfusion and airway
- Reassess more than skin appearance.
- Referral
- Use the full burn-center criteria.
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.
Use the pediatric estimation and disposition source
A child’s burn estimate needs the age-appropriate body-region chart. Report the child’s age and weight, injured regions and depth, mechanism and airway findings with the estimated TBSA. PR-003 excludes first-degree burns from its surface-area calculation and contains additional pediatric disposition criteria.
Keep the source difference visible: SO-P-095 describes second-degree burns above 10% TBSA; PR-003 says 10% or more. Report a boundary estimate or uncertainty to base for destination direction. Do not use a value near that cutoff to dismiss other referral findings, such as inhalation injury, a critical anatomical location or electrical/chemical mechanism.
Open the full PR-003 age-specific estimation chart and burn disposition criteria during the destination discussion. The chart supports the assessment; it does not replace the pediatric treatment and base-contact instructions above.