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, the source lists albuterol 5 mg in 6 mL by continuous nebulization as tolerated.

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.

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.

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. Follow the source’s high-voltage ALS escort and rhythm-monitoring guidance. Report mechanism, TBSA/depth, airway findings, pain treatment, and fluid response.