Algorithm
- Stop the burning process; ABCDE; early airway assessment (face/neck burns, soot, stridor, enclosed-space fire → early definitive airway).
- Remove constricting clothing/jewelry; cool running water up to 20 min for thermal burns (avoid hypothermia); cover with clean cling film / sterile sheets.
- Estimate TBSA (Rule of Nines / Lund–Browder); calculate fluids for burns typically ≥15–20% TBSA in adults (Parkland or local formula); monitor urine output ~0.5 mL/kg/h.
- Analgesia early (IV opioids); tetanus status; avoid prophylactic systemic antibiotics for uncomplicated burns.
- Circumferential chest/limb burns: watch ventilation / perfusion; escharotomy if indicated.
- Transfer to burn center: large TBSA, inhalation injury, electrical/chemical, face/hands/perineum, deep burns, major comorbidity.
Red flags
- • Inhalation injury / airway edema
- • Circumferential chest burn — ventilation threat
- • Electrical injury — occult muscle damage / arrhythmias
- • Hypothermia from overcooling
Medications by step
Fluids / analgesia
- Lactated Ringer / balanced crystalloid · i.v.
Parkland ~4 mL × kg × %TBSA (half in first 8 h from injury) — titrate to UO
- Morphine / fentanyl · i.v.
Titrate IV analgesia
Adjuncts
- Tetanus toxoid · i.m.
Update if indicated
References
- • ABA / ISBI — Burn care principles (2023)
- • WHO — Burns fact sheet / first aid (2023)
Updated: Июль 2026