# Burns — GCMD Library living collection

Updated: n/a · 3 episodes · 65 cited statements

## Episodes
### Tools

### High-Yield Summaries
- [Pediatric Burns](https://library.globalcastmd.com/watch/pediatric-burns-2530) — video · 14:21 · [machine version](https://library.globalcastmd.com/watch/pediatric-burns-2530.md)

### In-depth Review
- [Burns](https://library.globalcastmd.com/watch/burns-292) — podcast · 51:18 · [machine version](https://library.globalcastmd.com/watch/burns-292.md)
- [Topics in 10: Burn](https://library.globalcastmd.com/watch/topics-in-10-burn-2055) — podcast · [machine version](https://library.globalcastmd.com/watch/topics-in-10-burn-2055.md)

### Work-up and Treatment

## Chapters
- [0:00](https://library.globalcastmd.com/watch/burns-292?t=0) Introduction and guest credentials (Ep 2)
- [1:49](https://library.globalcastmd.com/watch/burns-292?t=109) Fluid resuscitation strategy in pediatric burns (Ep 2)
- [11:07](https://library.globalcastmd.com/watch/burns-292?t=667) Outpatient management of small burns (Ep 2)
- [15:11](https://library.globalcastmd.com/watch/burns-292?t=911) Early excision: timing and indications (Ep 2)
- [19:51](https://library.globalcastmd.com/watch/burns-292?t=1191) Initial management of the extensively burned child (Ep 2)
- [27:04](https://library.globalcastmd.com/watch/burns-292?t=1624) Operative technique: excision, grafting, and hemostasis (Ep 2)
- [37:36](https://library.globalcastmd.com/watch/burns-292?t=2256) Advances in burn care over 25 years (Ep 2)
- [42:03](https://library.globalcastmd.com/watch/burns-292?t=2523) Long-term aftercare and multidisciplinary follow-up (Ep 2)
- [48:28](https://library.globalcastmd.com/watch/burns-292?t=2908) Special considerations in infants and closing remarks (Ep 2)
- [0:13](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=13) Introduction and Transfer Criteria (Ep 1)
- [3:00](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=180) Admission Criteria and Pre-Transfer Management (Ep 1)
- [4:40](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=280) Fluid Resuscitation Strategies (Ep 1)
- [8:00](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=480) Fluid Creep and Monitoring (Ep 1)
- [9:20](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=560) Inhalational Injury and Carbon Monoxide (Ep 1)
- [11:40](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=700) Wound Assessment and Surgical Timing (Ep 1)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Animal studies in the 1960s and 1970s showed that excessive colloid administration resulted in histologic accumulation of colloid in the lungs, leading to fear of pulmonary compromise before mechanical ventilation was widely available. — Robert Sheridan (clinical) [Ep 2 · 1:49](https://library.globalcastmd.com/watch/burns-292?t=109)
- Traditional crystalloid-only resuscitation formulas (Brooke, Parkland) cause severe anasarca with significant morbidity, including near-compartment syndrome and neurologic injury. — Robert Sheridan (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/burns-292?t=180)
- Children do not need to make 2 cc/kg/hr of urine unless they are extremely young or have abnormal renal concentrating ability; targets of 0.5–1 cc/kg/hr are reasonable. — Robert Sheridan (clinical) [Ep 2 · 3:30](https://library.globalcastmd.com/watch/burns-292?t=210)
- Starting 5% albumin colloid immediately in burns ≥30–40% reduces total fluid volume and eliminates the need for abdominal decompression in Sheridan's practice. — Robert Sheridan (clinical) [Ep 2 · 4:00](https://library.globalcastmd.com/watch/burns-292?t=240)
- For burns 15–20% or less, maintenance-and-a-half IV fluids or ad lib PO intake with clinical monitoring (tears, moist oral cavity, pulse quality) is sufficient; calculated resuscitation is not needed. — Robert Sheridan (clinical) [Ep 2 · 5:04](https://library.globalcastmd.com/watch/burns-292?t=304)
- For mid-range burns (20–50%), Sheridan calculates Parkland (4 cc/kg/% burn over 24 hours), subtracts 1× maintenance, and gives that volume as 5% albumin; the remainder is given as Ringer's lactate. If the child is young and at risk for hypoglycemia, he also subtracts 1× maintenance as D5 Ringer's. — Robert Sheridan (clinical) [Ep 2 · 5:50](https://library.globalcastmd.com/watch/burns-292?t=350)
- For burns >50%, Sheridan gives 2× maintenance as 5% albumin (or one-third of total calculated resuscitation as albumin), with the remainder as crystalloid. — Robert Sheridan (clinical) [Ep 2 · 7:30](https://library.globalcastmd.com/watch/burns-292?t=450)
- Resuscitation fluids are adjusted hourly based on urine output and distal perfusion; by 24 hours, total fluid infusion typically reaches approximately 150% of maintenance if resuscitation goes well. — Robert Sheridan (clinical) [Ep 2 · 8:10](https://library.globalcastmd.com/watch/burns-292?t=490)
- Thick, durable, non-tense blisters (e.g., on fingertips and palms) can be left intact for a few days to avoid painful debridement; thin blisters that will rupture should be debrided in the clinic. — Robert Sheridan (clinical) [Ep 2 · 15:55](https://library.globalcastmd.com/watch/burns-292?t=955)
- Most small burns (<10%) are managed outpatient; admission criteria are driven by family factors (distance, car access, ability to follow instructions), not wound size alone. — Robert Sheridan (clinical) [Ep 2 · 13:43](https://library.globalcastmd.com/watch/burns-292?t=823)
- Early excision for large burns (≥20–30%) means removing non-viable tissue within the first few days to prevent septic morbidity, which typically appears by day 3–5. — Robert Sheridan (clinical) [Ep 2 · 16:59](https://library.globalcastmd.com/watch/burns-292?t=1019)
- For small deep burns with no septic threat, early excision means clear identification of what needs excision, family teaching, and operative intervention within the first week. — Robert Sheridan (clinical) [Ep 2 · 18:20](https://library.globalcastmd.com/watch/burns-292?t=1100)
- Children with large burns (≥50%) are intubated early if airway edema or extensive surgery is anticipated, to secure the airway before swelling makes intubation difficult. — Robert Sheridan (clinical) [Ep 2 · 20:25](https://library.globalcastmd.com/watch/burns-292?t=1225)
- Central venous access is placed in nearly all large burns; femoral lines have the same infection rate as other sites in Sheridan's 1000-catheter review, with a slight trend toward higher infection in internal jugular lines in small children. — Robert Sheridan (clinical) [Ep 2 · 23:36](https://library.globalcastmd.com/watch/burns-292?t=1416)
- Central lines are rotated weekly in the pre-antiseptic-line era (infection spike at 10 days) and every 2 weeks with antiseptic-impregnated lines (spike at 2 weeks); lines are also rotated in conjunction with OR trips. — Robert Sheridan (clinical) [Ep 2 · 25:04](https://library.globalcastmd.com/watch/burns-292?t=1504)
- Army burn unit studies showed up to 42% incidence of occult bacteremia during major wound manipulations in children with open wounds. — Robert Sheridan (epidemiological) [Ep 2 · 26:03](https://library.globalcastmd.com/watch/burns-292?t=1563)
- Enteral feeding via nasogastric tube is started on day 1 in most burns; children with very large burns or prolonged transport may have splanchnic ischemia and require trophic feeds until bowel sounds return. — Robert Sheridan (clinical) [Ep 2 · 21:45](https://library.globalcastmd.com/watch/burns-292?t=1305)
- Prophylactic antibiotics are not routinely used; a study of ~600 children (300 per arm) showed no difference in infection rates but more rashes and diarrhea in the antibiotic group. — Robert Sheridan (clinical) [Ep 2 · 22:32](https://library.globalcastmd.com/watch/burns-292?t=1352)
- Escharotomies are performed in the first 24–36 hours if circumferential burns risk limb or torso ischemia; pulse oximetry or Doppler checks every 2 hours guide the decision. — Todd Ponsky (clinical) [Ep 2 · 27:22](https://library.globalcastmd.com/watch/burns-292?t=1642)
- Sheridan uses silver nitrate soaks, sulfamylon soaks (sometimes with amphotericin for difficult gram-negatives), and other wet topicals for large burns; the choice is unit-specific and differences in outcomes are modest if other program elements are strong. — Robert Sheridan (clinical) [Ep 2 · 28:20](https://library.globalcastmd.com/watch/burns-292?t=1700)
- Diagnostic dermatome passes in small representative areas help determine burn depth intraoperatively when clinical exam is uncertain. — Robert Sheridan (clinical) [Ep 2 · 29:40](https://library.globalcastmd.com/watch/burns-292?t=1780)
- Excision is staged over 2–3 days for very large burns to avoid critical illness, excessive blood loss, and fluid overload; the goal is to remove all threatened tissue by day 5–7. — Robert Sheridan (clinical) [Ep 2 · 30:20](https://library.globalcastmd.com/watch/burns-292?t=1820)
- Maintaining normothermia during excision (OR at 120°F, 100% humidity, continuous temperature monitoring) prevents coagulopathic bleeding from hypothermia. — Robert Sheridan (clinical) [Ep 2 · 31:40](https://library.globalcastmd.com/watch/burns-292?t=1900)
- Fascial excisions, once routine for full-thickness burns, are now rare; layered excision preserving remnant fat improves long-term appearance and reconstructive options. — Robert Sheridan (clinical) [Ep 2 · 33:36](https://library.globalcastmd.com/watch/burns-292?t=2016)
- Hemostatic excision endpoints include the appearance of fat and deep reticular dermis, not free bleeding; this minimizes blood loss compared to older techniques. — Robert Sheridan (clinical) [Ep 2 · 34:53](https://library.globalcastmd.com/watch/burns-292?t=2093)
- Allograft is used as temporary coverage when the child is unstable, excision depth is uncertain, or burns are too large for immediate autografting; it is treated like autograft (secured, allowed to vascularize) and replaced with autograft in 5–7 days. — Robert Sheridan (clinical) [Ep 2 · 35:40](https://library.globalcastmd.com/watch/burns-292?t=2140)
- Split-thickness autograft remains the definitive permanent membrane; no permanent skin substitute has proven superior. — Robert Sheridan (opinion) [Ep 2 · 37:41](https://library.globalcastmd.com/watch/burns-292?t=2261)
- Donor sites should be treated as the most valuable territory: thin harvests, meticulous care, no infections, no deep passes, to preserve tissue for future reconstruction. — Robert Sheridan (clinical) [Ep 2 · 38:20](https://library.globalcastmd.com/watch/burns-292?t=2300)
- Colloid-inclusive resuscitation has transformed outcomes by reducing anasarca and eliminating the need for abdominal decompression in Sheridan's practice. — Robert Sheridan (clinical) [Ep 2 · 39:28](https://library.globalcastmd.com/watch/burns-292?t=2368)
- Minimally ablative excision improves long-term aesthetic and functional outcomes but carries a slightly higher septic risk and makes definitive coverage on fat beds more challenging than on fascial beds. — Robert Sheridan (clinical) [Ep 2 · 40:20](https://library.globalcastmd.com/watch/burns-292?t=2420)
- Modern scar management favors small tension-relief operations over ablative excision and skin grafting; scars shrink with regional tension release, sometimes augmented by fractional CO₂ laser. — Robert Sheridan (clinical) [Ep 2 · 41:30](https://library.globalcastmd.com/watch/burns-292?t=2490)
- Early functional and aesthetic reconstruction (as soon as functional issues arise) has replaced the old practice of waiting 2 years before operating on healed burns. — Robert Sheridan (clinical) [Ep 2 · 42:03](https://library.globalcastmd.com/watch/burns-292?t=2523)
- Multidisciplinary aftercare (PT, OT, psychology, nutrition, nursing, surgery) in daily rounds and clinic is essential to long-term outcomes and reintegration. — Robert Sheridan (clinical) [Ep 2 · 43:20](https://library.globalcastmd.com/watch/burns-292?t=2600)
- Infants <6 months with large burns require obsessive attention to fluid management, line care, tube position, lung-protective ventilation, hemostatic excision, normothermia, and thin harvests; they are prone to flexion contractures and need aggressive PT/OT and early functional reconstruction. — Robert Sheridan (clinical) [Ep 2 · 47:06](https://library.globalcastmd.com/watch/burns-292?t=2826)
- Burns result in over 300 visits and 2 deaths per day in pediatric patients. — Pramod Pulliantla (epidemiological) [Ep 1 · 0:13](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=13)
- The mechanism of pediatric burns is hot liquids or steam in younger children, and fire in older children. — Pramod Pulliantla (epidemiological) [Ep 1 · 1:00](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=60)
- Transfer criteria to a burn center include burns of more than 5% total body surface area, particularly if they involve the face, hands, feet, genitalia, perineum, or major joints. — Pramod Pulliantla (guideline) [Ep 1 · 2:10](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=130)
- Electrical burns, chemical burns, and inhalational injury should be transferred to a burn center. — Pramod Pulliantla (guideline) [Ep 1 · 2:40](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=160)
- Patients with significant circumferential burns should be transferred to a burn center. — Pramod Pulliantla (guideline) [Ep 1 · 2:50](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=170)
- Admission criteria at a burn center include any infant under age 1 with a total body surface area burn greater than 8%. — Pramod Pulliantla (guideline) [Ep 1 · 3:40](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=220)
- Any 2nd degree burn greater than 10% or any 3rd degree burn greater than 5% are indications for admission. — Pramod Pulliantla (guideline) [Ep 1 · 4:00](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=240)
- Before transfer, provide adequate pain control, apply silver sulfadiazine, and wrap wounds lightly with gauze, possibly adding Bactigras to prevent sticking. — Pramod Pulliantla (clinical) [Ep 1 · 4:50](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=290)
- Patients with smaller burns can be treated with oral rehydration therapy and do not necessarily require intravenous fluids. — Pramod Pulliantla (clinical) [Ep 1 · 6:00](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=360)
- At the speaker's center, IV resuscitation is initiated for patients with greater than 10% total body surface area burns or teenagers with greater than 15%. — Pramod Pulliantla (clinical) [Ep 1 · 6:20](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=380)
- The Lund-Browder chart is the best chart for estimating burned surface area because it takes into account body shape variations in children. — Pramod Pulliantla (clinical) [Ep 1 · 6:50](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=410)
- The palm of the patient can be used as an estimate of 1% body surface area burn. — Pramod Pulliantla (clinical) [Ep 1 · 7:10](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=430)
- The Parkland formula uses Ringer's lactate solution at 3 cc per kg per percentage body surface area burn. — Pramod Pulliantla (clinical) [Ep 1 · 7:20](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=440)
- The Cincinnati and Galveston formulas are more pediatric-specific than the Parkland formula. — Pramod Pulliantla (opinion) [Ep 1 · 7:35](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=455)
- Dextrose-containing solutions should be added as maintenance fluids for any patient under 30 kg. — Pramod Pulliantla (clinical) [Ep 1 · 7:45](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=465)
- A prospective study by Dietrich showed that colloid use results in statistically less fluid use overall, shorter lengths of stay, and reduced incidence of fluid creep. — Pramod Pulliantla (clinical) [Ep 1 · 8:10](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=490)
- Fluid creep is the phenomenon of giving too much fluid and not accounting for fluid already given, such as previous boluses or miscalculating total volume. — Pramod Pulliantla (clinical) [Ep 1 · 8:40](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=520)
- Fluid overload can lead to respiratory compromise, making the patient difficult to ventilate. — Pramod Pulliantla (clinical) [Ep 1 · 9:00](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=540)
- If a patient is adequately fluid resuscitated, controlled diuresis and addition of colloid can help eliminate excess fluid. — Pramod Pulliantla (clinical) [Ep 1 · 9:10](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=550)
- Foley catheter placement is indicated for patients with extensive burns, multiple trauma, or electrical burns where rhabdomyolysis may occur. — Pramod Pulliantla (clinical) [Ep 1 · 9:30](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=570)
- All patients should receive at least a tetanus booster if their vaccination card is not available. — Pramod Pulliantla (guideline) [Ep 1 · 10:00](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=600)
- The speaker does not give antibiotics until there is a proven infection, as prophylactic use leads to development of resistant organisms. — Pramod Pulliantla (opinion) [Ep 1 · 10:15](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=615)
- Carbon monoxide levels should be checked in any patient with suspected closed space fire or inhalational injury. — Pramod Pulliantla (clinical) [Ep 1 · 10:40](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=640)
- Patients with carbon monoxide poisoning will have normal transcutaneous oxygen saturation but low PaO2 on blood gas because all hemoglobin is saturated with carbon monoxide rather than oxygen. — Pramod Pulliantla (clinical) [Ep 1 · 11:00](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=660)
- Patients with suspected inhalational injury need to be intubated very quickly because once edema sets in, intubation becomes extremely difficult. — Pramod Pulliantla (clinical) [Ep 1 · 11:40](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=700)
- Bronchoscopy is useful in inhalational injury to assess the extent of airway injury and for pulmonary toilet, as patients often shed mucosa and develop casts in their airways. — Pramod Pulliantla (clinical) [Ep 1 · 12:00](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=720)
- If a patient with chest burns is desaturating without good chest rise, an escharotomy may be needed with incisions in the anterior axillary lines bilaterally and an oblique chevron incision connecting them. — Pramod Pulliantla (clinical) [Ep 1 · 12:25](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=745)
- Burns evolve over time, and what initially appears as a superficial burn may progress to partial or full thickness requiring surgical debridement and grafting. — Pramod Pulliantla (clinical) [Ep 1 · 13:00](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=780)
- Wounds should be reassessed every 24 hours for the first 48 hours. — Pramod Pulliantla (clinical) [Ep 1 · 13:20](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=800)
- Resuscitation endpoints must be reached before considering surgical debridement, with urine output as the primary endpoint: 1 cc/kg/hr for children under 30 kg and 0.5 cc/kg/hr for those over 30 kg. — Pramod Pulliantla (clinical) [Ep 1 · 13:40](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=820)
- Half of the calculated fluid should be given in the first 8 hours and the remainder over the next 16 hours according to resuscitation protocols. — Pramod Pulliantla (clinical) [Ep 1 · 14:10](https://library.globalcastmd.com/watch/pediatric-burns-2530?t=850)

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