In the ED, their vitals/exam are as above. Airway ***. TBSA *** % with*** evidence of deep thickness burns. *** concern for overlying cellulitis given {Burn cellulitis:39307}
– Labs/Tests: VBG, ABG, Lactate, CBC, CMP, CO, CN, CK, Troponin T-hs q1h x2, BNP, ESR/CRP, serum tox, urine tox, blood cultures, wound cultures
– Imaging: CXR
– Treatments: IVF (If in first 24 hrs after burn: [10 x %TBSA] + 100cc/hr for each 10kg >80kg = ***, for goal UOP of 30-50ccs/hr with max 250cc/kg in first 24 hours; Post 24 hrs: 500cc LR boluses as needed if still fluid down) with supplementation with 5% albumin if MAP <65/supplementation with vasopressin if MAP still <65 despite albumin, pain control with IV opioids (can also use ketamine for dissociative/sedative properties, Tetanus booster, Low threshold for IV antibiotics (vancomycin/cefepime) - Consults: Burn Surgery, Trauma Surgery - Dispo: Likely admission to SICU given TBSA >20%