Major Burns (Parkland) — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Airway/inhalation injury risk?
   Any airway/inhalation injury risk? (Treat burns by trauma ABCs first. TBSA: rule of nines (adult head 9%, each arm 9%, anterior and posterior trunk 18% each, each leg 18%, perineum 1%), palm method ~1%, Lund-Browder in children (larger head share); count partial + full thickness only. Parkland: 4 mL × kg × %TBSA lactated Ringer's, timed from injury over 24 h, half in the first 8 h, half over the next 16 h (ABLS 2–4 mL); titrate to urine output (adults 0.5, children <30 kg 1 mL/kg/h), avoid over-resuscitation.)
   • Inhalation injury signs (facial/oral burns, hoarseness/stridor, carbonaceous sputum, enclosed space) → Inhalation injury → early intubation
   • No airway risk, resuscitate by TBSA → No airway risk · Parkland resuscitation
2. [End] No airway risk · Parkland resuscitation
   No airway risk: estimate TBSA (rule of nines/Lund-Browder), Parkland 4 mL × kg × %TBSA lactated Ringer's (timed from injury, half in 8 h, half over 16 h), Foley to titrate urine output (adults 0.5, children 1 mL/kg/h); circumferential eschar → escharotomy (limb ischemia/chest wall restricting ventilation); analgesia (IV opioids), tetanus, keep warm, wound care; transfer to a burn center per ABA criteria. <15–20% without inhalation injury can often be managed mainly with oral hydration.
3. [End] Inhalation injury → early intubation
   Inhalation injury signs (facial/oral burns, singed nasal hairs, hoarseness/stridor, carbonaceous sputum, enclosed-space fire, respiratory distress): early intubation (airway edema progresses fast — secure the airway early) + high-flow 100% oxygen (beware CO/cyanide); concurrently Parkland resuscitation, titrate urine output; escharotomy for circumferential eschar, analgesia, transfer to a burn center.

Source guidelines & references

• Major burns (ABA/ABLS; Parkland formula)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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