Major Burn Injury
Patient with significant thermal injury
All Pathways
Trauma SurgeryEmergency
Burns Resuscitation (ABA 2024)
Burns Resuscitation (ABA 2024): Major Burn Injury → Stop the Burning Process → Primary Survey → Calculate TBSA → IV Resuscitation Needed?.
Pathway Overview
13 steps
Algorithm Steps
13 total
01Start 02Warning Stop the Burning Process
Remove from source, remove clothing/jewelry
- Remove patient from heat source
- Remove clothing and jewelry
- Cool burns with room temp water (not ice)
- Cover with clean dry sheets
- Keep patient warm (prevent hypothermia)
03Action Primary Survey
ABCDE with burn-specific considerations
- A: Airway - assess for inhalation injury
- Facial burns, singed nasal hairs, carbonaceous sputum
- Early intubation if concern (edema progresses)
- B: Breathing - circumferential chest burns may need escharotomy
- C: Circulation - 2 large bore IVs (through burned skin if needed)
- D: Disability - associated trauma?
- E: Exposure - calculate TBSA
04Action Calculate TBSA
Total Body Surface Area burned
- Rule of 9s (adults):
- Head/neck: 9%
- Each arm: 9%
- Anterior trunk: 18%
- Posterior trunk: 18%
- Each leg: 18%
- Genitalia: 1%
- Palm method: Patient's palm = 1% TBSA
- Only count partial and full thickness burns
05Decision IV Resuscitation Needed?
Based on burn size and patient factors
- Adults: ≥20% TBSA
- Children/elderly: ≥10% TBSA
- Inhalation injury present
- High-voltage electrical injury
- Associated trauma
06Action Minor Burn Care
<20% TBSA, no inhalation
- Oral hydration may suffice
- Wound care: clean, debride loose tissue
- Topical antimicrobials
- Pain control
- Tetanus prophylaxis
07Action Burn Center Transfer Criteria
ABA referral guidelines
- Partial thickness >10% TBSA
- Burns to face, hands, feet, genitalia, major joints
- Full thickness (3rd degree) burns
- Electrical or chemical burns
- Inhalation injury
- Pre-existing conditions complicating care
- Associated trauma
- Children at non-pediatric hospitals
08Outcome Resuscitation Ongoing
Continue monitoring, transfer to burn center if indicated
09Action Calculate Initial Fluid Rate
ABA 2024 or Parkland formula
- ABA 2024 (preferred):
- 2 mL × kg × %TBSA in first 24h
- Half in first 8h, half in next 16h
- Traditional Parkland:
- 4 mL × kg × %TBSA in first 24h
- Use Lactated Ringer's
- Time starts from TIME OF BURN, not arrival
10Action Example Calculation
70kg patient, 40% TBSA
- ABA 2024: 2 × 70 × 40 = 5,600 mL/24h
- First 8h: 2,800 mL = 350 mL/hr
- Next 16h: 2,800 mL = 175 mL/hr
- Parkland: 4 × 70 × 40 = 11,200 mL/24h
- First 8h: 5,600 mL = 700 mL/hr
11Action Titrate to Urine Output
Formulas are guides - adjust to response
- TARGET UOP:
- Adults: 0.5-1 mL/kg/hr
- Children <30kg: 1 mL/kg/hr
- If UOP low: Increase rate by 10-20%
- If UOP high: Decrease rate by 10-20%
- Avoid over-resuscitation (fluid creep)
12Action Resuscitation Adjuncts
Additional considerations
- Albumin: Consider for burns >30% or high fluid needs
- 5% albumin starting hour 8-12
- Monitor for abdominal compartment syndrome
- No routine high-dose Vitamin C (insufficient evidence)
- Pain management essential
- Path rejoins step 07Shared downstream outcome
13Warning Escharotomy if Needed
For circumferential burns
- Chest escharotomy if impaired ventilation
- Extremity escharotomy if:
- Diminished pulses
- Poor cap refill
- Progressive paresthesias
- Incise lateral and medial midaxillary lines
- Path rejoins step 07Shared downstream outcome
Guideline Source
ABA Clinical Practice Guidelines on Burn Shock Resuscitation 2024
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- TBSA estimation is subject to error
- Pediatric and geriatric patients require modified targets
- Inhalation injury increases fluid requirements
- Formulas are starting points - titrate to UOP
Applicable Regions
USEUGlobal
EU: Parkland 4 mL/kg/%TBSA still commonly used
US: ABA 2024 recommends starting at 2 mL/kg/%TBSA to reduce fluid creep
Version 1Next review: 2027-01-01
Next steps
Finish the workflow by opening the most relevant calculator, then convert the session into a live account when you are ready.
Related Resources
Frequently Asked Questions
What is the Burns Resuscitation (ABA 2024)?
The Burns Resuscitation (ABA 2024) is a emergency clinical algorithm for Trauma Surgery. It provides a structured decision tree to guide clinical decision-making, based on ABA Clinical Practice Guidelines on Burn Shock Resuscitation 2024.
What guideline is the Burns Resuscitation (ABA 2024) based on?
This algorithm is based on ABA Clinical Practice Guidelines on Burn Shock Resuscitation 2024 (DOI: 10.1093/jbcr/irad173).
What are the limitations of the Burns Resuscitation (ABA 2024)?
Known limitations include: TBSA estimation is subject to error; Pediatric and geriatric patients require modified targets; Inhalation injury increases fluid requirements; Formulas are starting points - titrate to UOP. Individual patient factors may require deviation from these recommendations.
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