Pediatric Burn Patients (0-12 years) Admission Instructions from USAMC to USA CWH
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Call Ped Surg attending on call to discuss patient and accept admission-415-1000.
Notify Ped Surg resident on call of patient’s admission 340-3125.
Print and fill out Ped Surg H&P form
Print and fill out admit orders burns (see below to decide what wound care is needed-in general
we follow the same protocol as Drs. Luterman and Frye)
5. NPO orders are only needed if deep sedation is needed for the dressing change the day after
admission-in general this would include: special needs patients, patients with moderate amount
of intact blisters that need debridement, toddlers or other patients with high degree of anxiety
and/or pain with initial burn wound evaluation
6. If deep sedation is planned, please notify the PICU charge nurse at 415-1546 of the need for
deep sedation the next day so they may place the patient on the schedule. The ped surg team
can follow-up the day of the dressing change to confirm the time. You will need a time for the
dressing change in order to write the appropriate NPO orders. Handling this at the time you
transfer the patient can avoid unnecessary extra hospital days by allowing deep sedation for the
first dressing change.
7. Wounds can be dressed in USAMC ER with thermazine applied directly to wound and cover with
dry telfa or softsorb, kling, and net.
8. Ear burns require sulfamylon cream to open wounds and NO dressing
9. Face burns should go directly into collagenase, no thermazine. Eye burns require ophthalmic
Neosporin only. However, if face burns are of any significance, then they may be better
managed as an inpatient initially
Criteria for Inpatient Burn Wound Care
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Pain management
Infection
Size/location of burn
Patients with suspected abuse that require protection and state intervention
(admit to pediatrics with ped surg consult)
Patient with complex medical conditions requiring pediatric intensive care and/or
pediatric subspecialist care (admit to pediatrics with ped surg consult)
Meets American Burn Association Transfer Criteria-(may require transfer to
appropriate Burn Center-discuss with ped surg attending on call if you have
questions)
Criteria for Outpatient Burn Wound Care
Patients deemed suitable for outpatient care should meet the following criteria and be provided the
following elements of care.
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Small burn in healthy patient
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Expectation that pain with dressing changes can be managed with oral pain medication
Social situation allows family to return to therapy daily for wound care and to pediatric
surgery clinic within 48 hours of initial EC evaluation
Does not meet criteria for inpatient care
Protocol for Outpatient Burn Wound Care
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CEC attending physician (CWH) or surgery resident (USAMC) determines outpatient
criteria are met
Provide information sheet to parents (Wound care follow-up instructions)
Provide prescriptions necessary for therapy services prior to discharge from the CECplease fax Rx for collagenase, polysporin, or bactroban (meds needed for dressings) to
the pharmacy at 415-1030 PRIOR to discharging patient from CEC so meds can be ready
the following day for the dressing change
o Script for “PT wound care-daily dressing changes and debridement
o Script for collagenase (daily) and polysporin powder (every two days) and apply
to wounds daily until wound is closed. Bactroban ointment as needed for signs
of infection.
o Script for PO pain meds (Tylenol with codeine) to be filled by family and given 30
minutes prior to treatment the next morning
All outpatient wound care appointments are at 8:00am everyday. Patients are seen at
the CCD building across the street from CWH M-F and at CWH lower level on weekends
and holidays (ask at information desk in lobby for directions).
Wounds can be dressed in CEC with thermazine applied directly to wound and cover
with dry telfa or softsorb, kling, and net.
Ear burns require sulfamylon cream to open wounds and NO dressing
Face burns should go directly into collagenase, no thermazine. Eye burns require
ophthalmic Neosporin only. However, if face burns are of any significance, then they
may be better managed as an inpatient initially