291 - Pediatric Burns In Prolonged Field Care Assessment, Resuscitation & Airway Management

<p>In this essential episode of the Prolonged Field Care Podcast, Dennis sits down with pediatric intensivist Dr. Sara Bibbens to tackle one of the most challenging and anxiety-inducing scenarios in austere medicine: <strong>pediatric burns</strong>. From initial trauma assessment using MARCH/ABCDE to nuanced airway decisions in small children, burn resuscitation formulas, fluid management pitfalls, hypothermia prevention, wound care, and safe pain/sedation strategies, this conversation delivers practical, downrange-applicable guidance every combat medic, flight medic, and austere provider needs.</p><p><strong>Key Takeaways:</strong></p><ul><li>Stick to MARCH/ABCDE — don’t get distracted by dramatic burns; treat life threats first.</li><li>Pediatric airways swell faster — early intubation considerations (GCS &lt;8, large TBSA, stridor, facial burns, soot).</li><li>Initial fluid resuscitation rates by age + precise TBSA calculation using the Consensus Formula (3 mL × kg × %TBSA).</li><li>Add maintenance D5 fluids in kids &lt;30 kg and titrate everything to urine output goals (1 mL/kg/hr under 30 kg; 0.5 mL/kg/hr over 30 kg).</li><li>Plasma-based resuscitation is preferred when available.</li><li>Hypothermia prevention is more critical in children due to higher BSA-to-mass ratio.</li><li>Pain management: Start low with opioids (morphine preferred), ketamine for dissociation/procedural sedation; watch for respiratory depression when combining meds.</li><li>Avoid routine prophylactic antibiotics; focus on source control and dry dressings.</li></ul><p>Whether you’re operating in contested environments, remote settings, or supporting pediatric casualties, this episode arms you with the knowledge to avoid common pitfalls like fluid creep and over-resuscitation while delivering life-saving care.</p><p><strong>Website:</strong> <a href="https://www.prolongedfieldcare.org">⁠www.prolongedfieldcare.org⁠</a><strong></strong></p><p><strong>Follow @prolonged_field_care on Instagram</strong> for carousels, reels, and more austere medicine content.</p><p>Subscribe and stay on the bleeding edge of combat casualty care.</p><ul><li>Episode Chapters<strong>00:00</strong> - Introduction &amp; Welcome</li></ul><ul><li><strong>00:46</strong> - Guest Introduction: Dr. Sara Bibbens, Pediatric Intensivist</li><li><strong>01:04</strong> - Initial Assessment: MARCH/ABCDE in Burned Pediatric Patients</li><li><strong>02:43</strong> - Prioritizing Life Threats Over Dramatic Burns</li><li><strong>03:37</strong> - Airway Management in Children: When to Intubate?</li><li><strong>06:11</strong> - Surgical Airway Limitations &amp; Head Positioning in Pediatrics</li><li><strong>07:42</strong> - Burn Resuscitation: Initial Fluids &amp; Rule of Tens Limitations</li><li><strong>08:04</strong> - Pediatric Lund-Browder Chart, TBSA Estimation &amp; Consensus Formula</li><li><strong>11:46</strong> - Maintenance Fluids (D5) + 4-2-1 Rule in Kids &lt;30 kg</li><li><strong>13:26</strong> - Glucose Goals &amp; Dextrose Fluid Mixing in Austere Settings</li><li><strong>14:14</strong> - Urine Output Goals &amp; Endpoints for Resuscitation</li><li><strong>16:15</strong> - Avoiding Fluid Overload &amp; Fluid Creep in Pediatrics</li><li><strong>19:00</strong> - Plasma Resuscitation (Vanderbilt Protocol) in Burns</li><li><strong>20:25</strong> - Titration Strategy: Urine Output Over Fixed Formulas</li><li><strong>21:52</strong> - Creative Urine Output Measurement (Diaper Weights)</li><li><strong>22:59</strong> - Hypothermia Prevention in Children (Large Head, High BSA:Mass)</li><li><strong>24:26</strong> - Wound Care &amp; Why to Avoid Prophylactic Antibiotics</li><li><strong>25:37</strong> - Pain &amp; Sedation Management: Opioids, Ketamine Dosing &amp; Monitoring</li><li><strong>28:46</strong> - Common Pitfalls: Fluid Over-Resuscitation</li><li><strong>29:48</strong> - Managing Fluid Overload &amp; Closing Thoughts</li></ul><p></p>