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: pediatric burns. 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.
Key Takeaways:
Stick to MARCH/ABCDE — don’t get distracted by dramatic burns; treat life threats first.
Pediatric airways swell faster — early intubation considerations (GCS <8, large TBSA, stridor, facial burns, soot).
Initial fluid resuscitation rates by age + precise TBSA calculation using the Consensus Formula (3 mL × kg × %TBSA).
Add maintenance D5 fluids in kids <30 kg and titrate everything to urine output goals (1 mL/kg/hr under 30 kg; 0.5 mL/kg/hr over 30 kg).
Plasma-based resuscitation is preferred when available.
Hypothermia prevention is more critical in children due to higher BSA-to-mass ratio.
Pain management: Start low with opioids (morphine preferred), ketamine for dissociation/procedural sedation; watch for respiratory depression when combining meds.
Avoid routine prophylactic antibiotics; focus on source control and dry dressings.
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.
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