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

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.

Website: ⁠www.prolongedfieldcare.org⁠

Follow @prolonged_field_care on Instagram for carousels, reels, and more austere medicine content.

Subscribe and stay on the bleeding edge of combat casualty care.

• Episode Chapters00:00 - Introduction & Welcome

• 00:46 - Guest Introduction: Dr. Sara Bibbens, Pediatric Intensivist
• 01:04 - Initial Assessment: MARCH/ABCDE in Burned Pediatric Patients
• 02:43 - Prioritizing Life Threats Over Dramatic Burns
• 03:37 - Airway Management in Children: When to Intubate?
• 06:11 - Surgical Airway Limitations & Head Positioning in Pediatrics
• 07:42 - Burn Resuscitation: Initial Fluids & Rule of Tens Limitations
• 08:04 - Pediatric Lund-Browder Chart, TBSA Estimation & Consensus Formula
• 11:46 - Maintenance Fluids (D5) + 4-2-1 Rule in Kids <30 kg
• 13:26 - Glucose Goals & Dextrose Fluid Mixing in Austere Settings
• 14:14 - Urine Output Goals & Endpoints for Resuscitation
• 16:15 - Avoiding Fluid Overload & Fluid Creep in Pediatrics
• 19:00 - Plasma Resuscitation (Vanderbilt Protocol) in Burns
• 20:25 - Titration Strategy: Urine Output Over Fixed Formulas
• 21:52 - Creative Urine Output Measurement (Diaper Weights)
• 22:59 - Hypothermia Prevention in Children (Large Head, High BSA:Mass)
• 24:26 - Wound Care & Why to Avoid Prophylactic Antibiotics
• 25:37 - Pain & Sedation Management: Opioids, Ketamine Dosing & Monitoring
• 28:46 - Common Pitfalls: Fluid Over-Resuscitation
• 29:48 - Managing Fluid Overload & Closing Thoughts