two to three minutes of exposure. On the cellular level, CO impairs
mitochondrial function and causes brain injury as the result of oxidative stress.
The rationale for supplemental oxygen is to decrease the half-life of CO from 90
minutes on room air to 20-30 minutes with high flow oxygen. Although
hyperbaric oxygen therapy (HBOT) clears CO beyond the clearance achieved
using 100% oxygen, proponents primarily advocate its use for prevention of
delayed neurocognitive syndrome. A Cochrane review performed on six
randomized controlled trials exploring the effects of HBOT on CO poisoning
suggested no benefit. Factors associated with an increased mortality in
patients exhibiting CO poisoning are decreased level of consciousness of
presentation, fire as a source of carbon monoxide, and elevated
carboxyhemoglobin level on presentation.
B. Resuscitation
The first forty-eight hours of treating pediatric burn patients are the most
critical due to the burn-induced hypovolemic shock these patients exhibit. The
primary goal of fluid resuscitation in burn patients is to achieve adequate organ
and tissue perfusion while trying to minimize soft tissue edema as a result of
diffuse capillary leak. The Parkland formula (4mL x kg x %TBSA) is the
resuscitation guideline most commonly used in the United States. However,
many institutions utilize the Parkland formula for the first 24 hours then vary
their resuscitation strategies in the second 24 hours. There is currently no
consensus regarding the type of fluid, or formula to be used in pediatric burn