Initial management Remove from source of current Cardiopulmonary resuscitation as needed Provide mechanical ventilation until spontaneous ventilation is adequate Immobilize neck and spine Clinical assessment Neurologic examination (thorough evaluation for possible spinal cord injury) Peripheral pulses and perfusion and evaluation of the limbs for compartment syndrome Oral burns/edema Chest wall injury Abdominal distention Eye or ear trauma Cutaneous burns or bruises Laboratory/Imaging determinations Complete blood cell count Blood urea nitrogen, creatinine, urinalysis including myoglobin Electrolytes Troponin Electrocardiogram (ECG) Consider skull, spine, chest, long bone radiographs Consider computed tomography scan of brain (especially in lightning injuries) Consider electroencephalogram Monitoring Heart rate, ECG, respiratory rate, blood pressure Management Maintenance fluids: 5% dextrose in normal saline Volume expansion in presence of thermal burns or extensive deep tissue injury: 0.9% sodium chloride or lactated Ringer’s solution Fluid restriction for central nervous system injury Maintain urine output >1 mL/kg/hr