responsive to fluid therapy, should have an aggressive diagnostic workup for concurrent problems Antibiotics Burn sepsis continues to be the major cause of mortality after the period of initial resuscitation despite improvements in topical and systemic antimicrobials Meticulous antiseptic techniques can lessen colonization of burns with potential pathogens Topical antibiotics further reduce bacterial number Early streptococcal cellulitis is less common than in years before the development of topical antibiotics for burns Most burn centers not routinely treat patients with prophylactic systemic antibiotics given absence of data to support this practice, and the increased likelihood of inducing resistant organisms Frequent examination of healing burns for signs of infection and cultures to monitor colonization can direct specific antibiotic therapy if documented infections were to occur Wound Care Early surgical management of some partial- and most fullthickness burns with excision and grafting has been an important advance in burn treatment Initially, burns should be covered loosely with sterile sheets during the resuscitation phase in severe injuries Once the cardiorespiratory status is stabilized, the wounds are uncovered and fully assessed for size and depth The goals of burn wound care are to promote rapid healing and prevent infection Cleansing with large volumes of lukewarm sterile saline reduces contamination Loose tissue can often be wiped away with sterile gauze, simplifying and expediting burn debridement Blisters should be left intact whenever possible However, large blisters or those that obscure the assessment of the burn depth may need debridement Smaller blisters may be left intact to preserve the barrier to bacterial invasion Application of temporary skin substitutes may reduce pain, expedite healing, and reduce length of hospitalization compared with topical antibiotics and conventional dressings but are often not applied in the ED It is not necessary to apply topical antimicrobials to burns prior to transfer to a burn center or tertiary care children’s hospital Escharotomy First, all jewelry and watches should be removed because these may restrict distal flow of the blood For extensive and deep extremity burns, pulses should be checked by Doppler ultrasound if they cannot be