Emergency department management of house fire burns and carbon monoxide poisoning in children.

Fires continue to be a major killer of children, accounting for as many as 34% of fatal injuries in those younger than 16 years of age. Recent advances in burn care have improved to the extent that attention is being refocused on the initial resuscitation period as a time when significant improvements in mortality and morbidity may be achieved. Early invasive monitoring in selected patients may help children survive very severe burn injury. Carbon monoxide poisoning remains a common and controversial problem. Although it is clear that venous carboxyhemoglobin levels are similar to arterial levels, the treatment of children with significant poisoning has not been well studied. Hyperbaric oxygen therapy may be helpful in preventing serious central nervous system injury, but studies in children are lacking. Prevention of burns is far superior to treatment of burns.