All of the essentials of a severely burned patient’s management are presented. Blood is cauterized in the burned area. The need for transfusion is universal. Fluid resuscitation follows the Parkland formula, with crystalloids being the main component. Singed nasal hairs indicate airway involvement. Burns around the mouth are interpreted as a possible esophageal burn. This mandates that TEE cannot be used. Surgical procedures are done in the patient’s room in the ICU, including debridements and washouts. Burn shock is a combination of distributive, cardiogenic, and hypovolemic shock. All fluids given are warmed and address burns. Antibiotics are administered early. Sepsis is the rule in most patients. The pulmonary service does a bronchoscopy to determine if the fire damaged the lungs. Stents are placed if there is any narrowing in the major airways in the lung and are deployed before respiratory distress develops. Pulmonologists assess lung injury and determine if a stent will be needed. Pain management is a lifelong mandated commitment