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Pediatric burns

R
rupalpatel81

- Burns and scalds account for 6% of pediatric injuries, most commonly affecting preschool-aged children through hot drinks, baths, and cooking oils. House fires are a major cause of fatal burns through smoke inhalation. - The severity of the burn is related to the temperature and duration of contact - even low temperatures can cause damage with prolonged exposure. Burns are classified as partial thickness, deep partial thickness, or full thickness depending on the depth of tissue damage. - Burn assessment tools like the Rule of Nines and Lund & Browder chart are used to estimate the percentage of total body surface area burned to guide management. Large burns require extensive resuscitation, wound care, surgery, nutrition support,

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Burns and scalds account for 6% of peadiatric injuries. The majority involve pre-school children,burns being most common between 1-2 yrs,flame burns bet 5-18 yrs. House fires are the cause of most fatal burns with smoke inhalation being the immediate cause of death in many cases. Scalds are most commonly associated with hot drinks in toddlers, also occur with over heated bath water and hot cooking oil.
Severity of burn is related with 1.Temperature and 2.Duration of contact.e.g., At 44c - tissue damage occurs with 6hrs of contact with heat source While At 70c epidermal injury occurs in just 1sec.
Wounds caused by exposure to: 1. Excessive heat 2. Chemicals 3. Fire/steam 4. Radiation 5. Electricity 4 5
Pediatric burns
Wound excision until fine punctate bleeding occurs
Pediatric burns
s Partial thickness burn = involves epidermis Deep partial thicknes =involves dermis Full thickness = involves all of skin
Involves only the epidermis Tissue will blanch with pressure Tissue is erythematous and often painful Involves minimal tissue damage Sunburn
Referred to as partial- thickness burns Involve the epidermis and portions of the dermis Often involve other structures such as sweat glands, hair follicles, etc. Blisters and very painful Edema and decreased blood flow in tissue can convert to a full-thickness burn
Referred to as full- thickness burns Charred skin or translucent white color Coagulated vessels visible Area insensate patient still c/o pain from surrounding second degree burn area Complete destruction of tissue and structures
Involves subcutaneous tissue, tendons and bone
Rule of Nines: Quick estimate of percent of burn Lund and Browder: More accurate assessment tool Useful chart for children takes into account the head size proportion. Rule of Palms: Good for estimating small patches of burn wound
Head & Neck = 9% Each upper extremity (Arms) = 9% Each lower extremity (Legs) = 18% Anterior trunk= 18% Posterior trunk = 18% Genitalia (perineum) = 1% 17
ABA
19
As the primary survey is starting ,give high flow O2 from face mask with a reservior bag. Cooling the burn wound cold running water for 15- 20 min,avoid making pt hypothermic. Prevent hypothermia-there is disruption to thermoregulation with a significant burn. Insert min 2 peripheral cannula in unburnt skin if possible. Give iv Fluid according to protocol
Insert urinary catheter in all pts>20% BSA. Fast the pt and insert NG tube for all pts with>20% BSA,all intubated pts,head and neck burns,younger children >10%BSA. Adequate analgesia-IV opioids. Emergency wound management e.g.,cling film or clean non-adhesive dressing. Escharotomy if indicated e.g., circumferential burns around limbs or trunk.
FBC Clotting studies. Electrolytes,renal and liver function. CK( creatin kinase) if suspicion of significant tissue damage. Cross match if early surgery anticipated.
Evidence of possible airway compromise: .burn to head and neck with swelling .stridor,hoarse voice,swollen lips. .singed facial ,nasal or head hairs. . Unconscious . If complex/severe burns which require significant interventions.
ETT used,as chest wall compliance may be reduced resulting in significant leak. Intubation should be performed by experienced individual failed attempts can create edema and further obstruct the airway
4 ml R/L x % burn x body wt. in Kg (eg. 4 x 50% x 45 kg = 9000 ) 遜 of calculated fluid is administered in the first 8 hours( 9000/2 =4500 ml) Balance is given over the remaining 16 hours. (4500ml ) Maintain urine output at 0.5 ml/kg/hr.
Surgery and dressings Airway/ventilation Nutrition Antibiotics Miscllaneous
Escharotomy may be needed for circumferential burns to limbs,neck or trunk. Early surgical debridement of nectrotic tissue is preferred as early grafting is associated with improved outcome. Blood loss during operative sessions can be large.
Early enteral nutrition ideally post pyloric. Aim for a high calorie,high protein intake. Supplement with parenteral if enteral feeding is not well tolerated. Add trace element supplements.
Prophylactic antibiotics are avoided. Fever is universal after a severe burn and doesnt mean infection. Monitor wbc count,check frequent cultures.
Minor changes of dressings are often performed in ward with sedation and analgesia. ICU pts are transferred to operation theater with sedative and analgesic infusions continuing.
Pediatric burns

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Pediatric burns

  • 1. .
  • 2. Burns and scalds account for 6% of peadiatric injuries. The majority involve pre-school children,burns being most common between 1-2 yrs,flame burns bet 5-18 yrs. House fires are the cause of most fatal burns with smoke inhalation being the immediate cause of death in many cases. Scalds are most commonly associated with hot drinks in toddlers, also occur with over heated bath water and hot cooking oil.
  • 3. Severity of burn is related with 1.Temperature and 2.Duration of contact.e.g., At 44c - tissue damage occurs with 6hrs of contact with heat source While At 70c epidermal injury occurs in just 1sec.
  • 4. Wounds caused by exposure to: 1. Excessive heat 2. Chemicals 3. Fire/steam 4. Radiation 5. Electricity 4 5
  • 8. s Partial thickness burn = involves epidermis Deep partial thicknes =involves dermis Full thickness = involves all of skin
  • 9. Involves only the epidermis Tissue will blanch with pressure Tissue is erythematous and often painful Involves minimal tissue damage Sunburn
  • 10. Referred to as partial- thickness burns Involve the epidermis and portions of the dermis Often involve other structures such as sweat glands, hair follicles, etc. Blisters and very painful Edema and decreased blood flow in tissue can convert to a full-thickness burn
  • 11. Referred to as full- thickness burns Charred skin or translucent white color Coagulated vessels visible Area insensate patient still c/o pain from surrounding second degree burn area Complete destruction of tissue and structures
  • 13. Rule of Nines: Quick estimate of percent of burn Lund and Browder: More accurate assessment tool Useful chart for children takes into account the head size proportion. Rule of Palms: Good for estimating small patches of burn wound
  • 14. Head & Neck = 9% Each upper extremity (Arms) = 9% Each lower extremity (Legs) = 18% Anterior trunk= 18% Posterior trunk = 18% Genitalia (perineum) = 1% 17
  • 15. ABA
  • 16. 19
  • 17. As the primary survey is starting ,give high flow O2 from face mask with a reservior bag. Cooling the burn wound cold running water for 15- 20 min,avoid making pt hypothermic. Prevent hypothermia-there is disruption to thermoregulation with a significant burn. Insert min 2 peripheral cannula in unburnt skin if possible. Give iv Fluid according to protocol
  • 18. Insert urinary catheter in all pts>20% BSA. Fast the pt and insert NG tube for all pts with>20% BSA,all intubated pts,head and neck burns,younger children >10%BSA. Adequate analgesia-IV opioids. Emergency wound management e.g.,cling film or clean non-adhesive dressing. Escharotomy if indicated e.g., circumferential burns around limbs or trunk.
  • 19. FBC Clotting studies. Electrolytes,renal and liver function. CK( creatin kinase) if suspicion of significant tissue damage. Cross match if early surgery anticipated.
  • 20. Evidence of possible airway compromise: .burn to head and neck with swelling .stridor,hoarse voice,swollen lips. .singed facial ,nasal or head hairs. . Unconscious . If complex/severe burns which require significant interventions.
  • 21. ETT used,as chest wall compliance may be reduced resulting in significant leak. Intubation should be performed by experienced individual failed attempts can create edema and further obstruct the airway
  • 22. 4 ml R/L x % burn x body wt. in Kg (eg. 4 x 50% x 45 kg = 9000 ) 遜 of calculated fluid is administered in the first 8 hours( 9000/2 =4500 ml) Balance is given over the remaining 16 hours. (4500ml ) Maintain urine output at 0.5 ml/kg/hr.
  • 24. Escharotomy may be needed for circumferential burns to limbs,neck or trunk. Early surgical debridement of nectrotic tissue is preferred as early grafting is associated with improved outcome. Blood loss during operative sessions can be large.
  • 25. Early enteral nutrition ideally post pyloric. Aim for a high calorie,high protein intake. Supplement with parenteral if enteral feeding is not well tolerated. Add trace element supplements.
  • 26. Prophylactic antibiotics are avoided. Fever is universal after a severe burn and doesnt mean infection. Monitor wbc count,check frequent cultures.
  • 27. Minor changes of dressings are often performed in ward with sedation and analgesia. ICU pts are transferred to operation theater with sedative and analgesic infusions continuing.