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Presented by :Mrs Rupal Patel
.
Mrs.Rupal Patel,Assistant Professor, Sumandeep Nursing College

• 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.
Mrs.Rupal Patel, Assistant Professor, Sumandeep Nursing College

Wounds caused by exposure to:
1. Excessive heat
2. Chemicals
3. Fire/steam
4. Radiation
5. Electricity
4 5Mrs.Rupal Patel,Assistant Professor, Sumandeep Nursing College

Wound
excision until
fine punctate
bleeding
occurs

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 Mrs.Rupal Patel,Assistant

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

19Mrs.Rupal Patel,Assistant Professor, Sumandeep Nursing College

 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. Mrs.Rupal Patel,Assistant Professor, Sumandeep Nursing College

 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 )
 ½ 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
doesn’t 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.

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