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Paediatric Burns

Paediatric Burns. 2013. BURNS IN CHILDREN. In South Africa burns are the number one cause of unnatural death in children under the age of 4 years The vast majority of burns occur in the home of the child Hot water scalds are the most common cause of burns. The ABC of Burns resuscitation.

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Paediatric Burns

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  1. Paediatric Burns 2013

  2. BURNSIN CHILDREN • In South Africa burns are the number one cause of unnatural death in children under the age of 4 years • The vast majority of burns occur in the home of the child • Hot water scalds are the most common cause of burns

  3. The ABC of Burns resuscitation

  4. Basic first care • SAFE approach: • Shout for help • Advance with care • Free the person from danger • Evaluate the patient - ABCD • Stop the burning • Cool the burn wound

  5. Airway • History: • enclosed space? Smoke? Steam? • Examination: • burns to face • Sputum containing soot • Change in voice or cry, brassy cough, dysphonia, stridor • Management: • Clear airway,chin lift, jaw thrust. Beware: spine • Close observation • Humified 100% oxygen for 24h in all major burns • ET tube

  6. Breathing • Breathing effort: • Tachypnoea, hypopnoea • Abnormal chest movements • Cyanosis or bright pink colour • Cardiopulmonary resuscitation if not breathing, endotracheal intubation

  7. Circulation • Check the pulse • Capillary refill time (normal < 3 sec) • Shock in burns does not occur immediately, but evolves over time. If early shock look for bleeding elsewhere

  8. Circulation: Fluids • Initial 20mls/kg fluid bolus of Ringers Lactate if patient is shocked (can be repeated) • Ongoing fluid requirements need to be calculated • Resuscitation (Ringers Lactate): • Day 1: 2-3ml x kg x % burn first half given in the 8 hours from the time of injury and the second half in the subsequent 16 hours • Day 2: 1 - 2ml x kg x % burn over 24 hours • Plus: Maintenance, per day (Paediatric maintenance solution with Glucose): 100 ml/kg up to 10kg plus 50 ml/kg from 10 – 20 kg

  9. Disability: Level of consciousness • Altered sensorium may be due to: • Associated head trauma • Poor oxygenation • Shock • Carbon monoxide toxicity

  10. Exposure • Purpose of full exposure is to assess total burnt surface area and other injuries • Be aware that children are at risk of developing hypothermia

  11. Burn wound assessment • Two components: • Assessment of burn wound area: Determines fluid and metabolic needs • Estimation of depth of the wound: Determines local and surgical management

  12. Estimation of total burn surface area

  13. Estimation of burn depth

  14. Analgesia • Pain management must be started from the beginning: Diminishes SIRS, diminishes long term psychological scaring • Oral: • Tilidine HCL (Valoron): 1 mg/kg 6 hourly • Paracetamol: Loading dose 20 mg/kg; maintenance 15 mg/kg/dose, can be repeated 6 hourly

  15. Analgesia • Parenteral analgesia: • Morphine 0.5 mg/kg in 50 ml 5% D + W. Infusion rate 1 – 4 ml/hour • Ketamine 2 mg/kg/dose: For procedures • Need to be able to ventilate child if stops breathing (resuscitation equipment must be ready)

  16. Definitive management • Transfer to burns centre is indicated for the following: • Partial thickness burns greater than 10% TBSA • Burns involving face, hands, feet, genitalia, perineum, major joints • Third degree burns (any extent) • Electrical, chemical burns • Inhalation injury • Circumferential burns • Suspected child abuse • Any patient that can not be managed at the referring facility

  17. Definitive management Before transfer to the burns centre do the following: • Document history and time of the burn • Document fluids planned and received • Diagrammatic sketch of burnt area • Send signed consents for slough excision and grafting • Ensure safe transport and qualified accompanying personnel to continue resuscitation en-route (working drip essential)

  18. Definitive management • Prevent limb ischemia: Escharotomies • Prevent Katabolism: Early enteral feeding • Prevent sepsis: Early sloughectomy, skin grafting. Prophylactic antibiotics do NOT work • Prevent contractures: Splinting

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