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Pediatric Burns

ppt on Burns in children, pediatric burns with types of burns, scoring, management and complications, Thermal burns, electric burns and scald burns. how to calculate fluid loss in burns

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Ankit Mangla
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176 views34 pages

Pediatric Burns

ppt on Burns in children, pediatric burns with types of burns, scoring, management and complications, Thermal burns, electric burns and scald burns. how to calculate fluid loss in burns

Uploaded by

Ankit Mangla
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Pediatrics Burns

Dr Ankit Mangla
Head of Department Pedictric ICU and
Critical care Nephrology
HOPE HOSPITALS
JAIPUR
Severity of burns
• Thickness or type of burn
• Extent of Burn
• Location on Body
• Duration of Exposure
• Timing of Presentation
Depending upon circumstances
• Look for
Inhalational Injury
Carboxyhemoglobinemia
Cyanide poisionong
Internal electrical injury
Modified Wallace rule of 9
ACS Burn Severity assessment in children
SEVERITY PARTIAL THICKNESS FULL THICKNESS

MINOR <10% TBSA <2%

MODERATE 10 -20% <10%

SEVERE >20% or Special areas >10% or special areas

Special area include Palms, Perineum, Face, Feet


Burn Thickness
Superficial Burn
Superficial Partial Thickness Burn
Deep partial thickness burn
Full Thickness burn
Pathophysiology – Local area

• Complement and coagulation activation leads to microvascular


thrombosis and histamine and bradykinin release which leads to
edema
Pathophysiology—Systemic
• Systemic inflammatory response with burn >20-30% TBSA

• Hypovolemia secondary to fluid loss

• Decreased perfusion and DO2

• Large burns – Release of Catecholamines, vasopressin and AT cause


peripheral and splanchnic vasoconstriction and may compromise end-
organ perfusion
• Myocardial suppression -TNF- alpha (40-60% TBSA)

• Hemolysis - Especially in deep 3rd and 4th degree burns


• Anaemia – Eruthrocyte progenitor effected, so Hb drops about a week
after impact

• Deterioration in pulmonary function


• Independent of inhalation injury
• Due to bronchoconstriction of histamine, serotonin and TXA 2
• Decreased chest wall compliance
• Bacterial translocation
• Hypermetabolic state
• Nutritional support prevents intestinal villous atrophy
• Syndrome of decreased bowel mucosal integrity, capillary leak and
decreased mesenteric blood flow
• Enteral nutrition plus glutamine help preserve mucosal barrier and
prevent bacterial translocation to portal system
• Adequate resuscitation ensures mesenteric blood flow
• Immune Consequences - Deficits in neutrophil chemotaxis, phagocytosis
and intracellular bacterial killing
JACKSON’S three zones of burn
Who gets admitted?
• Any infant <1 yr with >8% BSA burn
• 2nd degree of >10% BSA
• 3rd degree of >5% BSA
• Burns to face, eyes, ears, hands, joints, genitalia, feet, perineum
• Significant electrical and chemical burns
• Polytrauma
• Significant comorbidities
• Inhalation injury
• Circumferential burns
Initial Burn Care
• Cooling – Tap water (10-15 degree)
• Effective upto 1st hour

• Removal of affected clothes

• Removal of constricting jwellery

• Cover to minimize infection and heat loss


Wound Care
• Partial thickness
• Cleaned with saline gauze to remove sloughed epidermis
• Avoid chlorhexidine- impairs healing
• Blister: <1cm2 (leave intact); >1cm2 (controversy)
Initial Burn Management- cABC’s
• C-spine precautions
• Airway
• Breathing
• Circulation
• Disability
• Exposure
Inhalational Burns
• Airway should be carefully examined for signs of inhalation injury.
• Clues to injury of the upper and lower airway include
• burns to the face
• singed nasal hairs
• soot in the oropharynx and
• carbonaceous sputum.

• Respiratory distress may be present, including tachypnea, use of


accessory muscles of breathing, and stridor.
• If inhalation injury is suspected, difficult intubation should be
anticipated
• Aggressive resuscitation can unmask occult laryngeal edema
Algorithm of fire
related inhalational
injury
• Vascular access: Obtain reliable vascular access; this may require
central venous cannulation or 2 wide bore cannulas.
• Fluid resuscitation: In general, burns >15-20% TBSA are associated
with large fluid shifts and require careful management of volume
status.
• Parkland formula ? 4ml x wt x TBSA% + maintainence fluid
• Galveston Formula ? 5000ml /m2 x TBSA % + 2000ml/m2
maintainence
• How to give?
• Galveston vs Parkland (no head to head trial)
• Better outcome in <10kg child

• NS vs RL (No head to head trial)


• 63% studies used RL
• Whether colloid (albumin) should be provided in the early period of
burn resuscitation?

• If utilized, one approach is to administer colloid replacement


concurrently with crystalloid therapy if the burn is >85% of TBSA
(e.g., 50% albumin infusion, 50% crystalloid infusion).

• Colloid is usually administered 12 to 24 hours after the burn injury.


• Wound care: Debridement of dead tissue

• Nutrition: Nutritional support is extremely important to the healing of


wounds, preferably with early enteral nutrition

• Prophylactic antimicrobial therapy??


• recommended only for coverage of the immediate perioperative period
surrounding excision or grafting of the burn wounds to cover the documented
increase in risk of transient bacteremia
• Surveillance cultures of the wounds, especially if the patient arrived
from another unit or location, are standard of care

• Pain management: Burns can be extremely painful, as are


debridement and dressing changes, especially in children
• What is superficial burn?

• Which area of skin is included in burn TBSA measurement??

• Which is the most painful burn and why?


THANK YOU

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