the child with burns or scalds
DESCRIPTION
The Child with Burns or Scalds. Objectives. To understand the structured approach to the child with burns To learn how to identify the severity of burns in a child To introduce the skills and equipment used for the resuscitation of a child with severe burns. Epidemiology. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/1.jpg)
![Page 2: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/2.jpg)
To understand the structured approach to the child with burns
To learn how to identify the severity of burns in a child
To introduce the skills and equipment used for the resuscitation of a child with severe burns
![Page 3: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/3.jpg)
755 pts. ≤15 yoa in 14/17 Burns Units in A & NZ
Figures from Bi-NBR
Figures by courtesy of Bi-NBR 2010-2011 year
![Page 4: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/4.jpg)
Causes of Burns
•Overall •55% are scalds•21% are contact•14% are flame
•Scalds are commonest cause up to 11 yoa
•78% of scalds occur in the usual place of residence
•>10 yoa flame burns are commonest cause
![Page 5: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/5.jpg)
![Page 6: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/6.jpg)
![Page 7: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/7.jpg)
Severity of InjurySeverity of Injury Temperature
Duration of contact
% of Body Surface Area burnt
![Page 8: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/8.jpg)
irway nd C spine control
reathing
irculation
ABC
![Page 9: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/9.jpg)
Airway managementmust not be delayed
![Page 10: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/10.jpg)
Systemic poisoning
◦ CO & HCN: usual cause of death at the scene
Supraglottic injury
◦ Swelling within hours causing obstruction
Infraglottic injury
◦ Smoke particles cause chemical response >1-3 days
SMOKE IS HOT
![Page 11: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/11.jpg)
History of exposure
Soot in mouth
Carbonaceous sputum
Singed facial hair
Hoarseness or cough
StridorSMOKE IS HOT
Watch for Watch for progressive progressive
signssigns
45% of patients45% of patients with flame burnswith flame burns
above the claviclesabove the clavicles have inhalation injuryhave inhalation injury
![Page 12: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/12.jpg)
![Page 13: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/13.jpg)
Associated chest injuries
Circumferential burns
Small children use the diaphragm
so a burn of the front & sides
of the trunk can impair
ventilation.
![Page 14: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/14.jpg)
Fluid loss is obligatory, max. 8 hrs, continues 48 hrs
Hypovolaemia from burns occurs relatively late
If shocked early, look elsewhere for a cause
![Page 15: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/15.jpg)
Resuscitation Burn (%) x Weight (kg) x 4 ml per day
Calculated from the time of the burn
Half in first 8 hours
Hartmann’s
Maintenance – as usual over 24 hours
![Page 16: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/16.jpg)
Assess fluid requirements by urine output
0.5 - 2 ml / kg / hr
◦ Ideally 0.5-1 ml/kg/hr
◦ Avoid overhydration
>2 ml/kg/hr if haemochromogenuria
Formulae are only Formulae are only guidesguides
![Page 17: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/17.jpg)
BURNT CHILDREN LOSE HEATBURNT CHILDREN LOSE HEAT
VERY RAPIDLYVERY RAPIDLY
![Page 18: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/18.jpg)
Blast
Falls
MVAs
Falling objects
Escape
Associated injuries may be obvious or hiddenAssociated injuries may be obvious or hidden
![Page 19: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/19.jpg)
Surface area
◦ % of Body Surface Area (%BSA)
Depth
◦ Describe anatomically
Site
◦ Involves “special” areas?
![Page 20: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/20.jpg)
Paediatric BSA chart
Child’s hand(palm and adducted
fingers)is 1% BSA
![Page 21: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/21.jpg)
For simplicity use “Rule of 9s”
In Infant1 X 9 for each
arm.2 X 9 for head 14% each lower
limb4 X 9 for trunk
Take 1% off head Take 1% off head & add to legs for & add to legs for each year of life each year of life
>1>1
In adult1 x 9 for h & n, each arm2 x 9 for each lower limb
4 x 9 for trunk
![Page 22: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/22.jpg)
Superficial- Pink- Blistered
◦ Base blanches on pressure◦ Refills on release
![Page 23: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/23.jpg)
Mid dermal – dark, mottled red, non-blanching
Deep - White/charred - Leathery
Early depth assessment is inaccurate
![Page 24: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/24.jpg)
Remove FBs and wash
Cling film loosely applied
Elevate
Ointments, creams or dressings ONLY as part of
definitive care or transfer delayed (discuss).
![Page 25: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/25.jpg)
Opiates IV
Opiates IM
![Page 26: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/26.jpg)
Flowing water 8-25°C
Most effective for partial thickness
Continue 20 minutes
Excellent pain relief
AVOID HYPOTHERMIA
![Page 27: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/27.jpg)
“Glove and stocking” scalds Artefact shape of burn Absence of splash marks Inconsistency of history and
examination Delay in presentation Signs of other injuries Repeated presentation Witness to event not at ED
![Page 28: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/28.jpg)
Adult – total > 10 % or full thickness >5% Child - total > 5 % Special areas: Face, hands, feet, perineum and major joints Circumferential burns Inhalational injury Chemical, radiation or electrical burns Suspicion of non accidental injury Patient with pre-existing medical disorders which may
complicate management, prolong recovery or affect mortality
Associated significant trauma
![Page 29: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/29.jpg)
The Child with Burns or ScaldsThe Child with Burns or Scalds
![Page 30: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/30.jpg)
Treat airway compromise earlyTreat shock and resuscitateLook for associated injuries
Use IV analgesia as appropriateCare for wounds
Refer appropriatelyQuality transfer
![Page 31: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/31.jpg)
![Page 32: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/32.jpg)
The leading cause for accidental death of children worldwide
NZ 18 deaths per year28 if include up to 19 yrcf Eng & Wales 34 in 1998
62 admissions per year > 24 h
![Page 33: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/33.jpg)
Prevention Effective, early basic life support Assume cervical spine injury Handle gently if hypothermic
![Page 34: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/34.jpg)
Intubate to prevent aspiration Gastric drainage to remove
swallowed water Measure core temperature
and treat hypothermia Full trauma assessment for other injuries
![Page 35: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/35.jpg)
External RewarmingExternal Rewarming Remove wet clothing Wrap warmly Radiant heat Warm air system Direct heat
Core RewarmingCore Rewarming IV fluids to 39oC Ventilator gases to
42oC Gastric/bladder/
peritoneal/pleurallavage at 42o C
Extra-corporeal rewarming with
by-pass
![Page 36: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/36.jpg)
Active core re-warming vital No initial medications until core >30o C Initial defibrillating shocks, but no repeat till core >30o C Volume expansion may be needed Continue to resuscitate until expert advice obtained
![Page 37: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/37.jpg)
No single factor reliably predicts outcome Immersion time Time to first respiratory effort Core temperature Persisting coma The clinical course is determined by
hypoxic-ischaemic injury and adequate CPR
![Page 38: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/38.jpg)
DrowningDrowning
![Page 39: The Child with Burns or Scalds](https://reader034.vdocument.in/reader034/viewer/2022052223/5681492b550346895db666ce/html5/thumbnails/39.jpg)
Good BLSRemember cervical spine injury
Protect the airway from aspiration
Remember hypothermia