Burns

Despite continuing improvement in burn care, many children continue to suffer death and significant morbidity from burns. Burns are the second most common cause of accidental death among children under the age of 4 years. Younger children are more commonly injured by scalding water, accidental spills being twice as frequent as intentional immersions. Older children are more commonly burned by flame. 31

DIAGNOSIS Resuscitation principles are unchanged for pediatric burn patients. 32 Management of airway and circulation is paramount. Any traumatic injuries should be managed without regard to the burn itself. Aggressive airway management is crucial, as large burns may require high-volume fluid resuscitation, leading to airway edema and the inability to intubate the child later. Early intubation particularly with inhalational burns cannot be overemphasized. Burn surface area (BSA) cannot always be estimated by the "Rule of Nines" in children because the proportion of body surface area changes with growth. A Lund and Browder chart that is age-appropriate should be used (see Fig 194-2). Alternately, the burn area can be estimated by using the child's palm as 1 percent. Fluid resuscitation can be estimated by the Parkland formula (4 mL/kg x %BSA), the modified Brooke formula (2 mL/kg x %BSA), or the Shriners formula (5000 ml x BSA in m2 + 2000 mL x total surface area in m2). All formulas call for one-half the estimated fluid to be given in the first 8 h after the burn, the second one-half in the following 16 h so that the total volume is given in 24 h. All resuscitation formulas are a guide only. Proper management requires that the response to fluid administration be carefully monitored and adjustments be made individually.32

CRITERIA FOR BURN CENTER REFERRAL IabJ.e,..244-7 lists the criteria for referral to a burn center from the American Burn Association. Predictors for mortality rate in children by importance are burn size over 30 percent, age less than 4 years, and the presence of an inhalation burn. 31 Any questions regarding an individual patient should be directed to the regional burn center.

ta'AM J#Bl r%Hil .ritfffN hrti mM ÍK2 ¡ViVrrd FValp iuHhV Jf¥j TW-fcpn turu b™ II pauri tvi Hiira uci

IMTAU- Md UM wyw IMH MM LU jwrvíw IM E^IWH WI U rWu wSfr lt>mM "wmi- jad fsrt-^jTT Inni cm he* lurch fwr. ¡nicÉi iM —J —i™, ta'AM J#Bl r%Hil .ritfffN hrti mM ÍK2 ¡ViVrrd FValp iuHhV Jf¥j TW-fcpn turu b™ II pauri tvi Hiira uci

IMTAU- Md UM wyw IMH MM LU jwrvíw IM E^IWH WI U rWu wSfr lt>mM "wmi- jad fsrt-^jTT Inni cm he* lurch fwr. ¡nicÉi

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

Get My Free Ebook


Post a comment