Paediatrics: Burns

2021-03-10 12:00 AM

There are different forms of thermal injury to the body: · Contact with fire. · Scalding fluids. · Chemicals. · Electricity.

Burns

There are different forms of thermal injury to the body:

  • Contact with fire.
  • Scalding fluids.
  • Chemicals.
  • Electricity.
  • Inhalation of flame, heated vapour, and toxic fumes.
  • Cold: freezing injury.

The severity of a burn to the skin is assessed according to its severity and total surface area.

Severity

The severity of the burn site is categorized according to the degree of involvement of the skin:

  • First degree: limited to the epidermis; painful and erythematous.
  • Second degree: epidermis and dermis. Superficial is blistered and painful, and deep is white and painless.
  • Third degree: the epidermis and all of the dermis; painless and leathery.

Surface area

  • The extent of the burn as a proportion of the body surface area (% body surface area) can be calculated by making a sum of the individual areas involved in the injury. Table 5.1 gives the percentage of the body surface area taken up by the individual areas at different ages.

Symptoms

  • Features of hypovolaemia, pain, and signs of inhalation injury may be present

Symptoms of inhalation in the lung

  • Tachypnoea.
  • Stridor.
  • Crackles.
  • Wheeze.
  • Cough.
  • Respiratory distress.
  • Black sputum.

Other burn symptoms

Brain

  • Confusion.
  • Dizziness.
  • Headache.
  • Restlessness.
  • Coma.
  • Seizures.

Skin

  • Facial burns.
  • Nasal burn.
  • Cherry-red colour.

Aetiology

You should find out the following about the injury:

  • Its mechanism.
  • The duration of exposure.
  • Environmental factors (closed or open space).
  • Loss of consciousness during the accident.

Investigations

Minor burns

There is no need for routine investigations in children with minor burns, i.e. burns that are:

  • partial-thickness and <5% body surface; or
  • full-thickness and <2cm2(unless hands, face, genitals, joints involved).

Major burns

  • Arterial blood gas.
  • Carboxyhaemoglobin level.
  • Blood count and cross-match.
  • Blood urea, creatinine, and electrolytes may be tested.
  • Consider child protection issues!