Paediatrics: Treatment for Burns

Burns: treatment

Initial treatment

Follow a standard protocol

• ABC: if there is evidence of inhalation then a pulmonary toilet with endotracheal intubation may be needed.
• Assume that there are carbon monoxide poisoning and measure carboxyhaemoglobin level and PaO₂. Give humidified 100% oxygen until results are available.
• Follow serial arterial blood gases and CXRs.
• Consider cyanide exposure and poisoning if the breath smells of almonds, or if the accident is fire-related, or if there is metabolic acidosis with raised anion-gap.
• In infants with burns >10% of body surface area, or children with >15% burns, consider an IV bolus of normal saline (10–20mL/kg). Further fluid resuscitation should be directed toward maintaining a urine output of 0.5–2mL/kg/h. In patients with >25%, burns use Parkland’s formula.
• Analgesia: pain must be treated. First ensure that ventilation, oxygenation, and perfusion are adequate. Use IV analgesics if required.
• Other injuries: do a secondary survey of associated traumatic injuries. Assess for cardiac and skeletal muscle injury in electrical accidents. In chemical burn, wash and neutralize the chemical.
• Place a nasogastric tube(NGT) and urinary catheter. Follow outputs.
• Pulse oximetry and cardiac monitoring are useful but remember their limitations in carbon monoxide poisoning.
• Eyes: examine the eyes for burn or abrasion, and treat with topical antibiotics if required.
• Give tetanus immunoprophylaxis required.

Box 5.3 Parkland’s formula

0–24hr afterburn

Crystalloid

• 4mL/kg per 1% burn
• Use 50% of this volume in the first 8hr
• 24–48hr afterburn

Crystalloid + colloid

• Use 50–75% of fluid requirements on day 1
• Add albumin (1g/kg/day) to maintain serum level above 2g/dL