Pathology of childhood burns

2021-01-30 12:00 AM

Calculate the burn area based on Lund and Browder's or Berkow's table that divides the surface of the body into age-appropriate area units to help accurately diagnose the burn area.

Burns in children are preventable. Burn patient is very painful regardless of the agent and can leave scarring when it burns deeply and can cause other problems.

In the treatment the initial assessment is very important for the burn area, depth of the burn and location of the burn. Special positions such as face, neck, perineal layer, and limb need attention. In the case of severe burns, the child can be rapidly shocked by the rapid loss of fluid from the intravascular fluid from the lumen, so resuscitation is very important. Prolonged shock can cause impaired organ function, making it difficult to treat later. A sterile burn treatment unit with a full set of equipment is crucial in infection prevention and treatment… maintaining a balance of hemodynamic and supporting mental and courageous.


Recall the importance of childhood burns.

Point out the key points of pain, handle it properly and at the right time, and provide emotional and social support for the burned child.

Materials and results

A study in Thailand of 100,000 households found that an average of 9 children died every day from traffic accidents, 4 from drowning and then by burns. But these figures are often not officially informed or recorded at the hospital. We are currently conducting a campaign to change public attitudes to stay alert to accidents including child - proof caps for medicine bottles and the installation of smoke alarms ...
According to data from In UNICEF, 90% of the accidents are in developing countries due to ponds, ditches, water wells, fire fires, stairways without handrails, high steps, thin structures, warehouses Unsafe chemical toxins, traffic congestion, and unsafe buildings are common causes of child injury.

We would like to highlight two cases in which an 18-year-old male was exposed to acid vapors after cleaning a textile factory waste truck. Factory waste is a mixture of sulfuric acid and when combined with water, it will form acid vapors and will be easily inhaled, causing respiratory tract damage, causing difficulty breathing and death upon reaching the hospital.
Discussion: Childhood burns are the second leading cause of accidents in Thai Land, including heat burns, boiling water burns, fire or spark burns, electrical burns, chemical burns and radiation burns.

Heat burns and boiling water burns often occur at home and in the kitchen and are preventable, although I don't have exact figures. Fire burns are common in Thailand because there are so many chute settlements and will be very serious if a fire occurs. Burns from fire or sparks can also be caused by burning clothes, prolonged exposure, possible choking from smoke and respiratory damage and death.

Hot fat burns (lard) are common among Chinese residents. Often burns wide and deep to the muscle layer and often in the position of the hands and face.

Calculate the burn area based on Lund and Browder's or Berkow's table that divides the surface of the body into age-appropriate area units to help accurately diagnose the burn area.

Accurate diagnosis of deep burns is often difficult even for experienced people

Classification of burns

Grade I burn: epidermal lesions with congestion, may be edematous but not scaled or scaly. The main cause in Thailand is boiling water, without risk of infection and scarring. Treatment for the first period by washing under cold water, oral pain relief is enough then you can use a cream to soothe the burn.

Grade II burns: lesions of the epidermis and dermis often caused by boiling water or sparks. Can self-lion after 1-4 weeks. Burns usually have a scald dome containing a pinkish background fluid. Burns of this degree are very painful, so after washing with physiological saline, it is necessary to use pain relievers and then use a biological bandage to prevent the transformation into deep burns.

Grade III burns or deep burns of the entire skin layer: damage to the epidermis, dermis and possibly to the deep layers of the skin, such as muscles ... do not heal on their own unless narrow area burns <1 inch. Usually burns from fire, fat or immersion in boiling water. The burn area is deeper and covered with a layer of hemorrhage on the surface of the secretions. Management includes pain relief, topical antibacterial agents, fluid resuscitation, possible blood transfusions and skin grafting (usually after 4 weeks).

Burns IV: deep burns to muscles and necrosis of other organs, treated as deep burns III.

Childhood burns have its own characteristics:

Children under 2 years of age have a different burn area of ‚Äč‚Äčeach section than an older child. Thinner skin and other physiological characteristics are responsible for the higher morbidity and mortality rates. Care should be taken to take care of burns on the face, neck, perineal layer, and limbs. Children with neurological defects often have poor coordination, especially in bronchospasm cases.

General management of burns in children

At the accident site: Cooling the burn area with sterile cold water for 20-30 seconds will have the effect of relieving pain, reducing bleeding and possibly reducing the depth of damage by limiting the effects of heat. We do not recommend the use of ice because it can cause hypothermia and freezing damage. Young children should be covered with a clean cloth or warm blanket.

In the emergency room / burn unit: should follow the burn classification guidelines of the American Burn Association for severe burns.

Burns of the dermis> 10% of body area.

Burns to the face, hands, feet, genital area, episiotomy, or large joint.

Deep full skin burns at any age.

Electrical burns include spark cat.

Chemical burns.

Respiratory burns.

Burns in a patient with a pre-existing chronic medical condition can cause problems with treatment, complications or death.

Burn patients have combined injuries in which burns are the greatest risk.

Burns in the patient require long-term social, psychological counseling or rehabilitation.

Reassessment of burn area, location, depth, and vital signs is extremely important

Burns level I: should be rinsed with sterile solutions or physiological saline, bandage and outpatient treatment, follow-up after 2-3 days.

Burns of degree II: need to be washed with sterile solution or physiological saline, can remove dead organs, burned arches on the back of hands, palms of hands, soles of the feet should be kept intact. Patients who burn more than 10% of their body area should be treated in the burn treatment unit. Open burns should be covered with pig skin and covered with gauze. The wound should be checked every 2 days, if the pig skin is firmly attached to the burned base, leave it alone, if not sticky, it is recommended to relieve the pain before changing the bandage then gently rinse in the bath, use the medicine topically. (silver sulfate), bandages, and physical therapy (active and passive) should be started early.

Genital burns should be washed off with a cotton gauze then covered with a thin gauze.

Grade III and IV burns require hospitalization. Take care of burns in hospital beds as well as second degree burns. Resuscitation and fluid maintenance are essential. Need to monitor vital signs, urine monitoring by sonde Foley. Nasal gastric catheterization to reduce gastric pressure and prevent vomiting, especially in the first 24 hours after burns in severe burns. Closely monitor the airway condition, pay special attention to lower respiratory tract burns. Closely monitor blood sugar. Monitor hematocrit to assess fluid needs and indicate blood transfusion when blood loss may occur

Injury from inhalation and airway care

The upper respiratory tract is often directly damaged by heat, causing edema of the glottis and pharynx leading to obstruction of the airways. Obstruction often has warning signs such as increased breathing rate, shortness of breath, sudden increase in secretion, or increased hoarseness. Children need to be closely monitored to be able to put the endotracheal tube in time.

Damage to the lower respiratory tract or parenchyma due to inhalation of hot air or smoke after 24 hours. Children may experience respiratory failure due to apnea, rale, wheezing. Need to monitor and care carefully by airway cleaning is the main measure in the early period. Tracheal secretions are usually very sticky and contain carbon fragments and mucosal plaques, which need to be gently washed down through the large endotracheal tube.

Electrical damage

Direct damage may be caused by electric current or by fire. Severe lesions are held right at the contact area, but necrotic lesions are also found far from the point of contact. All cases of high-voltage burns requiring close monitoring of cardiovascular status may require CPR measures when cardiac arrest, monitoring of arrhythmias in the emergency room. Resuscitation should begin with ringer lactate to maintain blood pressure and ensure a 1 ml / kg / h diuresis as soon as possible after the burn. Myoglobinuria is an indicator of deep burns and requires large amounts of fluid treatment to prevent kidney failure.

Burns caused by abuse

Child abuse should be considered with treatment. Most occur in young children. The burn part needs to be carefully considered because it is often multiple burns. There is often a history of neglect or abuse.

Summary and conclusion

In Thailand, infections are less and less, e.g., Diphtheria and… Acute rheumatism, and rheumatism used to be 50% or more and 30 years ago.

Burns are one of the great preventable causes of death in children. Painful and scarring during deep burns and other problems as a child grows up especially burns to open areas such as the face and neck. Pain is very important for children suffering from burns, so it is necessary to give pain relievers every time the dressing is changed, or the burn is cleaned.

During severe burns, children are often shocked quickly by fluid drainage from the lumen, so resuscitation is very important. Prolonged burn shock can cause multi-organ failure, making it difficult to treat later. A sterile burn treatment unit with a full set of equipment is crucial in infection prevention and treatment… maintaining a balance of hemodynamic and supporting mental and courageous.