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Burn Injury, What Are The Challlenges in Pediatric Patients (Dr. Irene Yuniar, SpA (K) )
Burn Injury, What Are The Challlenges in Pediatric Patients (Dr. Irene Yuniar, SpA (K) )
Anatomy
Narrow Burn
spectrum TBW
child
Immunity
Scope of problem
Initial Evaluation
Triage estimate of burn injury severity
Severity :
- minor burn injuries : < 5% total BSA outpatient
- moderate to severe burn injury : ABCDEFs
(airway, breathing, circulation, disability, exposure, and fluid
resuscitation)
Emergency assessment, clothing (temperature-controlled
environment)
Estimating burn severity
Age and medical history :
- Infants and children < 2 years old anatomical BSA varies
with age : Lund-Browder chart
- DM, sickle cell disease, and children receiving chemotherapy
Surface area, depth, and pattern of the burn injury
The mechanism of injury
Surface area, depth, and
pattern of the burn injury
Surface are :
- Rapid estimate of the TBSA of a burn injury in adolescents
and adults rule of 9s.
- Burn wounds >10% TBSA SIRS
Depth :
- influences the predicted degree of physiologic derangement
- direct implications for wound management
Schematic representation of Jacksons
burn model
Dermis
Source:
Hettiaratchy S, Dziewulski P. ABC of burns: pathophysiology and types of burns.
BMJ. 2004;328:1427-9.
Depth of burn injury
partial-thickness
scald burn
full-thickness
flame burn
Pathophysiology
Basic principles:
Degree of tissue injury: length of exposure,
temperature, age
Skin can tolerate temperature up to 40oC
Imflammatory mediators are released: edema,
fluid loss, circulatory stasis, protein and muscle
breakdown, coagulopaties, impaired immunity
Significant metabolic response: insulin
resistance, impaired GI barrier function
Treatment
Initial assessment : ABC
Minor partial-thickness burns (<5%) TBSA :
analgesia and wound care (debridement/ removal)
Burn dressing reduce pain
Minor burns
- outpatient basis with a low-cost
- topical antimicrobial agent prevents wound desiccation
inhibits bacterial colonization / invasion.
- Burn antimicrobial agents silver sulfadiazine or bacitracin ointment
- Epithelialize in 7 to 14 days
Minor- moderate (5-10% TBSA) partial-thickness burn injuries :
- wound coverage with a biological dressing (pigskin) or a biocomposite
temporary dressing (semipermeable silicone)
Severe burn injuries pediatric burn center
Treatment
Stigmata of inhalational injury high probability of requiring
mechanical ventilation
- history of closed-space structural fire
- soot in the nose or mouth
- elevated carboxyhemoglobin > 10%, PaO2 to FiO2 ratio < 200.
Inhalational injury and/or carbon monoxide poisoning intubation
(ventilation with 100% O2)
Prevent hypothermia.
Moderate or severe burn injuries (> 10% TBSA) IV fluid
resuscitation
The goal of fluid resuscitation : maintenance of end-organ perfusion
through preservation of intravascular volume
The most commonly used resuscitation formula : Parkland or Baxter
Monitoring
Airway and Ventilation
Circulation iv volume (urine output : 2
ml/kg/hour)
SIRS sepsis
Environment
Antibiotics therapy based on colonization
pattern
Nutrition
Family education
Nutritional support