Pediatric Burns

Epidemiology

 1,00,000 pediatric burn injuries each year

 Preschoolers are >50% of pediatric burns

 3rd leading cause of death in youth

Skin Functions

 Sensation
 Protection
 Temperature regulation
 Fluid retention
Types of Burn Injuries
 Thermal
 Scald
 Flame
 Radiation
 Chemical
 Electrical
Pathophysiology

 Loss of fluids

 Inability to maintain body temperature

 Infection
Developmental Trends
Infants and Toddlers Adolescents

75-90% are scald burns (I.e., 20% are household scalds

bathing, spills)
95% occur indoors 60% occur outdoors

Most play is indoors Increased experimentation

Increased responsibilities for
outdoor chores
Key Concepts

 TBSA = % of Total Body Surface Area

 Heat intensity and duration of skin contact

determine the extent and depth of skin
damage
Degrees of Burn Injuries
 Based on depth of burn injuries
 1st degree: damage to epidermis
 Heals in ~2-5 days with peeling; minimal scarring
 2nd degree: damage to dermis
 Partial thickness
 Heals in ~ 1-3 weeks with no grafting
 3rd degree: damage to multiple layers including
subcutaneous tissue
 Full thickness
 Heals in ~3-5 weeks; requires grafting
Layers of Skin
Degrees of Burns
 Burn Depth

 First Degree (Superficial)

 Involves only epidermis
 Red
 Painful
 Tender
 Blanches under pressure
 Possible swelling, no blisters
 Heal in ~7 days

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 Burn Depth

 Second Degree (Partial

Thickness)
 Extends through epidermis
into dermis
 Salmon pink
 Moist, shiny
 Painful
 Blisters may be present
 Heal in ~7 to 21 days

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Burn Depth

 Burns that blister are

second degree.
 But all second degree
burns don’t blister.

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 Burn Depth

 Third Degree (Full Thickness)

 Through epidermis, dermis into
underlying structures
 Thick, dry
 Pearly gray or charred black
 May bleed from vessel damage
 Painless
 Require grafting

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Burn Depth

 Often cannot be accurately determined in

acute stage

 Infection may convert to higher degree

 When in doubt, over-estimate

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Burn Extent

Rule of Nines

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 Burn Extent
 Pediatric Rule of Nines

1
8
9 9
18, Front
18, Back
1

13. 13.
5 5
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Burn Severity
 Based on
 Depth
 Extent
 Location
 Cause
 Patient Age
 Associated Factors

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Medical Management:
Emergency Phase
 Remove source of heat
 Apply first aid
 Assess for and treat shock
 Evaluate breathing (inhalation injury)
 Use CPR at scene, if necessary
 Fluid resuscitation – to correct electrolyte
imbalance and decreased blood volume
 Critical Burns
 3rd Degree >10% BSA
 2nd Degree > 25% BSA (20% pediatric)
 Face, Feet, Hands, Perineum
 Airway/Respiratory Involvement
 Associated Trauma
 Associated Medical Disease
 Electrical Burns
 Deep Chemical Burns
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Moderate Burns
 3rd Degree 2 to 10%
 2nd Degree 15 to 25% (10 to 20%
pediatric)

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Minor Burns
 3rd Degree <2%
 2nd Degree <15% (<10% pediatric)

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MANAGEMENT

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 Stop Burning Process

 Remove patient from source of injury

 Remove clothing unless stuck to burn

 Cut around clothing stuck to burn

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 Assess Airway/Breathing
 Start oxygen if:
 Moderate or critical burn
 Decreased level of consciousness
 Signs of respiratory involvement
 Burn occurred in closed space
 History of CO or smoke exposure
 Assist ventilations as needed

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 Assess Circulation
 Check for shock signs /symptoms

Early shock seldom results from effects of

burn itself.
Early shock = Another injury until proven
otherwise

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Fluid Management

 4 mls / kg/ %burns + maintenance fluids

 Strict input-output monitoring

Upper Airway Burn
 True Thermal Burn
 Danger Signs
 Neck, face burns
 Singing of nasal hairs, eyebrows
 Tachypnea, hoarseness, drooling
 Red, dry oral/nasal mucosa

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Lower Airway Burn
 Chemical Injury
 Danger Signs
 Loss of consciousness
 Burned in a closed space
 Tachypnea (+/-)
 Cough
 Rales, wheezes, rhonchi
 Carbonaceous sputim

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Medical Management:

 Goal: close the wound

 Reduce infection risk
 Remove eschar (dead skin) by debridement
 Apply topical dressings
 Use physiological dressings to reduce fluid and
heat loss
 Perform autografting surgery
 Use tissue-cultured skin as last resort