Mosby items and derived items © 2005, 2001 by Mosby, Inc.

Mosby items and derived items © 2005, 2001 by Mosby, Inc.

The Child with BURN INJURY

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Burns• Toddlers: hot water scalds

• Older children: flame-related burns

• Child abuse

• Child with matches or lighters accounts for 1 in 10 house fires

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Characteristics of Burn Injury• Extent of injury described as TBSA (total body

surface area)—use age- related charts• Depth of injury

– 1st degree—superficial– 2nd degree—partial thickness– 3rd degree—full thickness– 4th degree—full thickness + underlying

tissue• Severity of injury

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SuperficialSuperficial

Superficial partial-thicknessSuperficial partial-thickness

Deep partial-thicknessDeep partial-thickness

Full-thicknessFull-thickness

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Very painful, dry, red burns which blanch with pressure. They usually take 3 to 7 days to heal without scarring. Also known as first-degree burns. The most common type of first-degree burn is sunburn. First-degree burns are limited to the epidermis, or upper layers of skin.

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Very painful burns sensitive to temperature change and air exposure. More commonly referred to as second-degree burns. Typically, they blister and are moist, red, weeping burns which blanch with pressure. They heal in 7 to 21 days. Scarring is usually confined to changes in skin pigment.

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Blistering or easily unroofed burns which are wet or waxy dry, and are painful to

pressure. Their color may range from patchy, cheesy white to red, and they do not

blanch with pressure. They take over 21 days to heal and scarring may be severe. It

is sometimes difficult to differentiate these burns from full-thickness burns.

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Burns which cause the skin to be waxy white to a charred black and tend to

be painless. Healing is very slow, if at all, and may require skin grafting.

Severe scarring usually occurs.

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Severity of Injury• Major burn injury—treat in specialized

burn center

• Moderate burn injury—treat in hospital with expertise in burn treatment

• Minor burn injury—treat in outpatient setting

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Inhalation Injury• Trauma following inhalation of heated

gases and toxic chemicals produced during combustion

• Heat damage below vocal cords is rare

• Upper airway obstruction may require endotracheal intubation

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Pathophysiology of Thermal Injuries• Systemic response involving capillary

permeability

• Edema

• Hypovolemia

• Anemia

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Complications of Burn Injuries• Immediate threat of airway compromise

• Profound shock

• Infection (local and systemic sepsis)

• Inhalation injuries, aspiration, pulmonary edema, pulmonary embolus

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Burns: Therapeutic Management • Emergency care priorities

– Stop burning process

– Assess victim’s condition

– Cover burn to prevent contamination

– Transport child to appropriate level of care

– Provide reassurance

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Burns: Therapeutic Management • First priority: airway maintenance

• Fluid replacement therapy: critical in first 24 hours

• Nutrition: enhanced metabolic demands

• Medication: antibiotics, analgesics, anesthetics for procedural pain

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Care of Major Burns• Primary excision• Debridement• Topical antimicrobial agents• Biologic skin coverings

– Allograft (human cadaver skin)– Xenograft (porcine skin)– Synthetic skin substitutes– Split-thickness skin grafts (sheet or mesh

graft)

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Care of Minor Burns• Wound cleansing

• Debridement

– Controversy: removal of blisters

• Dressings

– Controversy: cover wound with antimicrobial ointment or use of occlusive dressings

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Rehabilitation After Major Burns• Begins once wound coverage has been

achieved

• Prevention/management of contractures

• Physical/occupational therapy

• Multi-disciplinary team

• Facilitate adaptation of child and family

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Sunburn• Ultraviolet A waves

• Ultraviolet B waves

• Importance of protection: sunscreens

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Cold Injury• Frostbite

– Tissue damage due to ice crystals in tissues– Blisters appear 24-48 hrs after rewarming– Treatment of blisters similar to burn treatment

• Chilblain– Redness/swelling especially of hands– Vasodilation, edema, bluish patches, itching

and burning; symptoms continue after rewarming; usually resolve in few days

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The burn/wound center includes an expanded reception area for children receiving outpatient care.