But it’s all about careful monitoring- vital signs, urine output, level of consciousness, electrolytes and temperature. Formulas used will vary from hospital to hospital. So, the first thing we need to do is give fluids. The patient becomes severely hypovolemic, cardiac output decreases and organs are at risk for hypoxia due to decreased blood flow. When a large percentage of the body has been burned fluids and electrolytes start to shift and are lost. During this time something called Burn Shock can happen. Once the kid has arrived to the hospital the first 24-48 hours are the most crucial. So remember the younger the kid the more skin they have compared to their body size and this is why the first two things listed here are super important. Taking care of minor burns is, again, basic first aid, so we are going to focus on how to manage severe burns. An scald injury that is truly accidental is likely to be on the front of the body and will have a spill pattern. These red flags are 1) patterned burns, like cigarettes, irons, curling irons 2) burns that are the same level of thickness throughout and 3) circumferential burns. There are some really important red flags to be on the lookout for when it comes to identifying non-accidental burns. They can be used as a form of punishment and this is abuse. Okay so one thing that’s really important to be aware of is that sometimes burns aren’t accidental. So, things like singed hair on the face or actual burns like the girl in the photo here. This is especially true if there are any signs that the face has been burned. Respiratory distress may not present until 24-48 hours after the burn so kids have to be monitored closely for a couple of days after the burn. Inhalation injury is important and also kind of scary because there may not be any outward signs the that respiratory tract has been injured. A couple of things that are really important not to miss with burn assessments are inhalation injury and non-accidental burns. We’ll talk more about these severe burns in a sec. Burns that cover >30% of the body cause a systemic response and have poorer outcomes. Age specific charts have to be used to determine the percentage of skin that has been injured. Kids have a larger BSA compared to adults so the Rule of 9’s formula you use in adults doesn’t work here. The extent of the burn is determined by looking at Body Surface Area. A key point to remember about burns is that every burn has varying degrees of injury throughout (draw circle). Just a quick recap on these: with 1st degree burns the skin is red but intact, 2nd degree burns are blistered, 3rd degree burns are dry and leathery 4th degree burns are all the way through the skin to underlying tissues. So you already know burns are classified in degrees, 1st degree through 4th degree. Preventing burns is all about supervision and making the environment safe. More severe burns are usually caused by flames, house fires and electrical burns. The most common causes of the more simple burns are from hot liquids, (pulling a cup of hot coffee off the coffee table) hot surfaces (reaching up to touch the stove eye) and even sunburns can be really bad. Okay, let’s get started! Burns are a pretty common injury for our pediatric patients. For a more general review of burns there is a lesson in the Integumentary course that you can check out. I just want to highlight things about burns that are specific to kids. I’m not going to try and cover everything here. Management of these two are totally different. This is a big topic because a burn can range from a simple sunburn all the way to full thickness burns that cover the majority of the body. Hey, so we are going to cover burn injuries in this lesson.
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