UMEM Educational Pearls

Title: In light of recent July 4th celebrations, lets talk about burns! Submitted by Dr. To-Lam Nguyen

Keywords: burns, pediatric (PubMed Search)

Posted: 7/7/2023 by Jenny Guyther, MD (Updated: 4/29/2024)
Click here to contact Jenny Guyther, MD

Burns are common pediatric injuries and usually represent preventable unintentional trauma.

Approximately 10% of children hospitalized with burns are victims of abuse. Thermal burns are the most common type of burn and can result from scalding injuries or contact with objects (irons, radiators, or cigarettes). Features of scald burns that are concerning for inflicted trauma include clear lines of demarcation, uniformity of burn depth and characteristic pattern. Abusive contact burns tend to have distinct margins (branding of the hot object), while accidental contact burns tend to have less distinctive edges

How Kids are Different than Adults:

- Kids have thinner skin, so time to burn/energy required to cause a burn is less.

- Kids have increased blood volume relative to their mass, so may need more volume resuscitation compared to adults.

- Kids are more likely to become hypoglycemic so give glucose in mIVF in kids <20 kgs.

- Risk of airway compromise in kids following inhalation injury is higher due to their smaller airway openings

Treatment:

- Initial treatment should follow ABCs of resuscitation

- Airway: Airway management should include assessment for presence of airway or inhalation injury, with early intubation if such an injury is suspected. Smoke inhalation may be associated with carbon monoxide toxicity; 100% humidified oxygen should be given if hypoxia or inhalation is suspected.

- Circulation: Parkland's formula

- Fluid requirements = TBSA burned (%) x weight (kg) x4mL

- Give ½ of total requirements in 1^st 8 hours, then give 2^nd half over the next 16 hours.

- REMEMBER KIDS HAVE BIG HEADS

- Rule of 9's for adults: 9% for each arm, 18% for each leg, 9% for head, 18% for front torso, 18% for back torso

- Rule of 9's for children" 9% for each arm, 14% for each leg, 18% for head, 18% for front torso, 18% for back torso.

Options for pain management

- fentanyl IN

- morphine IV

- ketamine IV

Burns you should consider admission

- >6% TBSA

- full thickness burns

- specialty areas: face, eyes, airway, genitalia, palmar crease, sole of foot

- concern for non-accidental injury

- caused by treadmill

References

Kliegman, R. M., MD, Stanton, B. F., MD, St Geme, J., MD, & Schor, N. F., MD PhD. (2015). Nelson Textbook of Pediatrics (20th ed.). Elsevier Health Sciences.