Pediatric Burns By Bradley J. Phillips

Chapter 2

Principles of Pediatric Burn Injury

Alice Leung, MD,

and

Bradley J. Phillips, MD

Outline

1. Introduction

2. Pathophysiology

3. Burn Management

a. Triage

Outpatient Care

Inpatient Care

Pre-hospital Preparation

b. Emergent

Airway—Upper Airway Injury

Breathing—Lower Airway Injury

Circulation

Fluids

Temperature

Secondary Assessment

Tetanus

c. Acute Phase

Operative Management

Sepsis

Antibiotics/Antifungals

Nutrition and Metabolism

d. Rehabilitation and Reintegration

Hypertrophic Scarring

Contracture

Heterotopic Ossification

Leukoderma

Psychological

Follow-Up

4. Key Points

5. Figures and Tables

6. References

Introduction

Over 250,000 children suffer from burn injuries each year, accounting for one-third of all burns in the United States.¹ Thirty thousand of these patients sustain injuries that require admission to a hospital.² In the last 25 years, pediatric mortality has decreased through improved resuscitation and aggressive operative treatment. However, burn injuries are still the fifth leading cause of death in pediatric patients and are estimated to cost society $2.3 billion each year.^3,4

Burn injuries are ubiquitous, affecting every age, class, and ethnicity. Toddlers are most at risk for injury, as their newly gained mobility and ability to explore their environment outpace their cognitive development and sense of danger.⁵ In all age groups, males are 50% to 100% more likely to be burned than females. The majority of pediatric burns are scald injuries, followed by flame injuries. Chemical and electrical injuries occur less frequently; these burns tend to be small, involving less than 10% of the body. One of the greatest dangers in caring for pediatric burn patients is underestimation of the severity of the injury, both by physicians and by families. The presence of an inhalation injury in children younger than 4 years is associated with a poor prognosis. Even small burns in the absence of inhalation in infants have been known to be fatal.⁶ Although death from burn injury can result from burn shock in the immediate postinjury period, it is more commonly due to septic complications such as pneumonia, respiratory distress syndrome, and multisystem organ failure.⁷ The best outcome for patients with large burns is achieved by referral to the multidisciplinary setting of specialized burn centers. The first line of care is often given by emergency medical services, pediatricians, and emergency department