Burns in kids

-MaryAnn Dakkak, MD

(Almost) 3 yo girl

Healthy

No significant PMH

Making pancakes with father, puts her hand on the skillet

Immediately brought in by mother to ED

Questions?

What are burn etiologies?

1) Scalds: from hot steam, pulling down a pan/pot, and immersion in too hot of water

2) Touching of hot objects: stoves, pans, irons, space heaters, radiators

3) Chemical burns: bleach, swallowing drain fluid or battery fluid

4) Electical burns: sticking things in sockets, playing with wires

5) Overexposure to the sun

*** Many of these are preventable and it is important to discuss at well-child visits, especially in the age range 2-5 ***

Evaluating the burnFirst Degree: involves only the epidermis, produce redness, swelling, dry skin and minor pain. Heal in 3-6 days. Peeling can be as early as 1-2 days.

Second Degree: involves the epidermis and part or most of the dermis. Produces blisters, redness, severe pain. Blisters often break open days 2-4. Complete healing can take from 7-21 days depending on severity. (superficialpartial thickness blanch, deep partial thinkness do not)

Third Degree: involves epidermis, dermis into the subcutaneous fat. Produces waxy white or brown and charred look, no pain b/c of nerve damage. Healing is very slow usually requires grafting and infection control and scarring can be severe.

Different % Distribution in

children.

Indicator of Secondary fluid losses

If >10% burn, best to see specialist

(First degree not included)

How to treat?Cool running water. Not ice, not submersion. Up to 20 minutes. Cool compress can help up to 1 hr.

Pain control.

Clean the wound water is adequate. (no need for betadine or chlorhexidine)

Blisters – small ones leave intact. Large blisters may be better to debride.

Special young child considerations:

Play in dirt

They will use their hands, lower risk of contractures and scarring

Wound dressingDressings: (all the fuss over not much of a difference?)

Moist is good. Wet is not.

For open blisters, an occlusive dressing is recommended

Topical Agents: provide some pain control, promote healing, and prevent wound infection and desiccation

First degree: lotion, honey, aloe vera or antibiotic ointment of choice is adequate. Aloe vera has evidence of reducing pain. No steroids.

Second degree: require topical antimicrobial and/or absorptive occlusive dressing to reduce pain and prevent desiccation.

Third degree: these patients should be treated by specialist/surgeon.

What does your burn want to wear?

Epidemiological changesNo longer seasonal

No longer related to infectious agents

Does NOT run in families(infanticide, drinking, smoking, etc.)

As diagnosis method changes, epi does

When to refer out:

ComplicationsPruritis and neuropathic pain: can use antihistamines, in difficult cases can use pregabalin for neurpathic pain.

Contractures: important to have physical therapy in cases of hand burns, facial burns, circumfrencial burns

Infection:

Can be hard to assess since sight is already erythematous and swollen.

Look for signs of fever and other systemic responses.

Common Pathogens: staph aureus, sterp pyogenes, pseudomonas, acinetobacter and klebsiella

Abx choice should cover gram negative and gram positive bacteria.

Questions?