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Only a few other public items share this expert — go deeper there →
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What the experts said
Burns result in over 300 visits and 2 deaths per day in pediatric patients.
The mechanism of pediatric burns is hot liquids or steam in younger children, and fire in older children.
Transfer criteria to a burn center include burns of more than 5% total body surface area, particularly if they involve the face, hands, feet, genitalia, perineum, or major joints.
Electrical burns, chemical burns, and inhalational injury should be transferred to a burn center.
Patients with significant circumferential burns should be transferred to a burn center.
Admission criteria at a burn center include any infant under age 1 with a total body surface area burn greater than 8%.
Any 2nd degree burn greater than 10% or any 3rd degree burn greater than 5% are indications for admission.
Before transfer, provide adequate pain control, apply silver sulfadiazine, and wrap wounds lightly with gauze, possibly adding Bactigras to prevent sticking.
Patients with smaller burns can be treated with oral rehydration therapy and do not necessarily require intravenous fluids.
At the speaker's center, IV resuscitation is initiated for patients with greater than 10% total body surface area burns or teenagers with greater than 15%.
The Lund-Browder chart is the best chart for estimating burned surface area because it takes into account body shape variations in children.
The palm of the patient can be used as an estimate of 1% body surface area burn.
The Parkland formula uses Ringer's lactate solution at 3 cc per kg per percentage body surface area burn.
The Cincinnati and Galveston formulas are more pediatric-specific than the Parkland formula.
Dextrose-containing solutions should be added as maintenance fluids for any patient under 30 kg.
A prospective study by Dietrich showed that colloid use results in statistically less fluid use overall, shorter lengths of stay, and reduced incidence of fluid creep.
Fluid creep is the phenomenon of giving too much fluid and not accounting for fluid already given, such as previous boluses or miscalculating total volume.
Fluid overload can lead to respiratory compromise, making the patient difficult to ventilate.
If a patient is adequately fluid resuscitated, controlled diuresis and addition of colloid can help eliminate excess fluid.
Foley catheter placement is indicated for patients with extensive burns, multiple trauma, or electrical burns where rhabdomyolysis may occur.
All patients should receive at least a tetanus booster if their vaccination card is not available.
The speaker does not give antibiotics until there is a proven infection, as prophylactic use leads to development of resistant organisms.
Carbon monoxide levels should be checked in any patient with suspected closed space fire or inhalational injury.
Patients with carbon monoxide poisoning will have normal transcutaneous oxygen saturation but low PaO2 on blood gas because all hemoglobin is saturated with carbon monoxide rather than oxygen.
Patients with suspected inhalational injury need to be intubated very quickly because once edema sets in, intubation becomes extremely difficult.
Bronchoscopy is useful in inhalational injury to assess the extent of airway injury and for pulmonary toilet, as patients often shed mucosa and develop casts in their airways.
If a patient with chest burns is desaturating without good chest rise, an escharotomy may be needed with incisions in the anterior axillary lines bilaterally and an oblique chevron incision connecting them.
Burns evolve over time, and what initially appears as a superficial burn may progress to partial or full thickness requiring surgical debridement and grafting.
Wounds should be reassessed every 24 hours for the first 48 hours.
Resuscitation endpoints must be reached before considering surgical debridement, with urine output as the primary endpoint: 1 cc/kg/hr for children under 30 kg and 0.5 cc/kg/hr for those over 30 kg.
Half of the calculated fluid should be given in the first 8 hours and the remainder over the next 16 hours according to resuscitation protocols.