RT Book, Section
A1 Fishe, Jennifer N.
A1 Hendry, Phyllis L.
A2 Tenenbein, Milton
A2 Macias, Charles G.
A2 Sharieff, Ghazala Q.
A2 Yamamoto, Loren G.
A2 Schafermeyer, Robert
SR Print(0)
ID 1155749747
T1 Pediatric Burns
T2 Strange and Schafermeyer's Pediatric Emergency Medicine, 5e
YR 2019
FD 2019
PB McGraw-Hill Education
PP New York, NY
SN 9781259860751
LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1155749747
RD 2024/04/20
AB Burns  are  the  fifth  leading  cause  of  unintentional  injury–related  death  in  children.  Children  younger  than  4  years  typically  suffer  scald-related  burns,  whereas  older  children  typically  sustain  flame-related  burns.For  pediatric  patients,  the  Lund  and  Browder  chart  estimates  percent  of  body  surface  area  (BSA)  burned  by  adjusting  for  age.  Another  method  to  estimate  percent  of  BSA  uses  the  area  of  the  child’s  palm  (including  fingers)  to  approximate  1%  BSA.The  primary  survey  should  focus  on  airway  patency  as  well  as  burn  severity.  Facial  burns,  the  presence  of  soot,  carbonaceous  sputum,  or  singed  nasal  hairs  should  alert  the  physician  to  impending  airway  edema.Circumferential  burns  may  cause  both  vascular  and  respiratory  compromise.  If  vascular  compromise  is  present,  the  patient  should  undergo  an  immediate  escharotomy.The  Parkland  formula  is  widely  used  to  estimate  fluid  requirements.  This  formula  calls  for  an  isotonic  crystalloid  solution  (such  as  Lactated  Ringers)  to  be  given  at  4  mL/kg/%BSA  over  a  24-hour  period.  Half  of  the  fluid  volume  is  given  over  the  first  8  hours;  the  second  half  is  given  over  the  next  16  hours.Pain  control  is  of  the  utmost  importance  in  burn  management.  Opioid  analgesia  is  often  required.Initial  emergency  department  (ED)  wound  care  consists  of  covering  burns  with  a  dry,  sterile  sheet.  Antiseptic  solutions  (such  as  povidone–iodine)  and  topical  antibiotics  should  be  avoided  in  patients  who  are  being  transferred  to  a  burn  center  so  the  specialty  burn  service  may  visualize  the  wounds.Topical  antibiotics  (such  as  bacitracin  or  1%  silver  sulfadiazine)  are  routine  in  outpatient  burn  care.All  burn  patients  should  be  re-evaluated  at  24  to  48  hours  to  ensure  proper  wound  healing  and  to  examine  for  signs  of  infection.