4.2 Pediatric Burns

Question 1

1st Degree Burn

Answer 1

• Superficial (only involves epidermis)
• Typically a sunburn

Symptoms
- Pink or red skin that is slightly painful but no blisters
- Blanches with pressure
- Heals on its own in 3-7 days

Question 2

2nd Degree Burn

Answer 2

• Involves epidermis and a portion of the dermis
• Hair follicles, sweat glands, nerve endings are still intact

Symptoms
- Painful blistering
- Moist skin
- Skin will be in pink/red or white
- Edema and decreased blood flow in surrounding area
- Heals in <21 days depending on how deep and possible scarring

Question 3

3rd Degree Burn

Answer 3

• Complete destruction of epidermis and dermis
• Can be red, tan, black, white
• Nerves, hair follicles, sweat glands are all damaged
• There is no pain because nerve endings were damaged however during healing, extensive pain will return when nerves start healing.

Involves extensive scarring and requires graft to heal
- Takes weeks to months to fully heal

Question 4

4th Degree Burn

Answer 4

• Burns through epidermis, dermis
• Involves Sub-Q Tissue (fat), tendons, bones, fascia
• All nerve endings are destroyed so there is no pain, but could involve amputation of extremities or extensive grafting.
• There will be significant scarring

Question 5

Burn Treatment

Answer 5

• Important to prevent infection

Question 6

How to Classify Burns

Answer 6

BASED ON
- Child’s age
- Causative agent
- Total body area involved
- Extent and depth of burn

Classifications
- Minor - Can be handled in an outpatient basis
- Moderate - Involves 10-20% total body surface area and requires hospitalization
- Major - Involves more than 20% total body surface area and requires admission to burn center

Question 7

Minor Burn Treatment

Answer 7

• Stop the burning (remove the source of the burning such as touching something hot or removing burning necklace, etc)
• Run temped water over the burn
• Cover the burn with dressing to prevent infection (with antibiotic ointment)
• Mild pain medications like acetaminophen
• Keep a child warm because child may have heat loss through the damaged skin
• DO NOT APPLY ICE OR COLD WATER TO A BURN BECAUSE IT CAN CAUSE FURTHER DAMAGE
• Check child’s tetanus status (especially if unknown or longer than 5 years since vaccine). Break in skin and causes of burns can be a risk factor for tetanus.
• Monitor infection

Question 8

Major Burn Treatment

Answer 8

• Biggest thing is airway. ABC’s
• Hypovolemic shock is a major concern with burns so after airway is stable, we need to administer a large bore IV to administer fluids. (VERY IMPORTANT TO ADMINISTER FLUIDS WITHIN THE FIRST 24 HOURS)
• First 24 hours is crystalloid fluid, NS, or LR then after 24 hours Colloid fluids (albumin, plasma) to maintain blood in the intravascular space.
• When burns occur there is a fluid shift from intracellular space to interstitial space causes a decrease in intravascular volume which can lead to hypovolemic shock.

Check urinary output (could be a sign of shock) - 1-2 mL/kg if less than 30kg
- Lab values for electrolyte imbalances
- Renal function (due to reduced cardiac output from fluid loss)

Complications
- Altered Neuro Status due to shock (change in capillary refill, skin temperature, VS, decrease in urinary output)
- Infection (which can lead to sepsis)
- Pain management