Burns

Question 1

What are the leading causes of pediatric burns?

Answer 1

→ Unintentional injuries are the 3rd leading cause of death for those under 19 years.
→ 28% of burn admissions are under age 16.
→ Fireworks injuries account for about 3,000 injuries around July 4th.
→ Non-accidental trauma (NAT) contributes to up to 8% of burn hospital admissions.

Question 2

List risk factors for pediatric burns.

Answer 2

→ Male gender
→ Age under 4 years
→ Disabilities

Question 3

What are common etiologies of pediatric burns?

Answer 3

→ Thermal (e.g., fires, MVA, fireworks, kitchen scalds)
→ Chemical (contact, ingestion, or inhalation)
→ Electrical (contact with faulty wiring, power lines)
→ Mechanical/Friction (road rash, treadmills)
→ Cold (frostbite)
→ Radiation

Question 4

What are key prevention strategies for pediatric burns?

Answer 4

→ Educate parents on safe cooking practices.
→ Use engineering controls like child-proofing.
→ Enforce safety laws for smoke alarms, water heaters, and children’s sleepwear.

Question 5

How are burns classified?

Answer 5

→ Superficial (1st degree): Involves only the epidermis.
→ Partial-thickness (2nd degree): Involves the epidermis and dermis.

Superficial partial thickness: Epidermis + papillary dermis, with pain and blistering.
Deep partial thickness: Down to reticular dermis, may be waxy and insensitive to light touch.
→ Full-thickness (3rd degree): Involves epidermis, dermis, and subcutaneous tissue.

Question 6

How is TBSA used in burn classification?

Answer 6

→ TBSA (Total Burn Surface Area) measures burn severity.
→ Lund and Browder chart is commonly used.
→ TBSA > 20% is considered a major burn.

Question 7

What professionals are part of a burn center team?

Answer 7

→ Surgeon
→ Surgery Practitioner
→ Nurse
→ Occupational Therapist (OT)
→ Physical Therapist (PT)
→ Dietitian
→ Child Life Therapist
→ Psychiatrist
→ Plastic Surgeon

Question 8

Describe symptoms of superficial burns.

Answer 8

→ Involves only the epidermis.
→ Pink to red color, no blisters.
→ Commonly caused by sunburns.
→ Heals without scar tissue.

Question 9

What are the characteristics of superficial partial-thickness burns?

Answer 9

→ Involves the epidermis and papillary dermis.
→ Painful, red with blisters.
→ Heals in 2 weeks or less without scarring.

Question 10

Describe deep partial-thickness burns.

Answer 10

→ Involves epidermis, papillary, and reticular dermis.
→ Waxy white appearance, may be insensitive to light touch.
→ Takes 3-6 weeks to heal, scar tissue forms, but no grafting needed.

Question 11

What are the symptoms of full-thickness burns?

Answer 11

→ Involves epidermis, dermis, and subcutaneous tissue.
→ May appear red, cherry, white, or brown.
→ Anesthetic to touch but painful due to nerve activation around the burn.
→ Requires grafting to heal.

Question 12

What factors contribute to the depth of burn injury?

Answer 12

→ How the injury occurred
→ Thickness of burn
→ Clothing over burned area
→ Age (children have thinner skin)

Question 13

What factors affect initial burn treatment?

Answer 13

→ Depth, size, location of burn
→ Presence of other injuries (e.g., smoke inhalation)
→ Age and premorbid health

Question 14

What are the initial pulmonary considerations in burn care?

Answer 14

→ Ensure adequate airway and breathing.
→ Check for inhaled smoke or fumes.
→ Administer oxygen or intubate if needed.
→ Watch for carbon monoxide inhalation and pulmonary edema.

Question 15

Describe burn shock and its treatment.

Answer 15

→ Caused by fluid loss and increased capillary permeability.
→ Leads to reduced circulatory volume and cardiac output.
→ Requires aggressive fluid resuscitation.

Question 16

How is fluid resuscitation managed in pediatric burns?

Answer 16

→ Burns < 10-20% TBSA: Oral fluids, vasoconstriction, and urine retention.
→ Burns > 20% TBSA: IV fluids, urinary catheterization, and monitoring for hypovolemic shock.

Question 17

What are the renal considerations for burn management?

Answer 17

→ Fluid loss can cause renal vasoconstriction and failure.
→ Electrical burns can release myoglobin, leading to kidney occlusion.

Question 18

What are circulatory concerns in full-thickness burns?

Answer 18

→ Inelastic skin and edema can cause compromised circulation.
→ Compartment pressures > 30 mmHg may require escharotomy.

Question 19

How are musculoskeletal injuries addressed in burn care?

Answer 19

→ Splinting and traction are common.
→ Internal fixation within 48 hours is recommended.

Question 20

What nutrition considerations are there in pediatric burns?

Answer 20

→ Increased calories and proteins are needed.
→ Hypothermia risks require maintaining room temperature above 85°F.

Question 21

Describe physical therapy goals for pediatric burn patients.

Answer 21

→ Wound management
→ Increase ROM and strength
→ Promote normal development
→ Prevent deformities and contractures.

Question 22

What are pain management strategies for pediatric burns?

Answer 22

→ Pharmacologic: Premedication before therapy.
→ Non-Pharmacologic: Cognitive behavioral therapy, relaxation, distraction, etc.

Question 23

What is the role of splinting and positioning in burn care?

Answer 23

→ Prevent contractures and maintain ROM.
→ Splints are worn 24 hours/day except during dressing changes.

Question 24

Describe early mobilization strategies for pediatric burns.

Answer 24

→ Begin with dangling at the edge of the bed (EOB).
→ Progress to ambulation with compression for edema control.

Question 25

What exercises are beneficial for burn rehabilitation?

Answer 25

→ Resistance training
→ Aerobic exercises
→ Stretching and breathing activities.

Question 26

What are family considerations in pediatric burn care?

Answer 26

→ Involvement in wound care, massage, and exercises.
→ Addressing psychosocial needs for community reentry.

Question 27

How do social factors affect pediatric burn recovery?

Answer 27

→ Disfigurement impacts quality of life.
→ Strong family support improves outcomes.

Question 28

What are scar management strategies for pediatric burns?

Answer 28

→ Pressure garments
→ Scar massage
→ Silicone, taping, sun protection, and surgical options (e.g., laser, Z-plasty).

Question 29

What role do burn camps play in recovery?

Answer 29

→ Provide physical, psychological, and social support.
→ Facilitate social integration for burn victims.

Question 30

Summarize key takeaways for managing pediatric burns.

Answer 30

→ Use a systems approach tailored to each case.
→ Begin early mobilization and advocate for social reentry.
→ Monitor for contractures and pressure sores.