Child with Severe Burns or Abdominal Trauma

Question 1

What is the most common aetiology of burns in the paediatric cohort?

Answer 1

Scalding (> contact > flame)

Question 2

What are the important components of assessing a paediatric burn?

Answer 2

• Aetiology and timing
• Total body surface area
• Depth of burn
• Weight of child
• Tetanus status

Question 3

Describe what would make you think a burn is superficial

Answer 3

• Appearance - pink, small white blisters
• Sensation - painful
• Cap refill - returns after compression
• Spontaneous healing - 5-7 days

Question 4

Describe what would make you think a burn is partial

Answer 4

• Appearance - red-white, large blisters +/- mottled
• Sensation - intact or dulled
• Cap refill - diminished to absent
• Spontaneous healing - 7-21 days +/- graft

Question 5

Describe what would make you think a burn is full thickness

Answer 5

• Appearance - waxy, charred, leathery
• Sensation - absent
• Cap refill - absent
• Spontaneous healing - none, requires grafting

Question 6

Outline the general approach to managing a child with burns

Answer 6

• A - care with C-spine especially if burns here
• B - circumferential burns can restrict chest - consider axillary escharotomy
• C - check pulses and CRT in each limb, consider escharotomy if circumferential
• D
• E - warm room and blankets (dehydrate/become hypothermic fast)
• First aid - remove heat. Running water 20 mins, cover with cling film in interim. No ice
• Fluids
• Analgesia
• Dressing

Question 7

In a child with burns, in which particular situations should you refer on to a specialist?

Answer 7

• > 10% TBSA or perineum/genitals, face, hands
  
  • Circumferential - elevate limb, frequent vascular obs, compare to uninjured limbs. Consider escharotomy
• Non-accidental injury
• Co-morbidities
• Pain/poor feeding

Question 8

When is fluid resuscitation appropriate in a child with burns? What fluid and how much?

Answer 8

• > 15% TBSA (not including superficial burns)
• Management
  
  • Resuscitation fluid - crystalloid 2-4 mL/kg/%TBSA burned. 50% in first 8 hours, 25% in each subsequent 8 hours
  • Maintenance fluid - 4, 3, 2 rule
  • Nasogastric tube if > 10% TBSA
  • Indwelling catheter if perineal burns or fluid required

Question 9

Do paediatric burns require antibiotic therapy?

Answer 9

• Not unless complicated by other injuries/comorbidities

Question 10

What should you clean a burn with? How should it be dressed? How do you manage blisters?

Answer 10

• Clean with saline
• Deroof blisters to avoid vascular compromise and dressing impedement
  
  • Dress
  • Temporary - glad wrap (reduce water loss)
  • Superficial - non-stick e.g. vaseline gauze/Mepilex; absorbent e.g. gauze/duoderm
  • Partial/full - nano-silver e.g. Acticoat/Mepilex Ag; biological

Question 11

If you are seeing a child with possible abdominal trauma - what clinical criteria could satisfy you to send them home?

Answer 11

• No abdo wall/seat belt signs, no GCS <14, no abdo tenderness or pain, no vomiting, no thoracic wall trauma, no decreased breath sounds
• Normal abdominal CT - clear in 99.6%