Paediatric burns and trauma

Question 1

what type of burn is not painful?

Answer 1

full thickness burns as the nerve endings are burnt off

Question 2

what is an escharatomy

Answer 2

escharatomy is a surgical procedure used to treat full-thickness (third-degree) circumferential burns. In full-thickness burns, both the epidermis and the dermis are destroyed along with sensory nerves in the dermis. The tough leathery tissue remaining after a full-thickness burn has been termed eschar.

Question 3

what type of burn is sunburn

Answer 3

epidermal burn (superficial)

Question 4

what burns are counted in calculating body surface area of burns?

Answer 4

superficial dermal burn
mid dermal burn
deep dermal burn
full thickness burn

(NOT epidermal burns)

Question 5

First aid management of burns?

Answer 5

call for ambulance

for at least 20 minutes- cold running water over burns

cling wrap over burn area

warm the child

Question 6

what are the components of a burn wound assessment?

Answer 6

Determining the depth of the burn
Is it circumferential?
What is the %TBSA

Question 7

what might you do for a circumferential SUPERFICIAL burn?

Answer 7

always elevate the limb if possible

Question 8

how might you calculate the %TBSA of burns?

Answer 8

discount simple erythema (epidermal burn)

Rules of 9s
or
Palmar method
or
Lund and Browder chart (most accurate)

Question 9

describe the rule of 9s for TBSA?

Answer 9

Think of the person in anatomical position

Adult:
whole head = 10%
whole arm = 9%
Front of chest= 18%
Back= 18%
whole leg=18%

Child:
Bigger head= 18%
smaller legs= 14%

Question 10

why is TBSA% important for burns patient?

Answer 10

guides fluid resuscitation requirements

Question 11

what are the x-rays we order for trauma?

Answer 11

lateral C-spine
CXR
pelvic x-ray

Question 12

what consists of a secondary survey for a burns patient?

Answer 12

head to toe examination

1. AMPLE history
2. Tetanus status
3. Wound care
4. Reassess need for primary survey

Question 13

why are children more susceptible for abdominal trauma?

Answer 13

Kids ribs are very compliant and so more vulnerable to abdominal injury

More force going through a smaller body- hence more prone to abdominal trauma

Question 14

why is a child’s airway more likely to obstruct than an adults?

Answer 14

• the child’s airway is smaller
• relatively larger tongue and smaller oral cavity
• cartilaginous nature of a child’s airway is more collapsable

Question 15

what are some reasons why intubation may be difficult in a child?

Answer 15

• smaller airway and oral cavity
• may have enlarged tonsils
• larynx is higher and more anterior than in adults
• larger head, particularly occiput region

Question 16

how might you check capillary refill in a child? what are the normal values?

Answer 16

CRT= press for 5 seconds, and make sure you lift the limb above the level of the heart! Normal is less than 2 secs. Delayed is greater than 3 or more seconds

Question 17

what are some adjunct management things you need to consider in a burns patient?

Answer 17

• warming the patient as they are often hypothermic
• fluid resuscitation!!
• analgesia (usually opiate)
• gastric tube (NGT may not be possible)
• IDC

Question 18

what are the organs we need to consider in a paediatric abdominal injury?

Answer 18

spleen, kidney, liver as they make up 75% of intra-abdominal injuries

other= bowel/pancreas etc

Question 19

what is a common mechanism for causing abdominal injuries in a child?

Answer 19

blunt force at high velocity e.g. seatbelt injury

Question 20

what are some adjunct management procedures to consider in a child with an abdominal injury

Answer 20

Gastric decompression tube

IDC

Question 21

why do we use a gastric decompression tube in a child with an abdominal injury?

Answer 21

prevents gastric dilation
prevents vomiting
improves image quality
improves ventilation

Question 22

what is the admission criteria for a child with a burn to hospital?

Answer 22

Criteria for Admission

• Partial thickness (superficial) burns with a surface area greater than 10%, except very superficial burns.
• All full thickness burns, except those that are extremely small.
• All burns to face, ears, eyes, hands, feet, genitalia, perineum or a major joint, even if less than 5‐10%.
• Circumferential burns.
• Chemical burns.
• Electrical burns (including lightening). Extensive tissue damage can occur to underlying structures.
• Burns associated with significant fractures or other major injury.
• All inhalation burns.
• Burns in children under the age of 12 months.
• Small burns in patients with social problems, including children at risk.

Question 23

which fractures are suspicious of non-accidental injury?

Answer 23

spiral fractures of the humerus
posterior rib fractures
bucket handle/corner fractures of metaphysis of long bones
skull fracture