Topics Discussed: acute illness; burns; critical care.
Sections: Epidemiology, Etiology, Pathophysiology, Clinical Evaluation, Laboratory Studies, Management, Disposition, References.
- Burns are the fifth leading cause of unintentional injury-related death. Children younger than 4 years tend to have scalding-related injuries, whereas older children tend to suffer from exposure to flames.
- Most physicians use the classic Lund and Brower chart to estimate %BSA burned as it adjusts for the age of the patient. Because of the possibility for error in estimations, some physicians use the child's palm, considered approximately 1%, to measure the total %BSA burned.
- The primary survey should focus on the patency of the child's airway as well as the severity of the burn. Any carbonaceous sputum or singed nasal hairs should alert the physician to impending airway edema.
- Of particular importance are circumferential burns, which may cause both vascular and respiratory compromise. If vascular compromise is apparent, 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 this fluid volume is given over the first 8 hours, and the second half is given over the next 16 hours.
- Pain management is an important consideration in burn management. Opioid analgesia is often required.
- Initial wound care in the emergency department should consist of covering the burns with a dry, sterile..."
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