Blog Archives

Paediatric Burns series: #2

27/1/2017

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ED Approach to a major paediatric burn

Initial process

ATMIST
Primary & secondary survey
Safeguarding
Stabilisation

Assessment

Mechanism: scald, flame, chemical (what, acid/alkali), electrical (high/low voltage)
Time of injury
Estimated burn area and which parts of body (Mersey Burns app)
Airway compromise
First aid measures
Other injuries

Management (consultant led care)

Airway (all above + work of breathing, may need suction/nebs in inhalation injury) – see Blog post 3
Consider c-spine
100% O2
CO level, cyanide level (if required: hydroxycobalin 70mg/kg)
IV/IO access
Fluids – see Blog post 4
Catheterise if >20% TBSA

Record body surface area, using appropriate chart (Mersey Burn app). Exclude erythema (sunburn type), use Lund & Browder. Note palm surface area is 0.8%. Rule of 9’s not accurate in children, and not really in adults either.

Consider need for escarotomy prior to leaving peripheral hospital
Clingfilm
Analgesia
KEEP warm
Monitoring is an issue: may need invasive, consider ear probe on lip, may have to stitch lines through burn,

The suggested minimum threshold for referral into specialised burn care services can be summarised as:

All burns ≥2% TBSA in children or ≥3% in adults
All full thickness burns
All circumferential burns
Any burn not healed in 2 weeks
Any burn with suspicion of non-accidental injury should be referred to a Burn Unit/Centre for expert assessment within 24 hours

In addition, the following factors should prompt a discussion with a Consultant in a specialised burn care service and consideration given to referral:

All burns to hands, feet, face, perineum or genitalia
Any chemical, electrical or friction burn
Any cold injury
Any unwell/febrile child with a burn
Any concerns regarding burn injuries and co-morbidities that may affect treatment or healing of the burn

If the above criteria/threshold is not met then continue with local care and dressings as required.
If burn wound changes in appearance / signs of infection or there are concerns regarding healing then discuss with a specialised burn service.
If there is any suspicion of Toxic shock syndrome (TSS) then refer early.

Click here for full guideline: http://www.britishburnassociation.org/

Clare Bosanko, Jan 2017

Link to previous learning blog: http://derriforded.weebly.com/derrifoam-blog/gems-wdwlt

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Paediatric Burns series: #1

25/1/2017

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An introduction + first aid

Epidemiology
Predominantly scalds and contact burns in children.
Cups of tea and coffee.
Think about primary prevention.

First aid
Stop the burning process: remove clothing, don’t remove if adherent
Cool with running water, for 20 minutes
Temporary dressing: cling film
Elevate limbs

Basic principles

IGNORE the burn in the primary survey
Call for help! Ideally a senior (paediatric) anaesthetist. Roles: airway management, vascular access, analgesia, transfer, to bring calm where there is panic
Consider the mechanism (are there any non-burn injuries?)
Keep the patient warm (EDs are cold)

How are hospitals that look after burned patients organised?
Facility > unit > centre (National Burn Care Referral Guidance)

Facilities: less complex burns, part of a plastic surgery service
Units: moderate size or moderate severity burns, include providing treatment for those requiring critical care
Centres: highest level of care with most severe injuries and highest level of critical care

In the South West:
Derriford is a burns facility.
Bristol Southmead is a burns unit for adults
Morriston, Swansea is a burns centre for adults
Bristol Children’s Hospital is burns centre for children

C Bosanko; Jan 2017

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Paediatric Burns series: #2

ED Approach to a major paediatric burn

Paediatric Burns series: #1

An introduction + first aid

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Paediatric Burns series: #2

ED Approach to a major paediatric burn

Paediatric Burns series: #1

​An introduction + first aid

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An introduction + first aid