Paediatric Burns series: #2

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,

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​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