THE ED PLYMOUTH
  • Home
    • About us
    • TUEC >
      • Timeline
      • Current drawings
  • Education
    • Derrifoam Blog >
      • Get involved
      • FOAM
    • Education Faculty >
      • Core Education guide
    • Core education >
      • non-accs
      • accs
    • Higher specialist education
  • Clinical
    • EM Induction
    • Guidelines

Paediatric Burns series: #4

3/2/2017

6 Comments

 
Picture

Fluids

Fluid losses are slow and predictable. In the early phase of injury, shock is due to another cause.
 
All fluid formulae
  • take no account of other injuries
  • are a starting point only
  • increase oedema in injured and uninjured tissues
Baxter (parkland) formula: 2-4ml/kg x body weight x %burn
  • From time of burn: Half in first 8 hours, remainder in 16 hours. If you are ‘playing catch up’ spread this over 8 hours rather than giving a bolus.
  • Note: you may well have estimated the body weight and the %burn, therefore potentially compounding your error
Picture
Flame burn patients are likely to be sicker and require more fluids than scald burns.
 
Timing of resuscitation fluid in children: if started within 1hour better survival in major burns (>20%).
Urine output targets: adult 0.5-1ml/kg, children 2ml/kg. May also use lactate to track response. Be prepared to cut back. Beware… children may develop SIADH picture post burn (some opinion that 0.5-1ml/kg/hr if Na/renal function + haemodynamics stable is OK).
Beware fluid creep: just because fluids are good in burns, does not necessarily mean more fluids are better. Consider starting at lower end of 2-4 ml/kg
 
Excess fluids cause: burn progression, non-wound oedema, compartment syndromes, impaired gas exchange, cerebral oedema
 
Remember that fluids are COLD, warm them before infusing.
Clare Bosanko, Febr 2017
6 Comments

Paediatric Burns Series: #3

1/2/2017

0 Comments

 

Airway

Picture

Predicting presence of airway burn:

Mechanism: entrapment, explosion, altered level of conscious (at any time). Few facial scalds require intubation.
Symptoms: voice change, retrosternal burning sensation, sensation of difficult breathing
Signs: reduced level of consciousness, voice change, perioral or perinasal burns (not just facial burns), soot in the oropharynx (not just nose), erythema or oedema of tongue, stridor
Undertaking intubation:
  • Techniques: RSI, inhalation induction (good body of evidence), awake fibreoptic (probably not available everywhere)
  • Requirement: Experienced staff, full range of equipment, ED or operating theatre, oral/nasal tube (uncut), document airway findings (if normal at the time consider discontinuing intubation, but certainly will help with planning onward care)
  • Be prepared for hypotension (consider preparing phenylephidrine to counteract)
  • Tracheal tube fixation, as appropriate to patient and institution: sticking plaster, ribbon tape ties, post-nasal sling, suture/wire to nasal septum or maxilla (may need maxfax assistance)
Pitfalls:
  • Facial burn does not equate to airway burn
  • No airway injury found at laryngoscopy (may choose to discontinue intubation attempts)
  • Late intervention in airway injury: be prepared with senior staff and helpers
  • Cutting tube (DON’T)
  • If in doubt intubate BUT consider
    • More patients are intubated now than 15 years ago
    • Incidence of confirmed inhalation injury is the same or falling
    • Rate and severity of intubation/ventilation complications is significant (safety, transfer logistics, ventilator related problems)
    • Ventilation of patients without inhalation injury associated with increased sepsis, ionotrope usage, mortality
Clare Bosanko, Febr 2017
0 Comments

    Categories

    All
    ACCS
    Cardiology
    ENT
    Minors
    Non Tech
    Non-tech
    Orthopaedics
    Paediatric
    Radiology
    Safety
    Simulation
    Toxicology

    The Derrifoam Blog

    Welcome to the Derrifoam blog - interesting pictures, numbers, pitfalls and learning points from the last few weeks. Qualityish CPD made quick and easy.....

    Subscribe to our mailing list

    * indicates required

    Archives

    October 2022
    April 2021
    March 2021
    February 2021
    January 2021
    December 2020
    November 2020
    October 2020
    September 2020
    July 2020
    June 2020
    May 2020
    April 2020
    January 2020
    December 2019
    July 2019
    May 2019
    February 2019
    December 2018
    November 2018
    September 2018
    July 2018
    May 2018
    April 2018
    December 2017
    November 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    November 2016
    September 2016
    August 2016
    July 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    November 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    January 2015
    November 2014
    October 2014
    September 2014
    August 2014

Picture
  • Home
    • About us
    • TUEC >
      • Timeline
      • Current drawings
  • Education
    • Derrifoam Blog >
      • Get involved
      • FOAM
    • Education Faculty >
      • Core Education guide
    • Core education >
      • non-accs
      • accs
    • Higher specialist education
  • Clinical
    • EM Induction
    • Guidelines