Transcript Burn Injuries - SBH Peds Res

Burn Injuries
Adaobi Okobi, M.D.
Learning Objectives
Epidemiology
 Pathophysiology
 Classification of burns
 Red flags
 Treatment
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Epidemiology
Burns are the 3rd leading cause of
accidental death in the U.S.
 >120,000 children under 20 receive care
for burns in the E.D. every year
 Under 5 years, scald burns cause 65% of
thermal injuries
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Pathophysiology
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Zone of coagulationmaximal injury from
coagulation of proteins
Zone of stasisdecreased tissue
perfusion; tissue is
potentially salvageable
Zone of hyperemiaincreased tissue
perfusion
Classification of Burns
First Degree
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Dry
No blisters
Minimal or no edema
Erythematous,
blanches
Very painful
Epidermis only
Heals in 2-5 days
without scarring
Second Degree (Partial Thickness)
Moist blebs, blisters
 Underlying tissue is
mottled pink and white
with fair cap refill
 Very painful
 Involves epidermis and
reticular layers of dermis
 Superficial: 5-21 days
 Deep partial: 21-35 days
with no infection; if
infected converts to full
thickness burn
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Third Degree (Full Thickness)
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Dry, leathery eschar
White or waxy
appearance
No blanching or
bleeding
Sensation: deep
pressure
Includes epidermis and
dermis and may go
down to subcutaneous
fat, muscle or bone
Will not heal without
skin graft
Fourth Degree
Extends into muscle
or bone
 Sensation: only deep
pressure
 Requires skin graft
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Size of Burn
Palm method- palm of patient’s hand is
~1% TBSA
 Lund-Browder method (Rule of nines)
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Red Flags: Abuse
Resuscitation
Airway
 Breathing
 Circulation
 Disability
 Exposure
 Fluids
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Fluid Resuscitation
Parkland formula: 4ml/kg/%TBSA (+
maintenance IVF if <5 years)
 Give 1st half in 8 hours
 Give 2nd half over next 16 hours
 D5LR is the fluid of choice in 1st 24 hours
 Colloids (ie albumin) may be added to
restore oncotic pressure and intravascular
volume after the first 24 hours
 Urine output should be >0.5-1ml/kg/hr
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Treatment
Silver sulfadiazine cream- impedes epithelialization
Topical antibiotics (Bacitracin)
Chlorhexidine- antimicrobial skin cleanser
Mafenide acetate- carbonic anhydrase inhibitor
(treat patient with high bacterial load on wound)
 Providone-iodine ointment- controversial because
of cytotoxicity and delay in wound
epithelialization
 Bismuth-impregnated petroleum gauze
(Xeroform) – helps prevent or control wound
infection
 Skin graft
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Treatment
Pain control
 Clean with soap and water
 Debridement (large or painful blisters
may be ruptured)
 Glycemic control
 High protein diet
 Prophylactic antibiotics- controversial
 Rehabilitation
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Take Home Points
Burns can be classified by size and depth
First and superficial partial second degree
burns are very painful
 Deep second, third and fourth degree burns
are not painful because of damage to nerves
 Be suspicious of abuse for burns that do not
match the mechanism of injury, immersion
burns or cigarette burns
 Fluid resuscitation should be aggressive in
the first 24 hours with monitoring of the
urine output
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