Chapter 138

• 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 sheet. Antiseptic solutions such as povidone–iodine and topical antibiotics should be avoided in patients who are being transferred to a burn center until the primary service has had the opportunity to evaluate the wounds.
• Topical antibiotics are routine in outpatient burn care. One percent silver sulfadiazine is most commonly used.
• All burn patients should be reevaluated at 24 to 48 hours to ensure proper wound healing and to examine for signs of infection.

Burns account for the fifth leading cause of unintentional injury-related death. Between 1987 and 2000, the mortality rate for children younger than 14 years old has fallen by approximately 50%.1 In 2002, there were about 90 000 visits to emergency departments related to pediatric burns.2 Children younger than 4 years old tended to have scalding-related injuries, whereas older children tend to suffer from exposure to flames. In a recent study on mortality in pediatric burns, those with at least 60% total body surface area (TBSA) involved had a decrease in mortality rates from 33% to 14% over the last 20 years.3 With earlier intervention, the morbidity and mortality related to thermal burns has decreased; however, there are still significant sequelae that increase with the amount of TBSA involved. The following chapter addresses common etiologies, clinical evaluation, management, and disposition of children who present to the emergency department with thermal injuries.

Thermal

Many pediatric burns are unintentional and entirely preventable. Scald injuries are the most common cause of burns in children younger than 4 years old. These typically occur as a result of hot liquids that tip over or are accidentally ...

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