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HIGH-YIELD FACTS

  • Burns are the fifth leading cause of unintentional injury–related death in children. Children younger than 4 years typically suffer scald-related burns, whereas older children typically sustain flame-related burns.

  • For pediatric patients, the Lund and Browder chart estimates percent of body surface area (BSA) burned by adjusting for age. Another method to estimate percent of BSA uses the area of the child’s palm (including fingers) to approximate 1% BSA.

  • The primary survey should focus on airway patency as well as burn severity. Facial burns, the presence of soot, carbonaceous sputum, or singed nasal hairs should alert the physician to impending airway edema.

  • Circumferential burns may cause both vascular and respiratory compromise. If vascular compromise is present, 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 the fluid volume is given over the first 8 hours; the second half is given over the next 16 hours.

  • Pain control is of the utmost importance in burn management. Opioid analgesia is often required.

  • Initial emergency department (ED) wound care consists of covering 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 so the specialty burn service may visualize the wounds.

  • Topical antibiotics (such as bacitracin or 1% silver sulfadiazine) are routine in outpatient burn care.

  • All burn patients should be re-evaluated at 24 to 48 hours to ensure proper wound healing and to examine for signs of infection.

EPIDEMIOLOGY

Burns are the fifth leading cause of unintentional injury–related death in US children, with approximately 2500 deaths annually.1,2 Non-fatal burn injuries are the third leading cause of unintentional injury, with approximately one million annual pediatric cases.2 Male children consistently represent two-thirds of patients.3,4 Children <6 years of age sustain 58% of burn injuries, approximately 60% of which are thermal (scald) burns.3–5 The most frequently affected body parts are the hands (36%), followed by the head and face (21%), with most burns occurring at home.5–7 Pediatric burn incidence, size, and mortality have decreased over the past three decades.4,8 Despite those improvements, the potential for other significant sequelae (i.e., infection, respiratory failure, and sepsis) increases with the percent of BSA involved.3 ED burn treatment is usually followed by outpatient management, with less than 10% of cases requiring hospital admission or transfer to a burn center.2 This chapter addresses common etiologies, pathophysiology, BSA calculation, clinical evaluation, management, and disposition of children presenting to the ED with thermal injuries. Electrical burns are covered in Chapter 139.

ETIOLOGY

THERMAL

Scald injuries are the most common cause of burns in children younger than 4 years old.3,4 Scalds typically occur when hot liquids tip ...

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