Title: In light of recent July 4th celebrations, lets talk about burns! Submitted by Dr. To-Lam Nguyen<br/>Author: Jenny Guyther<br/><a href='http://umem.org/profiles/faculty/314/'>[Click to email author]</a><hr/><div class="x_elementToProof x_ContentPasted0" style="border: 0px; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-alternates: inherit; font-stretch: inherit; font-size: 12pt; line-height: inherit; font-family: Calibri, Arial, Helvetica, sans-serif; font-optical-sizing: inherit; font-kerning: inherit; font-feature-settings: inherit; font-variation-settings: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: rgb(0, 0, 0) !important;">
<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Burns are common pediatric injuries and usually represent preventable unintentional trauma.</span></div>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Approximately 10% of children hospitalized with burns are victims of abuse. Thermal burns are the most common type of burn and can result from scalding injuries or contact with objects (irons, radiators, or cigarettes). Features of scald burns that are concerning for inflicted trauma include clear lines of demarcation, uniformity of burn depth and characteristic pattern. Abusive contact burns tend to have distinct margins (branding of the hot object), while accidental contact burns tend to have less distinctive edges</span></div>
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How Kids are Different than Adults: </div>
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- Kids have thinner skin, so time to burn/energy required to cause a burn is less. </div>
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- Kids have increased blood volume relative to their mass, so may need more volume resuscitation compared to adults. </div>
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- Kids are more likely to become hypoglycemic so give glucose in mIVF in kids <20 kgs.</div>
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- Risk of airway compromise in kids following inhalation injury is higher due to their smaller airway openings </div>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Treatment:</span></div>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">- Initial treatment should follow ABCs of resuscitation</span></div>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">- Airway: Airway management should include assessment for presence of airway or inhalation injury, with early intubation if such an injury is suspected. Smoke inhalation may be associated with carbon monoxide toxicity; 100% humidified oxygen should be given if hypoxia or inhalation is suspected.</span></div>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">- Circulation: Parkland's formula</span></div>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"> - Fluid requirements = TBSA burned (%) x weight (kg) x4mL</span></div>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"> - Give<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;"> <span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;">½</span> of total requirements in 1<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;"><sup>st</sup> 8 hours, then give 2<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;"><sup>nd</sup> half over the next 16 hours. </span></span></span></span></div>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"> - REMEMBER KIDS HAVE BIG HEADS</span></div>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"> - Rule of 9's for adults: 9% for each arm, 18% for each leg, 9% for head, 18% for front torso, 18% for back torso</span></div>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"> - Rule of 9's for children" 9% for each arm, <b>14% for each leg, 18% for head</b>, 18% for front torso, 18% for back torso. </span></div>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span class="x_ContentPasted0" style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;"><span class="x_ContentPasted2" style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;">Options for pain management</span></span></span>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span class="x_ContentPasted2" style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;">- fentanyl IN</span></span></div>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span class="x_ContentPasted2" style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;">- morphine IV</span></span></div>
<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span class="x_ContentPasted0" style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;"><span class="x_ContentPasted2" style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;">- ketamine IV</span></span></span></div>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"> Burns you should consider admission</span></div>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">- >6% TBSA</span></div>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">- full thickness burns</span></div>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">- specialty areas: face, eyes, airway, genitalia, palmar crease, sole of foot</span></div>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">- concern for non-accidental injury</span></div>
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<span style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">- caused by treadmill</span></div>
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<fieldset><legend>References</legend>
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<span class="x_ContentPasted3" style="border: 0px; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-alternates: inherit; font-stretch: inherit; font-size: medium; line-height: inherit; font-family: "Times New Roman", Inter, "sans-serif"; font-optical-sizing: inherit; font-kerning: inherit; font-feature-settings: inherit; font-variation-settings: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: rgb(5, 16, 62); text-indent: -48px; display: inline !important;">Kliegman, R. M., MD, Stanton, B. F., MD, St Geme, J., MD, & Schor, N. F., MD PhD. (2015).<span class="x_ContentPasted3" style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;"> </span></span><i class="x_ContentPasted3" style="font-size: medium; box-sizing: border-box; border-width: 0px; border-style: solid; border-color: rgb(236, 237, 238); font-family: "Times New Roman", Inter, "sans-serif"; text-indent: -48px; color: rgb(5, 16, 62);">Nelson Textbook of Pediatrics</i><span class="x_ContentPasted3" style="border: 0px; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-alternates: inherit; font-stretch: inherit; font-size: medium; line-height: inherit; font-family: "Times New Roman", Inter, "sans-serif"; font-optical-sizing: inherit; font-kerning: inherit; font-feature-settings: inherit; font-variation-settings: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: rgb(5, 16, 62); text-indent: -48px; display: inline !important;"><span class="x_ContentPasted3" style="border: 0px; font: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;"> </span>(20th ed.). Elsevier Health Sciences.</span></p>
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