BURNS IN CHILDREN FOR 5 SEM BSC NURSING .pptx

BURNS - INCIDENCE
Burns are the tissue injury caused by contact with
heat,flame,chemicals,electricity and radiation
80% of burns occurs in children from home
Burns are the third leading cause of death in children
More common between the age group 1& 4 years
• Common and serious childhood injury
• Higher risk with children than adults
• Over 65% of burns in age below 5 yrs and 25%
below 10 years of age

Definition
• Burns are wounds produced by various kinds
of agents that cause coetaneous injury and
destruction of underlying tissue.

TYPES OF BURNS IN CHILDREN
Wounds caused by exposure to:
1. Thermal injury or Excessive heat
2. Chemicals
3. Fire/steam
4. Radiation
5. Electricity
6. Iatrogenic injury-

1.Thermal injury
• Heat injury due to hot liquids hot
surfaces,flame..heat maybe either dry or moist
• Scald injury –spillage of hot liquids–most common
Eg.pulling hot coffee from the table or hot water
• Flame injury –second most cause of burns-occurs
due to faulty electrical wiring ,stove,heaters..
• Flash burns- due to exposure of natural
gas,alcohol,combustible liquids
• Contact burns –contact with hot metals or objects
or materials

2. Cold injury- frost bite
3. Chemicals – due to ingestion of strong acid
and alkali
4. Electrical – due to high voltage electrical
contact
5. Radiation –over exposure to ultraviolet rays
6. Iatrogenic injury- careless use of warmers,
hot applicants ,cauterization

Pathophysiology
Heat causes coagulation necrosis of skin and
subcutaneous tissue
↓
Release of vasoactive peptides
↓
Altered capillary permeability
↓
Loss of fluid → Severe hypovolemia
↓

Decreased cardiac Decreased myocardial ↓ output
function
Decreased renal blood → Oliguria
flow (Renal failure)
Altered pulmonary resistance causing pulmonary edema
↓
Infection
↓
Systemic inflammatory response syndrome (SIRS)
↓
Multiorgan dysfunction syndrome (MODS)

Classification of burns in children
1. Depending on the thickness of skin involved
A. First degree
 Superficial burns; epidermis is pink to red and painful. Heals
rapidly in 5-7days
 No blisters
 By epithelisation without scarring
B. Second degree:
 Mottled, red, painful, with blisters,
 Heals in 14-21 days.
 Superficial burn heals, causing pigmentation.
 Deep burn heals, causing scarring, and pigmentation.

C. Third degree:
 Charred, painless and insensitive,
 Thrombosis of superficial vessels.
 It requires grafting.
 Escher Charred, denatured, insensitive, contracted full thickness
burn.
 These wound must heal by re- epithelialisation from wound edge.
D. Fourth degree:
 Involves the underlying tissues—muscles, bones.
• First degree second degree burns are included in partial thickness and third
degree burns is considered as full thickness burns

II. Depending on the depth of burn injury
a. Partial thickness burns:
It is either first or second degree burn which is red and painful, often
with blisters.
Epidermis, superficial layers of dermis involved
b. Full thickness burns:
It is third degree burns which is charred, insensitive, deep involving
all layers of the skin.
The wound does not heal normally and needs skin grafting

111. Depending on the severity /percentage of Burns
a. Mild (Minor):
• Partial thickness burns < 15% in adult or 10% TBSA in
children. First and second degree burns
• Full thickness burns less than 2%.
b. Moderate:
• Second degree burns 10-20% in children.
• Third degree between 2-5% burns.
• Burns which are not involving eyes, ears, face, hand,
feet,perineum.

c. Major (severe):
• Second degree burns in children more than 20%.
• All third degree burns of 10% or more.
• Burns involving eyes, ears, feet, hands, perineum.
• All inhalation and electrical burns.
• Complicated Burns with Trauma, fractures or major
mechanical trauma like head injury,DM,pulmonary
diseases,cancer, and all at-riskpatients

ASSESMENT OF BURNS/ ESTIMATION OF
BURNS SURFACE AREA
1,Rule of hand (Palmar method)
• The child’s one hand with closed fingers is considered as 1% of BSA
• The percentage is calculated comparing with the hand
2.Rule of five (Lynch and Blocker method)
• Body parts are approximated in multiplies of five
3.Rule of nines
• Used in an emergency situation which is adjusted for the child’s age.
For children above 10 years, rule of nines can be applied just like in
adults
• For children below 10 years it can be adjusted

Contined..
4. Use of Lund and Browder charts
• This method gives accurate percentage of burnt
surface area
• Percentage of BSA of various anatomic parts,
dividing the body in to very small area especially
the head and legs that change with growth
• Time consuming

• Wallace`s rules of nine
• It is used for early assessment

• The Lund and
Browder chart
 Better method for
assessing the burns
wound.
 Here each part of
the body is individually
assessed

Investigation
• Clotting studies
• LFT
• RFT
• Electrolytes
• Cross matching- for surgery

Management
1. First aid management
2. Management in the hospital
3. Fluid management
4. Pain management
5. Wound management and healing of wound
• Debridement
• Hydrotherapy
• Grafts
6. Drug therapy
7. Nutritional support
8 .Nursing management
9.Rehabilitation
Refer text books
and focus on
these points in
detail.
Wongs 923-930
Parul Datta 377-
380
Sharma 727-
736(first edition)

EMERGENCY TREATMENT
• Minor burns:
• Stop burning process: apply cool water/ hold
burned area under cool running water
• Don’t use ice
• Don’t disturb any blisters
• Don’t apply anything to wound
• Remove burned clothing and jewelry

Emergency management..
Major burns
Stop burning process
• Flames burns- smoother the fire
• Place victim in horizontal position
• Roll victim in a blanket
• Avoid covering head
• Cover with a clean cloth
• Transport to hospital

Conti..
General Principles
• >10% total BSA - IV fluid resuscitation &
urinary catheter.
• In major injury - nasogastric tube to
decompress the stomach.
• During transport - maintain body temperature.

MEDICATIONS
• Antibiotics – are usually not administered
prophylactically because decreased circulation to the
injured area prevents delivery of the medication to areas
of deepest injury.
• Tetanus toxoid prophylaxis
Analgesics-
• Morphine sulphate – for severe burns
• Midazolam and fentanyl – excellent iv sedation and
analgesia
• Propofol and nitrous oxide – for procedural pain

Topical therapy :
• 0.5% Silver nitrate dressing
• Mafenide acetate or Sulfacetamide acetate cream
• Silver sulfadiazine cream
• Povidone-iodine ointment
• Gentamicin cream or ointment
Fluid Resuscitation
• Burn leads to intravascular volume depletion
• Major losses occur during the first 24 hrs – crystalloids
used. Myocardial depression - 24-“36 hrs after injury.
• The goal of resuscitation _ to maintain adequate
intravascular volume to support tissue perfusion and
thereby preserve organ function.

• The adequacy of resuscitation
• based on observation of blood pressure, heart
rate, and urine output.
• Focus to maintain normal blood pressure,
heart rate, and hourly urine output of 1
mL/kg/hr in the infant and young child and
0.5 mL/kg/hr in the child >12 years of age or
>50 kg in weight

• Parkland formula - crystalloid-based formula
- with RL - based on the BSA of burn and the
patient's body weight. Maintenance fluids (5%
dextrose in lactated Ringer solution)
= (4ml/kg+ BSA of burn) + Maintainance fluids
• (For adults and children who weigh >40 kg,
maintenance fluids are not included in the estimate
of fluid requirements.)
• Half of this - in the first 8 hrs after injury, and
other half is given in the following 16 hrs

After the first 24 hrs,
- maintenance requirements + to replace ongoing
losses.
- The hourly evaporative fluid loss from wounds
can be estimated as:
= ( 25 + Burn surface area) x total BSA
- The evaporative losses are primarily free water,
to avoid rapid changes in sodium concentration
in children, this loss is replaced with - 5%
dextrose in 0.2% normal saline, loss of serum
protein occurs in > 40% BSA burns.

Brooke’s formula
First 24 hours – Colloids 0.5ml/kg/BSA
-Saline 1.5ml/kg/TBSA
-D5 as maintenance fluid
Next 24 hours – colloids 0.25ml/kg/TBSA
NS-0.75 ml/kg/TBSA
D5 as maintenance fluid

- When the injury is larger, the loss is replaced
in the second 24 hrs after injury with 5%
albumin
- URINE OUTPUT
- Best guide to tissue perfusion
- Adequate renal perfusion = 0.5mL/kg/hr

Complications
Hypovolaemia (refractory and uncontrolled) and shock
 Renal failure
 Pulmonary oedema and ARDS
 Septicaemia
 Multiorgan failure
 Acute airway block in head and neck burns
 Septicemia ,cardiac and GI complications
 Post burn seizures ,depression ,carcinoma in burn scar

BURNS IN CHILDREN FOR 5 SEM BSC NURSING .pptx

More Related Content

What's hot

Similar to BURNS IN CHILDREN FOR 5 SEM BSC NURSING .pptx

More from Shibili Abraham

Recently uploaded

BURNS IN CHILDREN FOR 5 SEM BSC NURSING .pptx