Burns
There are different forms of
thermal injury to the body:
·
Contact
with fire.
·
Scalding
fluids.
·
Chemicals.
·
Electricity.
·
Inhalation
of flame, heated vapour, and toxic fumes.
·
Cold:
freezing injury.
The severity of a burn to the skin
is assessed according to its severity and total surface area.
Severity of the burn site is
categorized according to the degree of involve-ment of the skin:
·
First degree: limited to epidermis; painful and
erythematous.
·
Second degree: epidermis and dermis. Superficial
is blistered and painful, and deep is white and painless.
·
Third degree: epidermis and all of the dermis;
painless and leathery.
· The extent of the burn as a
proportion of the body surface area (% body surface area) can be calculated by
making a sum of the individual areas involved in the injury. Table 5.1 gives
the percentage of the body surface area taken up by the individual areas at
different ages.
· Features of hypovolaemia, pain,
and signs of inhalation injury may be present
·Tachypnoea.
·Stridor.
·Crackles.
·Wheeze.
·Cough.
·Respiratory distress.
·Black sputum.
·Confusion.
·Dizziness.
·Headache.
·Restlessness.
·Coma.
·Seizures.
·Facial burns.
·Nasal burn.
·Cherry-red colour.
You should find out the following
about the injury:
·Its mechanism.
·The duration of exposure.
·Environmental factors (closed or
open space).
·Loss of consciousness during the
accident.
There is no need for routine
investigations in children with minor burns, i.e. burns that are:
·partial thickness and <5% body
surface; or
·full thickness and <2cm2
(unless hands, face, genitals, joints involved).
·Arterial blood gas.
·Carboxyhaemoglobin level.
·Blood count and cross-match.
·Blood urea, creatinine, and
electrolytes may be tested.
·Consider child protection issues!
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