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Chapter: Paediatrics: Emergency and high dependency care

Paediatrics: Treatment for Burns

Assume that there is carbon monoxide poisoning and measure carboxyhaemoglobin level and PaO2. Give humidified 100% oxygen until results are available.

Burns: treatment

 

Initial treatment

 

Follow a standard protocol

 

·  ABC: if there is evidence of inhalation then pulmonary toilet with endotracheal intubation may be needed.

 

·  Assume that there is carbon monoxide poisoning and measure carboxyhaemoglobin level and PaO2. Give humidified 100% oxygen until results are available.

 

·  Follow serial arterial blood gases and CXRs.

 

·  Consider cyanide exposure and poisoning if the breath smells of almonds, or if the accident is fire-related, or if there is metabolic acidosis with raised anion-gap.

 

·  In infants with burns >10% of body surface area, or children with >15% burns, consider an IV bolus of normal saline (10–20mL/kg). Further fluid resuscitation should be directed toward maintaining a urine output of 0.5–2mL/kg/h. In patients with >25% burns use the Parkland’s formula.

 

·  Analgesia: pain must be treated. First ensure that ventilation, oxygenation, and perfusion are adequate. Use IV analgesics if required.

 

·  Other injuries: do a secondary survey of associated traumatic injuries. Assess for cardiac and skeletal muscle injury in electrical accidents. In chemical burn, wash and neutralize the chemical.

 

·  Place a nasogastric tube (NGT) and urinary catheter. Follow outputs.

 

·  Pulse oximetry and cardiac monitoring are useful, but remember their limitations in carbon monoxide poisoning.

 

·  Eyes: examine the eyes for burn or abrasion, and treat with topical antibiotics if required.

 

·  Give tetanus immunoprophylaxis if required.

 

Box 5.3 Parkland’s formula

 

0–24hr after burn

 

Crystalloid

 

·  4mL/kg per 1% burn

 

·  Use 50% of this volume in the first 8hr

 

·  24–48hr after burn

 

Crystalloid + colloid

 

·  Use 50–75% of fluid requirements on day 1

 

·  Add albumin (1g/kg/day) to maintain serum level above 2g/dL

 

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Paediatrics: Emergency and high dependency care : Paediatrics: Treatment for Burns |

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