Paediatrics: Treatment for Burns

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