Assessing Burns

Burns and scalds are common in children, particularly in small children after domestic accidents:

  • House fires (open cooking), hot water, chemicals
  • Remember:
    • The child may have suffered other injuries at the same time as the burn (including smoke inhalation)
    • Burns may be due to non-accidental injury

Question: What is the ABC approach to managing burns?

Answer

Burns and scalds are common in children, particularly in small children after domestic accidents:

  • House fires (open cooking), hot water, chemicals
  • Remember:
    • The child may have suffered other injuries at the same time as the burn (including smoke inhalation)
    • Burns may be due to non-accidental injury

Question: What is the ABC approach to managing burns?

Answer: Fig 1 shows the ABC approach.

IV fluid resuscitation: If signs of circulatory shock – bolus 20 ml/kg 0.9% saline.

Give IV fluid resuscitation according to Parkland formula: Fluid requirement = % BSA burned x weight (kg) x 4ml

Use physiological saline (Ringer’s/ Hartmann’s).

Give half fluid requirement in the first 8 hours, then 2nd half over next 16 hours.

Assess haemodynamic status (include urine output, haematocrit).

The ABC approach is:

  • Consider intubation if burns to face and mouth
  • IV fluid resuscitation, depending on % BSA burned
  • Carbon monoxide poisoning may be seen after enclosed domestic fires:
    • Give high inspired oxygen concentration. Note: oximeter may over read
  • Burns are very painful - opioid analgesia is required
  • Avoid infection. This is essential and repeated examinations add to the risk; for this reason and pain relief, full burn assessment is often best undertaken at time of early cleaning under (ketamine) anaesthesia
  • Early debridement may be required - prepare for blood loss during surgery. Escharotomy maybe required for circumferential burns. Don't forget tetanus toxoid

Fig 1 The ABC approach