Pediatric burn | |
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Other names | Burns in children |
Specialty | Emergency medicine, plastic surgery |
A pediatric burn is an injury to the skin or underlying tissue in person under the age of 18, and is globally the most common type of pediatric injury. [1] Burns can be caused my heat, cold, chemical or irritation. Most burns do not require hospital admission but a small percentage are serious and need to be transferred to specialist burn centers, where a multidisciplinary team of specially trained doctors, including surgeons and anesthesiologists can care for the child. Mortality rates at centers like this at are recorded at 3%. [2]
There are three types of burns;
Depending on the type of burn that has occurred, there will be different signs and symptoms.
A superficial burn has damaged the epidermis, and this appears as redness.
A partial thickness burn has damaged the epidermis and underlying dermis, and is red, painful and often blisters
A full thickness burn has damaged the epidermis and the entire dermis, nerves and skin appendages. These burns are often described as painless as the nerve endings have been burned so they can no longer transmit pain along their axon. These burns are white in appearance as the capillaries have been damaged, the skin is leathery. [3]
Up to 70% of children's burns are as a result of scalds, where the child is exposed to hot liquids e.g. spilling hot water or a hot bath. [4] neglected children's are also a risk factors for burns
There are several risk factors for pediatric burns;
More burns are reported in under 15-year-old boys than girls and more burns are recorded in children living in urban areas than rural areas. [1]
To determine the management strategy of any burn, it is essential that the Total Burn Area is calculated. This differs from an adult to a child as the total body surface area is divided up differently for a child and for an adult- mainly as a child's head takes up a larger percentage of the TBSA than it does in a fully developed adult. A doctor will assess the burns and calculate the total area of the child's body that is covered in the burn and from there will determine the course of treatment depending on the extent of the burns. Depending on the TBSA the patient may be transferred to a specialist burn unit for specialized care, however often patients that are transferred to these units have had their TBSA overestimated in the hospital that they presented too and perhaps did not require the referral. [5] Depending on the TBSA the management of the patient will differ, for example an adult burn <10% TBSA is classified as a minor burn however in a young patient a minor burn is classified as <5% TBSA and for moderate burns in adults is classified as 10-20% TBSA and in a child is 5-10% TBSA. All child burns which are >10% TBSA are referred to specialized center to management. [6]
Fluid resuscitation is an initial management step of all major burns, with the objective to replace the fluid that has been lost due to the burn and to re-establish the normal fluid level in the child, without overloading with fluid. To determine how much fluid to give the Parkland formula is often used-4 times the weight of the patient (kg) times the total burn surface area (TBSA). [7] Once this has been calculated, half of this volume is to be given to the patient in the first 8 hours from the time the burn occurred (adjusted if the patient presents later to hospital) and the remaining volume to be given over the next 16 hours, therefore the total volume is given over 24 hours. The fluid is given to ensure that there is enough volume flowing around the body so tissues are not starved of oxygen or nutrients. However, the Parkland Formula has often underestimated the needs of children in this case, especially those with inhalation injuries. [7]
Patients with severe burns may be treated with surgery to remove the burnt area and at a later stage be offered skin graft over the area, this is made difficult in patients with a large TBSA as they have limited areas where grafts could be taken. In child with severe burns, surgery is often needed to change dressings that are covering the burn as it is too difficult to do this successfully due to the pain associated with this. [8] Depending on the anatomical location of the burn, at a later stage after the burn has healed and there are no signs of infection the patient may be offered surgery to release the burn so that their movement is not restricted.[ citation needed ]
It is important to remember that some child burns are not accidental and health care workers need to observe for suspicious injuries in children. Non-accidental child burns are more common in low income households, families with a single parent or young parents. [4] Social services may also be contacted when the burn injury is thought not to be deliberate but perhaps due to inadequate supervision of the child.[ citation needed ]
Pediatrics is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until the age of 18. The American Academy of Pediatrics recommends people seek pediatric care through the age of 21, but some pediatric subspecialists continue to care for adults up to 25. Worldwide age limits of pediatrics have been trending upward year after year. A medical doctor who specializes in this area is known as a pediatrician, or paediatrician. The word pediatrics and its cognates mean "healer of children", derived from the two Greek words: παῖς and ἰατρός. Pediatricians work in clinics, research centers, universities, general hospitals and children's hospitals, including those who practice pediatric subspecialties.
Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation.
A burn is an injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or ultraviolet radiation. Most burns are due to heat from hot liquids, solids, or fire. Burns occur mainly in the home or the workplace. In the home, risks are associated with domestic kitchens, including stoves, flames, and hot liquids. In the workplace, risks are associated with fire and chemical and electric burns. Alcoholism and smoking are other risk factors. Burns can also occur as a result of self-harm or violence between people (assault).
Fluid replacement or fluid resuscitation is the medical practice of replenishing bodily fluid lost through sweating, bleeding, fluid shifts or other pathologic processes. Fluids can be replaced with oral rehydration therapy (drinking), intravenous therapy, rectally such as with a Murphy drip, or by hypodermoclysis, the direct injection of fluid into the subcutaneous tissue. Fluids administered by the oral and hypodermic routes are absorbed more slowly than those given intravenously.
A wound is a rapid onset of injury that involves lacerated or punctured skin, or a contusion from blunt force trauma or compression. In pathology, a wound is an acute injury that damages the epidermis of the skin. To heal a wound, the body undertakes a series of actions collectively known as the wound healing process.
An injury is any physiological damage to living tissue caused by immediate physical stress. Injuries to humans can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, or overexertion. Injuries can occur in any part of the body, and different symptoms are associated with different injuries.
Skin grafting, a type of graft surgery, involves the transplantation of skin. The transplanted tissue is called a skin graft.
Grafting refers to a surgical procedure to move tissue from one site to another on the body, or from another creature, without bringing its own blood supply with it. Instead, a new blood supply grows in after it is placed. A similar technique where tissue is transferred with the blood supply intact is called a flap. In some instances, a graft can be an artificially manufactured device. Examples of this are a tube to carry blood flow across a defect or from an artery to a vein for use in hemodialysis.
A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of this system is as a barrier against the external environment.
Intraosseous infusion (IO) is the process of injecting medications, fluids, or blood products directly into the marrow of a bone; this provides a non-collapsible entry point into the systemic venous system. The intraosseous infusion technique is used to provide fluids and medication when intravenous access is not available or not feasible. Intraosseous infusions allow for the administered medications and fluids to go directly into the vascular system. The IO route of fluid and medication administration is an alternative to the preferred intravascular route when the latter cannot be established promptly in emergent situations. Intraosseous infusions are used when people have compromised intravenous access and need immediate delivery of life-saving fluids and medications.
A radiation burn is a damage to the skin or other biological tissue and organs as an effect of radiation. The radiation types of greatest concern are thermal radiation, radio frequency energy, ultraviolet light and ionizing radiation.
Lymphangiomas are malformations of the lymphatic system characterized by lesions that are thin-walled cysts; these cysts can be macroscopic, as in a cystic hygroma, or microscopic. The lymphatic system is the network of vessels responsible for returning to the venous system excess fluid from tissues as well as the lymph nodes that filter this fluid for signs of pathogens. These malformations can occur at any age and may involve any part of the body, but 90% occur in children less than 2 years of age and involve the head and neck. These malformations are either congenital or acquired. Congenital lymphangiomas are often associated with chromosomal abnormalities such as Turner syndrome, although they can also exist in isolation. Lymphangiomas are commonly diagnosed before birth using fetal ultrasonography. Acquired lymphangiomas may result from trauma, inflammation, or lymphatic obstruction.
The human skin is the outer covering of the body and is the largest organ of the integumentary system. The skin has up to seven layers of ectodermal tissue guarding muscles, bones, ligaments and internal organs. Human skin is similar to most of the other mammals' skin, and it is very similar to pig skin. Though nearly all human skin is covered with hair follicles, it can appear hairless. There are two general types of skin, hairy and glabrous skin (hairless). The adjective cutaneous literally means "of the skin".
The Parkland formula, also known as Baxter formula, is a burn formula developed by Charles R. Baxter, used to estimate the amount of replacement fluid required for the first 24 hours in a burn patient so as to ensure the patient is hemodynamically stable. The milliliter amount of fluid required for the first 24 hours – usually Lactated Ringer's – is four times the product of the body weight and the burn percentage. The first half of the fluid is given within 8 hours from the burn incident, and the remaining over the next 16 hours. Only area covered by second-degree burns or greater is taken into consideration, as first-degree burns do not cause hemodynamically significant fluid shift to warrant fluid replacement.
Transdermal is a route of administration wherein active ingredients are delivered across the skin for systemic distribution. Examples include transdermal patches used for medicine delivery. The drug is administered in the form of a patch or ointment that delivers the drug into the circulation for systemic effect.
An escharotomy is a surgical procedure used to treat full-thickness (third-degree) circumferential burns. In full-thickness burns, both the epidermis and the dermis are destroyed along with sensory nerves in the dermis. The tough leathery tissue remaining after a full-thickness burn has been termed eschar. Following a full-thickness burn, as the underlying tissues are rehydrated, they become constricted due to the eschar's loss of elasticity, leading to impaired circulation distal to the wound. An escharotomy can be performed as a prophylactic measure as well as to release pressure, facilitate circulation and combat burn-induced compartment syndrome.
Artificial skin is a collagen scaffold that induces regeneration of skin in mammals such as humans. The term was used in the late 1970s and early 1980s to describe a new treatment for massive burns. It was later discovered that treatment of deep skin wounds in adult animals and humans with this scaffold induces regeneration of the dermis. It has been developed commercially under the name Integra and is used in massively burned patients, during plastic surgery of the skin, and in treatment of chronic skin wounds.
Fracture blisters occur on skin overlying a fractured bone, and fractures complicated by the development of overlying blisters remain a clinical dilemma in orthopedics.
An aerosol frostbite of the skin is an injury to the body caused by the pressurized gas within an aerosol spray cooling quickly, with the sudden drop in temperature sufficient to cause frostbite to the applied area. Medical studies have noted an increase of this practice, known as "frosting", in pediatric and teenage patients.
Alexander Burns Wallace (1906–1974) was a Scottish plastic surgeon. He was a founding member and president (1951) of the British Association of Plastic Surgeons, and the first editor of the British Journal of Plastic Surgery. In authorship he appears as A. B. Wallace.
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