Thermal Burns and Inhalation Injuries

1

What is the prevalence of burn injuries in children in the United States?

Over 250,000 children require medical attention for burns; of these, 200,000 are scald injuries. Males outnumber females 2:1. Approximately 15,000 kids per year require hospitalization for burn injuries. Burns and fires kill 1100 children aged 14 years and under in the United States each year. Children aged 5 years and under are more than twice as likely to die in a fire as any other age group. Most fire-related deaths are caused by smoke inhalation of toxic gases. Actual flames and burns account for 30%. The majority of children under 4 years who are hospitalized for burns suffer from scald injuries (65%).

2

How are children different from adults?

• Larger body surface area-to-mass ratio.

• Smaller airway diameter.

• Shorter trachea.

• Thinner skin, especially in infants and toddlers, leading to deeper burn injury.

• Vascular access more challenging.

• More susceptible to hypothermia

( Fig. 45.1 ).

3

Name the different degrees of burn injury.

• First degree—red, dry, and painful.

• Second degree—wet and most painful.

• Third degree—dry and insensate.

• Fourth degree—injury to underlying muscle and bone.

4

What are the body’s responses to burn injury?

• Local: denatures and coagulates protein with irreversible tissue destruction. Surrounding area with decreased tissue percussion, which is potentially salvageable.

• Systemic response: release of vasoactive mediators (cytokines, prostaglandins, and oxygen radicals). Increased capillary permeability leads to fluid extravasation in interstitial space. Destruction of red blood cells may also reduce oxygen carrying capacity. Metabolic response: hypermetabolic increase in energy use and protein metabolism.

5

Describe the initial treatment of burns and inhalation injuries.

• ABC’s:

  • Airway—early airway intubation for upper airway injury before the anatomy becomes distorted by edema.

  • Breathing—decreased level of consciousness, inhaled smoke or toxins, and associated injuries can interfere with ventilation and/or oxygenation. Chest wall compliance may be compromised by circumferential burns to the chest or abdomen.

  • Circulation—at initial presentation, signs of compromised circulation such as unexplained tachycardia, poor peripheral percussion, or hypotension suggest associated traumatic injuries.

• Stop the burning process. Remove clothing and jewelry. Cool (not less than 8°C) water for 10–20 minutes for small scald burns. Dry clean sheets for flame burns.

• Oxygen for any smoke inhalation.

• Pain management.

• Preserve core temperature (most house fires occur in winter, and children lose heat rapidly).

• Rapid transfer to hospital.

• Fluid administration not necessary in field with short (<1 hour) transport time or small burns.

• Intravenous (IV) fluids for large burns or prolonged transport.

• Chemical burns require immediate decontamination at scene. Brush off any dry powders, then copious irrigation with water. Avoid contaminating rescuers.