burns in kids -maryann dakkak, md
DESCRIPTION
Burns in kids -MaryAnn Dakkak, MD. (Almost) 3 yo girl. Healthy No significant PMH Making pancakes with father, puts her hand on the skillet Immediately brought in by mother to ED Questions?. What are burn etiologies?. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Burns in kids -MaryAnn Dakkak, MD](https://reader035.vdocuments.mx/reader035/viewer/2022062810/56815de4550346895dcc0c19/html5/thumbnails/1.jpg)
Burns in kids-MaryAnn Dakkak, MD
![Page 2: Burns in kids -MaryAnn Dakkak, MD](https://reader035.vdocuments.mx/reader035/viewer/2022062810/56815de4550346895dcc0c19/html5/thumbnails/2.jpg)
(Almost) 3 yo girlHealthyNo significant PMHMaking pancakes with father, puts her hand on the skilletImmediately brought in by mother to EDQuestions?
![Page 3: Burns in kids -MaryAnn Dakkak, MD](https://reader035.vdocuments.mx/reader035/viewer/2022062810/56815de4550346895dcc0c19/html5/thumbnails/3.jpg)
What are burn etiologies?
1) Scalds: from hot steam, pulling down a pan/pot, and immersion in too hot of water2) Touching of hot objects: stoves, pans, irons, space heaters, radiators3) Chemical burns: bleach, swallowing drain fluid or battery fluid4) Electical burns: sticking things in sockets, playing with wires5) Overexposure to the sun*** Many of these are preventable and it is important to discuss at well-child visits, especially in the age range 2-5 ***
![Page 4: Burns in kids -MaryAnn Dakkak, MD](https://reader035.vdocuments.mx/reader035/viewer/2022062810/56815de4550346895dcc0c19/html5/thumbnails/4.jpg)
Evaluating the burnFirst Degree: involves only the epidermis, produce redness, swelling, dry skin and minor pain. Heal in 3-6 days. Peeling can be as early as 1-2 days.Second Degree: involves the epidermis and part or most of the dermis. Produces blisters, redness, severe pain. Blisters often break open days 2-4. Complete healing can take from 7-21 days depending on severity. (superficialpartial thickness blanch, deep partial thinkness do not)Third Degree: involves epidermis, dermis into the subcutaneous fat. Produces waxy white or brown and charred look, no pain b/c of nerve damage. Healing is very slow usually requires grafting and infection control and scarring can be severe.
![Page 5: Burns in kids -MaryAnn Dakkak, MD](https://reader035.vdocuments.mx/reader035/viewer/2022062810/56815de4550346895dcc0c19/html5/thumbnails/5.jpg)
Different % Distribution in
children.
Indicator of Secondary fluid losses
If >10% burn, best to see specialist
(First degree not included)
![Page 6: Burns in kids -MaryAnn Dakkak, MD](https://reader035.vdocuments.mx/reader035/viewer/2022062810/56815de4550346895dcc0c19/html5/thumbnails/6.jpg)
How to treat?Cool running water. Not ice, not submersion. Up to 20 minutes. Cool compress can help up to 1 hr.Pain control. Clean the wound water is adequate. (no need for betadine or chlorhexidine)Blisters – small ones leave intact. Large blisters may be better to debride.Special young child considerations:
Play in dirtThey will use their hands, lower risk of contractures and scarring
![Page 7: Burns in kids -MaryAnn Dakkak, MD](https://reader035.vdocuments.mx/reader035/viewer/2022062810/56815de4550346895dcc0c19/html5/thumbnails/7.jpg)
Wound dressingDressings: (all the fuss over not much of a difference?)
Moist is good. Wet is not. For open blisters, an occlusive dressing is recommended
Topical Agents: provide some pain control, promote healing, and prevent wound infection and desiccation
First degree: lotion, honey, aloe vera or antibiotic ointment of choice is adequate. Aloe vera has evidence of reducing pain. No steroids.Second degree: require topical antimicrobial and/or absorptive occlusive dressing to reduce pain and prevent desiccation.Third degree: these patients should be treated by specialist/surgeon.
![Page 8: Burns in kids -MaryAnn Dakkak, MD](https://reader035.vdocuments.mx/reader035/viewer/2022062810/56815de4550346895dcc0c19/html5/thumbnails/8.jpg)
What does your burn want to wear?
Epidemiological changesNo longer seasonalNo longer related to infectious agentsDoes NOT run in families
(infanticide, drinking, smoking, etc.)As diagnosis method changes, epi does
![Page 9: Burns in kids -MaryAnn Dakkak, MD](https://reader035.vdocuments.mx/reader035/viewer/2022062810/56815de4550346895dcc0c19/html5/thumbnails/9.jpg)
When to refer out:
![Page 10: Burns in kids -MaryAnn Dakkak, MD](https://reader035.vdocuments.mx/reader035/viewer/2022062810/56815de4550346895dcc0c19/html5/thumbnails/10.jpg)
ComplicationsPruritis and neuropathic pain: can use antihistamines, in difficult cases can use pregabalin for neurpathic pain.
Contractures: important to have physical therapy in cases of hand burns, facial burns, circumfrencial burns
Infection:Can be hard to assess since sight is already erythematous and swollen. Look for signs of fever and other systemic responses.
Common Pathogens: staph aureus, sterp pyogenes, pseudomonas, acinetobacter and klebsiellaAbx choice should cover gram negative and gram positive bacteria.
![Page 11: Burns in kids -MaryAnn Dakkak, MD](https://reader035.vdocuments.mx/reader035/viewer/2022062810/56815de4550346895dcc0c19/html5/thumbnails/11.jpg)
Questions?