Burns in kids -MaryAnn Dakkak, MD

1. Burns in kids-MaryAnn Dakkak, MD

2. (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?

3. What are burn etiologies? • 1) Scalds: from hot steam, pulling down a pan/pot, and immersion in too hot of water • 2) Touching of hot objects: stoves, pans, irons, space heaters, radiators • 3) Chemical burns: bleach, swallowing drain fluid or battery fluid • 4) Electical burns: sticking things in sockets, playing with wires • 5) 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 ***

4. Evaluating the burn • First 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.

5. Different % Distribution in children.Indicator of Secondary fluid lossesIf >10% burn, best to see specialist(First degree not included)

6. 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 dirt • They will use their hands, lower risk of contractures and scarring

7. Wound dressing • Dressings: (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.

8. What does your burn want to wear? • Epidemiological changes • No longer seasonal • No longer related to infectious agents • Does NOT run in families • (infanticide, drinking, smoking, etc.) • As diagnosis method changes, epi does

9. When to refer out:

10. Complications • Pruritis 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, sterppyogenes, pseudomonas, acinetobacter and klebsiella • Abx choice should cover gram negative and gram positive bacteria.

11. Questions?