Current Update:

Management of Paediatric
Burn Injury
Ulfa Elfiah
Bedah Plastik
 Introduction

Adults Children

Basic concepts of emergency burn

Same way in Assessment & treatment

Major Differences between adults and children:

- Large body surface area
- Thin skin
- Higher basal metabolic rate & small physiologic reserve
- the different social & emotional development
(Yi Tung, Kwan.2017 & ANZBA 2013)
 Epidemiology
Etiology

H. Richards, et al., A five year review of paediatric burns and social deprivation: Is there a link?,
Burns (2017), http://dx.doi.org/10.1016/j.burns.2017.01.027
 Etiology

H. Li, et al., Epidemiology of pediatric burns in southwest China from 2011 to 2015, Burns
(2017),http://dx.doi.org/10.1016/j.burns.2017.03.004
Etiology

Febrianto,Radhityo.2016
First Aid

ICED SHOULD NEVER BE USED

Emergency Burn Care: PRIMARY SURVEY

AIRWAY & BREATHING:

Occult upper airway obstructruction is
common
enlargement of adenoid & tonsil &
laringomalacia
Accumulation of secretion  lower airway is
narrower than adults & bronchial hyperactivity
Larinx more cephalad than adults
(Yi Tung, Kwan.2017 & ANZBA 2013)
Emergency Burn Care: PRIMARY SURVEY

CIRCULATION:
 Sign of decreased circulation by Advanced
paediatric Life Support(APLS): Tachycardia,
Capillary refill <2seconds, Pale cool
peripheries & Organ dysfuction (tachypnoe,
altered mental status)
 Fluid resusitation is strated infants > 10%,
Children >15%

(Yi Tung, Kwan.2017 & ANZBA 2013)

 Emergency Burn Care: PRIMARY SURVEY

CIRCULATION:
 First 24 hours of fluid resusitation
 based on weight & burn size

Rule of palm with child’s Lund –Browder  smaller unit& age

palm represent 1% appropriate correction
Emergency Burn Care: PRIMARY SURVEY

 First 24 hours of fluid resusitation

2ml-4ml x BSA(%) x weight (kg)+ Daily Maintanance

Salt containing fluids

Urine Output
1cc/kg/hour

(ISBI Guidline)
 Emergency Burn Care: PRIMARY SURVEY

CIRCULATION:
 Second 24 hours of fluid resusitation
- Daily maintenance

- The maintenance fluid Should contain glucose

- Half normal saline to maintain adequate urine
output
(Yi Tung, Kwan.2017 & ANZBA 2013)
 Emergency Burn Care: PRIMARY SURVEY

-DISABILITY, NEUROLOGIC DEFICIT & GROSS

DEFORMITY

- EXPOSURE (completely disrobe the patient,

examine for associated injuries & maintain a warm
environment)

(ISBI guidline . 2017)

Emergency Burn Care: SECONDARY SURVEY

- DETAIL HISTORY AMPLE(Allergy, medication,

previous illness, last meal and events preceding
injury)
- COMPREHENSIVE PHYSICAL EXAMINATION
- IMAGING, LABORATORY ANALYSES &
ADJUNCTIVE MEASURES ( NGT, Catheters
etc) complete at this time

(Yi Tung, Kwan.2017 & ISBI guideline 2017)

 Wound Management

EARLY WOUND MANAGEMENT:

- Stop burning process
- Antibiotics Ointment, Silversulphadiazine
- No wet dressing for large burn
- a burn wound is unhealed at 10 day should be
considered

(Yi Tung, Kwan.2017 & ANZBA
2013)
SURGERY
- a burn wound is unhealed at 10 day should be
considered as needing skin grafting
- Tangential excision up to 15%hemostasis&
blood loss
- Operation within 2 hours
- Meshed graft for large expantion ratio
- -Donor: Scalp & back
- Vascular compromised occurs earlier
than adults

- Elevate & assess hourly in any extremity

with circumferential burnsign of
vascular compromises.escharotomy

- Should be performed when escar on

trunk or neck compromises aeration
and breathing

(ISBI Guidline.2017)
Complication
Nutrition

Burned children have a markedly increased caloric

requirement early initiation of enteral feeding
PAIN MANAGEENT

Pain Relief

Resting Pain Procedure Pain

Sedative with medazolam

-average daily dose : 0,0349 mg/kg with maximal dose
0,0447mg/kg
- Burn <30% TBSA
- monitoring
NON ACCIDENTAL INJURY(CHILD ABUSE)

- HISTORY
 not compatible withpatern of injury
 inability to communication
 delay in presentation
 unresponsive child
 Vague of inconsistent history with different
observers

- PATTERN OF INJURY
- absence of splash marks, well
demarcated waterline or symetrical deep
injury
- Presence of other sign of trauma
(Yi Tung, Kwan.2017 & ANZBA 2013)
Transfer Criteria

- Hospital admission burned children = adults

 Conclusion

The principle treatment of burn care is

considered:
Major physical differences between child
and adult although have Same way in
Assessment & treatment