FRCA Notes

Paediatric Burns

The curriculum is heavy on adult burns but doesn't explicitly mention paediatric burns.

This topic perhaps falls under paediatric trauma, which is in the curriculum, but could be deemed expendable by the time-poor candidate.

In the interests of brevity, only paediatric-specific elements are included below and one should read the afore-linked adult burns page for greater detail.

Resources

  • Burns are a common cause of injury in children
  • 20% of all burns occur in those <4yrs old
    • Younger children tend to suffer more scalds
    • Older children tend to suffer more flame burns
  • For minor burns, oral hydration may be acceptable
  • However, any burn with >10% TBSA affected requires IV fluid replacement
  • Early fluid resuscitation is essential as delays can increase risks of AKI, MODS, prolong hospital stay and increase mortality

Shock

  • If there are signs of circulatory shock, manage as with other causes of paediatric shock i.e. 10-20ml/kg crystalloid bolus in the first instance
  • One should also consider other causes of shock rather than attributing the clinical picture solely to the burn e.g. unrecognised haemorrhage from trauma, sepsis, cardiogenic shock

Burns-specific resuscitation

  • Although the Parkland formula is still valid, a move towards more restrictive fluid regimens may instead make use of the modified Brooke formula:

    • 2ml x actual body weight (kg) x TBSA (%)

    • Administer in the time since the burn was sustained
    • Half of this fluid in the first 8hrs since burn injury
    • The remaining half of the fluid in the subsequent 16hrs
    • Subtract fluid given already e.g. pre-hospitally
    • No robust evidence of superiority of any particular fluid type although warmed, isotonic, balanced crystalloid is typically used
    • Add glucose at risk of, or demonstrating, hypoglycaemia

Maintenance fluid

  • The above-linked BJA Education article suggests all children should receive maintenance fluid alongside their burns resuscitation fluid, whereas the SORT guidelines suggest this is only necessary for those under 1 year of age

  • For children under 1 year, one should give maintenance fluid alongside the burns replacement fluid i.e. 80ml/kg/day of 0.45% NaCl + 5% dextrose

  • Management largely mirrors that of adult burns, as well as keeping to the principles of managing paediatric trauma

Specialist Referral Criteria

  • Burns >5% TBSA
  • Age <5yrs
  • Burns to airway | face | hands | feet | perineum | over a joint
  • Circumferential burns
  • Suspected NAI
  • Electrical, radiation, high pressure or chemical burns
  • Evidence of burns-associated toxic-shock syndrome

Infection

  • Infection is a leading cause of morbidity and mortality in burns
  • Burn wounds are typically sterile in the initial period and prophylactic antibiotics are not indicated

  • However colonisation by Gram-positive (within 2 days) and Gram-negative (within a week) organisms can occur
  • If there are signs of infection, empirical antibiotics should be administered
  • Exclude other non-burns sources of infection e.g. respiratory, urinary tract