This Presentation is about burn in children it's defination ,causes , classification , methods of estimation of TBSA of burn , diagnose , medical , surgical and nursing management and complications.
2. BURNS IN CHILDREN
• Burn are the tissue injury caused by the contect with heat , flame ,
Chemical, electricity and radiation. The effect of burn injury are not
limited to brunt area,but can cause serious systemic effect depeneding
upon the extent and depth of burn
3. CAUSES
• Scalds burn :- are important burn injury caused by hot liquids ( liquid hot food ,hot water
,tea ,coffee milk) or stream. It is common in children below 3 year of age .
• Electric burn :- are common in toddler and adolescents when playing with electrical outlet
, extension cord, touching ,high tention wires,etc.
• Open flame burn :- are common during playing with lighter or at kitchen near stove or
over gas line . It may be happen from open fire in winter season or from fireworks during
festivals our diwali .
• Inhalation burn :- may occur from fire works
4. • Chemical burn:- are allso common in children . Out of curiosity they handle
household cleansing chemical,acids etc. And injured.
5. Pathophysiology
Due to etiological factor like burn , electricity etc.
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Vessels start permeable
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. Fluid plasma Leak out on to interstial space
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Fluid plasma accumulate
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Result , edema
6. Fluid and blood looses from Vessels
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The blood are very concentrated
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Reduce blood flow to the vital oragns Like GI tract and kidney
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Lead to kidney failure
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To componsate normal Function of cardiac ooutput
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Ischemia of brain, kidney and vital organs
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lead to burn
7. Classification of burn in children
According to depth of burn injury
1. Superficial burn (partial thickness Burns)
• Superficial partial thickness burn : burn injury involves epidermis and superficial layers
of dermis , i.e. up to papillary dermise . The wound heal in less then 2 weeks period of
burn .
• Superficial and deep dermal burn : burn injury involves beyond papillary dermis and
takes more than two weeks time for healing.
2. Full thickness burns: burn injury involves all layer of skin and sometimes underlying
tissues are also destroyed . The wound doesn’t heal normally and need skin grafting.
8. Classification of burn in children
According to extent of burn inury
• first degree burns : superficial burn manifested as pink to red discolored area with
slight edema .pain may present up to 48 hours and relieved by cooling. Within 5
days epidermis peels off ,pink skin persistent for a week , no scar Developes .
Healing takes place spontaneously within 10-15 days ,if not infected.
• Second degree burns :
* superficial second degree burn are present as pink or red discoloration of the
area with blister formation , superficial layer are destroyed. Wound become moist and
painful and take several weeks to heal and scar may develop.
9. Classification of burn in children
*Secound degree deep thermal burn are manifested as mottled white and
red area become pale on pressure . The area may are may not be sensative to
touch but sensative to cold air.wound take several week to heal and scar may
develop.
• Third degree burns :it includes destruction of epithelial cells even fat ,
muscles and bone . It is not painful .
10. Classification of burn in children
Severity of burn injury depeneds upon total area injured, depth of injury , location of
injury,age , general health of the child presence of additional injury or chronic disease
and level of consciousness.
• Minor burns : 10% of total body surface area (TBSA) brunt with first and second
degree burns.
• Moderate burn:
- 10% to 20 % TBSA burnt and second degree burns.
- 2 to 5 %TBSA brunt and third degree burn but not involving eyes ,ear ,face ,genitals
,hand ,feet or circumferential burn (over chest and abdomen ).
11. Continue…..
• Major burns :
- 20% or more TBAS brunt and second degree burns .
- All third degree burns greater than 10% of TBSA brunt.
- All bruns involving face , eyes, ear ,feet hands and genitals.
- Complicated burn with truma , fractur ,head injury, dibeties mellitus,
pulmonary diseases and all at risk patient.
12. Method of estimation of TBSA
• Rule of nine
• Lund browder Classification
• Plam method
13. Rules of nine
• The rule of nine assesses the percentage of the burn and iS used to
Help guided treatment decisions including fluid resuscitation And
become part of guid lines To determine transfer to burn unit.
14.
15. Lund browder method
• The method for estimating extent of burn that allow for the varing
proportion of body surface in person of different ages . It used instead
of Rule of nine , for children In whome the head occupies a large area
and lower a limbs smaller area then adults.
16.
17. Plam method
• The ‘ rule of plam ‘ is another way to estimate the size of burn . The
plam of the person who burned ( not finger and wrist area) is about
1% of the body . Use the person plam to measure the body surface
area burned. It can be Hard to estimate the size of burn.
18.
19. Clinical feature of burn
• Pallor.
• Cynosis
• Poor muscle tone
• Failure to recognise familiar people
• Rapid pulse
• Low blood pressure
• Edema
20. Clinical feature
• Airway obstruction
• Dyspnea ,trachypnea , restlessness , cough and drooling.
• Decrease urin output
23. Medical management
• First aid management
1. Immidate removal from the heat source.
2. In case of open flame the child should help To lie flat on the ground and roll
on the floor.
3. Fire should Extinguished by pouring water.
4. Avoiding pouring of water over the burnt area once the fire has been
extinguished because it may dangerous and lead to hypothermia hyponatremia
(due to water absorption )convulsions and brain edema.
5. The child should be wrapped in clean sheet to prevent heat loss.
24. Continue….
• Oral fluid are oral rehydration solution ORS should be given if the
child Thirsty and able to drink.
• If necessary give mouth to mouth breathing.
• Avoiding use of painkiller and sedative not applying cotton are any
household material on the brand area blister should not be peeled off
and should be allowed to spontaneous collapse.
25. Management
Fluid replacement
Fluid replacement is done on the basis of TBSA and body weight of the child.
Additional measures
• Manage airway
• Tetanus prophylaxis
• Sedative and analgesics
• Antibiotics
• urinary catheter may be needed for some patient
27. Nursing management
Nursing diagnoses
• Decreased cardiac output related to hypovolemia and increase metabolism
• Impaired oxygenation related to inhalation injury and pulmonary
complications.
• Pain related to burn wound.
• Fear and anxiety related to pain and hospital procedure.
• Risk for infection related to alteration of skin integrity.
28. Continue….
• Potential to injury of gastric mucosa related to stress response and decrease
gastric motality.
• Impaired physical mobility related to pain and contractures.
• Altered nutrition less than body requirement related to poor appetite and
burn injury.
• Alteration of body image related to disfigurement in burn injury
29. Complications
• Burn injury may cause several complication which depends upon severity burn of
and available management facilities.
• Early complication
• Hypovolemic shock
• Respiratory failur
• Renal failure
• Paralytic ileus
• G I bleeding
• Hypertension seizure and depression etc.
• Urinary tract infection
• Thrombophlebitis
