Pediatric burns are still a relatively common trauma in our city. In recent years, with the increase of foreign population, seasonal changes, economic conditions, living habits and climate change, the incidence of pediatric burns has a tendency to increase year by year.
Characteristics of pediatric burns.
1, pediatric burns have little ability to save themselves when they are burned, so sometimes the burns are very serious.
2.The compensatory capacity of circulatory volume after pediatric burns is poor, requiring timely resuscitation by infusion, otherwise hypovolemic shock is likely to occur.
3, pediatric, especially infants and young children, the kidney function is not yet well developed, poor glomerular filtration fluid concentration capacity, as well as the amount of extracellular fluid in children is larger than that of adults, the implicit water loss is larger, the amount of burn shock resuscitation fluid is more difficult to estimate, easy to cause the estimated amount of too much or too little.
4, pediatric tracheal teaching fine, tracheal cartilage than adults easy to collapse, face, neck even shallow burns, tissue edema compression can cause obstruction of the child’s airway. Children with combined inhalation injury, the tracheal wall as long as the swelling of 1mm, the resistance of the whistle will increase 16 times, the airflow through the reduction of 75%.
5, pediatric neurological development is not yet perfect, burns are prone to convulsions, convulsions, and easily cause hyperthermia.
6, pediatric skin is thinner than adults, in estimating the depth of trauma burns, it is easy to consider the depth of trauma as shallow trauma.
7.Pediatric immune system is not fully developed, the incidence of burn infection is higher, and the clinical manifestations of infection are more variable and sometimes the symptoms are less typical.
8.Pediatric patients lack endogenous heat energy storage and cannot withstand longer fasting as adults do.
Early treatment of pediatric burns
I. Field treatment.
Small burn wounds do not need special treatment, available clean gauze or towels wrapped externally, and then sent to a burn specialist hospital for consultation. Avoid applying colored drugs, such as red mercury, gentian violet, etc., so as not to affect the judgment of the depth of the wound, and avoid using toothpaste, soy sauce, earthenware, ointment, etc., so as not to make it difficult to clear the wound, aggravate the pain of the wound, and also not conducive to heat distribution. After boiling water, hot liquid scald, should immediately take off the wet clothes, if it is too late to take off the clothes, can directly use cold water rinse to cool down, in order to reduce the residual heat on the clothes to the organism of the secondary damage and deepen the trauma, so try to take off the clothes, is conducive to the heat distribution. Cold therapy is the most important measure for the early treatment of scalded patients, with cold water to the trauma shower, cold compress, soak, or cold compress with a towel wrapped in ice, simple and easy, especially for small and medium-sized burns, the earlier the cold therapy starts the better, the appropriate temperature to the patient can tolerate the premise of as low as possible, with 5-10 degrees of tap water is most convenient commonly used, cold therapy duration is best to reach 20-30 minutes, sometimes 1 hour or so, until the patient can tolerate. The duration of cold therapy should be 20-30 minutes, sometimes about 1 hour, until the trauma surface does not feel pain or pain is significantly reduced, it can play a cooling, pain relief and reduce the effect of trauma swelling.
II. Principles of early treatment on admission.
It is developed according to the early damage situation. After pediatric burns, inactivated tissues produce toxic substances of lipoprotein complexes, post-burn stress of the organism, free machine produced by tissue ischemia-reperfusion, post-burn NO, release of various cytokines, especially inflammatory mediators, neuroendocrine reactions, such as sympathetic-adrenal system; hypothalamic-pituitary system; renin-angiotensin system, prompting blood catecholamines, endorphins, PGE, ADH
elevated, resulting in a series of early damages, increased capillary exudation, decreased blood volume, further depression of the already underdeveloped immune function, continued deepening of the trauma, impaired liver and kidney function, and metabolic changes.
Special attention should be paid to.
1. The amount of blood in pediatric patients is about 80ml/Kg body weight, while in adults it is about 60ml/Kg body weight; the proportion of extracellular fluid to body weight is higher in pediatric patients than in adults.
The ratio of body surface area to body weight is larger in children than in adults, and the tolerance to fluid loss after burns is poorer in children than in adults, and the incidence of shock is higher than in adults. Even small area burns in children can also occur shock.
2, pediatric due to the anatomical characteristics of the whistling tract.
Even if the face and neck are only superficial burns or only combined with mild inhalation injuries, it is possible to have an obstruction of the whistle, leading to serious consequences. Medical staff must closely observe the child’s whistle, have resuscitation equipment at the bedside, and take measures, including tracheotomy, to keep the whistle open if necessary. Because of the anatomical features of the pediatric whistle, tracheal intubation is more likely than in adults to cause tracheal wall ulceration and bleeding, increased secretions after dry accumulation caused by obstruction.
3, pediatric head and face account for a large proportion of the body surface area, while the area of both lower extremities is relatively small.
The younger the age, the more obvious the difference between the body surface area of the head and face and the area of the lower extremities, so when estimating the area of burns, the estimation method of the area of the head and face, neck and lower extremities is different from that of adults. Head and neck area (% area) = 9 + (12 – age), double lower limbs, buttocks area (% area) = 46 – (12 – age), double upper limbs area (% area) = 9 × 2, torso, perineum area (% area) = 9 × 3 pediatric burns can also be used to estimate the burn area by palm method, the same method as adult burns.
4, the contamination of pediatric burns trauma is generally not serious, when clearing the trauma strive to simple, gentle, to minimize the additional adverse stimulation of the child.