Question

A 7-year-old boy is a patient in your intensive care unit. He was on a camping trip with his family when he accidentally fell on the campfire, causing severe second- and third-degree burns over 60% of his body. The clinical care team tells his parents that it will be critical to maintain their son’s airway and keep his fluid levels high.

1. The father is confused and asks you why his son’s fluid level is important after a burn. How would you explain this to him?
2. After your explanation, the father nods that he understands. He then asks how you will measure his son’s fluid levels. How would you respond?
3. As a clinician with knowledge of physiology, which aspects of this boy’s condition would you be most concerned about?

Answer 1

Second-Degree Burn in Children; A burn is damage to tissues of the body caused by contact with things such as heat, radiation, or chemicals. A second-degree burn affects the outer layer of skin (epidermis) and part of the inner layer of skin (dermis).

Symptoms ;

• Blistered

• Deep red

• Swollen

• Wet and shiny

• Painful to the touch

• White or discolored in an irregular pattern in the burn area Diagnosis;  The healthcare provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam. The diagnosis of a second-degree burn is based on the signs and symptoms, and recent exposure to something that can cause a burn. This may be the sun, something hot, or a chemical. TREATMENT ;

  Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

  A second-degree burn usually heals in 2 to 3 weeks, as long as the wound is kept clean and protected. Deep second-degree burns may take longer to heal.

  Treatment may include:

• A wet cloth soaked with cold water (cold compress) held to the skin, to ease pain

• Antibacterial cream, to help prevent infection

• Other creams, to lessen pain and swelling

• Non-stick dressing or bandage that’s changed every day

• Over-the-counter medicine such as acetaminophen or ibuprofen for pain and swelling

• Keeping the area elevated (for example, an arm or leg) to lessen pain and swelling

• Giving a tetanus vaccine Complications ;

• Infection of the burned area

• The skin in the burned area will be more sensitive to sunlight while healing

• The skin in the burned area may stay darker or lighter than other skin. third-degree burns in children; A burn is damage to tissues of the body caused by contact with things such as heat, radiation, or chemicals. A third-degree burn damages affect the outer layer of skin (epidermis) and the inner layer of skin (dermis). A child with a third-degree burn needs immediate medical care.   causes ;

• Very hot liquids

• Contact with a hot object

• Fire

• Electricity

• Chemicals Symptoms ;

• Dry and leathery

• Changes color to black, white, brown, or yellow

• The symptoms of a third-degree burn can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis. Diagnosis; The healthcare provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam. The diagnosis of a third-degree burn has based on the signs and symptoms, and recent exposure to something that can cause a burn. This may be the sun, something hot, or a chemical. Treatment ;

  Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. A child will usually be treated in a hospital unit that specializes in burns.

  Treatment for a third-degree burn will depend on the severity of the burn. Burn severity is determined by:

• The amount of body surface that is affected

• Where the burn is located

• The depth of the burn

• Treatment for a third-degree burn may include:

• Immediate care in an emergency department, possibly in a hospital burn unit

• Breathing and blood circulation support

• IV (intravenous), given into a vein, fluids containing electrolytes

• IV or oral antibiotics for infections

• A large third-degree burn heals slowly. After the burn heals, surgery may be needed. This is done to improve the ability to move and to remove and repair scarred skin.

  In some cases, skin grafting may be needed to close or cover the burn. A skin graft is a piece of healthy skin from one part of the body that is removed and put on an area that needs skin. The burn area that’s covered is called the graft site. The area where a piece of skin is taken is called the donor site. After a skin graft, the donor site looks like a scrape. After a skin graft:

• A dressing is left on the graft site for a few days before it's changed. The site needs to be still and protected to start to heal.

• The donor site usually heals in about 2 weeks.

• What are the possible complications of a third-degree burn in a child?

  Possible complications ;

• Infections that may affect any part of the body, such as the lungs

• Scarring

• Being unable to move a joint due to scarred tissue (joint contracture)

• Emotional problems

• Organ failure and death

• Pain

• Cleaning and removal of dead tissue (debridement) from the burn area

• Antibacterial cream, and other creams

• Special bandages or dressings

• Nutritional supplements and a high-protein diet

• Pain medicines

• Anti-itch medicines

• Tetanus vaccine

• Swollen

• May not be painful, because of damage to nerve endings Fluid levels in 2nd and 3rd degree burns patients; Adults and children with burns greater than 20% TBSA should undergo formal Adults and children with burns greater than 20% TBSA should undergo formal fluid resuscitation using estimates based on body size and surface area burned.        type of fluid given; Predominantly, fluid resuscitation is carried out intravenously and the most commonly used resuscitation formula is the pure crystalloid Parkland formula. This advocates the guideline for the total volume of the first 24 hours of resuscitation at approximately 4ml per kilogram of body weight per percentage burn of TBSA How do burns cause fluid loss?

  Third-degree burns can sometimes lead to dehydration because they damage the entire thickness of the skin and affect nerve-endings. They leave the body more open to losing fluids. The layers of the skin keep fluids inside the body. The fluid will often seep from the burned area, causing dehydration and electrolyte imbalance. Treatment; The treatment of dehydration with burn patients is one that needs to be done with an extreme level of caution. For lesser burns, the patient can be given fluids orally. However, with more severe third-degree burns, if the patient is subject to too much fluid at once, they might be in danger of getting compartment syndrome, which is a pressure issue under the skin and can lead to less oxygenation and poor blood flow, which can result in nerve or muscle damage. Adults and children with burns greater than 20% TBSA should undergo formal fluid resuscitation using estimates based on body size and surface area burned. Common formulas used to initiate resuscitation estimate a crystalloid need for 2–4 ml/kg body weight/% TBSA during the first 24 hours.