Epidemiology
· 3rd
leading cause of accidental death amongst children
· Mortality
– higher for children and the elderly
· 2005:
>120,000 children <15 years of age received care in ED for burns / COMBUSTIO
· Children
<5 years old: 65% scald injuries
· 5-20
years old: 27% scald injuries
· Non-accidental
burns: estimated as high as 20% of burn admissions
· Inhalational
injury increases mortality significantly
Pathophysiology:
1. Local injury:
heat denatures and coagulates protein => irreversible tissue destruction
o
Surrounding this => zone of decreased
tissue perfusion (salvageable tissue)
o
Young children have thinner skin =>
deeper burns
o
Increased capillary leak around burn
2. Systemic response:
release of vasoactive mediators from tissue: cytokines, prostaglandins, O2 radicals
o
>15% burn in young children, >20%
burn in older children: systemic response to mediators
o
Systemic capillary leak lasts 18-24
hours => burn shock/SIRS
o
Immunosppuression
o
Local destruction of RBC’s
o
Myocardial depression
o
Hypermetabolic response: catecholamine
release, glucagon, cortisol elevation
3. Advocacy:
with140-150 degree water (normal for home water heater): 3rd degree burn in approximately
2 seconds
o
Reset
water heaters to 120 degrees
Classification
of Burns:
· Depth
of burns : based on intensity and
duration of thermal exposure
· Superficial burns
(1st degree) : erythematous,
painful
o
Only involve outer layer of epidermis
(fluid loss not an issue)
o
Heal without scarring in 4-5 days
· Partial thickness burns
(2nd degree)
o
Superficial
partial thickness: red and painful with blister formation
Partial
destruction of dermis
Weeping/moist
appearance
Healing
in 7-10 days with minimal scarring
o
Deep
partial thickness: greater than 50% of dermis lost
White,
pale, less painful (nerve fibers destroyed)
2-3
weeks to heal, severe scarring can occur, contractures
May
requires skin grafting
·
Full thickness
burns
(3rd degree): white, waxy, leathery
o
No bleeding, painless
o
High risk for infection and fluid loss
· Fourth degree burn : destruction of
underlying structures – tendons, nerves, muscle, bone, deep fascia
Estimation of Burn Area
(do not include superficial burns) :
· Adolescents/adults:
rule of 9’s
o Head/Arm: 9% each
o Leg, anterior trunk, posterior
trunk: 18%
o Neck and groin: 1% each
· Children:
surface of child’s palm = 0.5% TBSA
o Modified Lund and Brower chart
(see image)
