Pediatric emergency medicine trisk 3209 3209

Consider early intubation in patients with suspected pharyngeal or
airway swelling
Inquire about the circumstances of the burn and determine the
potential for associated injuries
Remember to remove sources contributing to ongoing thermal
damage

Current Evidence
Globally, burns are the 11th leading cause of death in children aged 1 to 9
and the fifth most common cause of nonlethal injury. A recent study
examining data on pediatric burns from the Nationwide Emergency
Department Sample (NEDS) found that the majority were burns to the
wrists/hands, followed by the lower limbs, with the most common causes
being electric appliances and hot liquids/vapors. Data from the National
Burn Repository suggest that burn injuries are more prevalent in minority
children than would be expected based on demographics alone. Scald and
contact burns are more common in the younger ages, with fire/flame more
common in adolescent and adult patients.
Recent data suggest significantly improved survival for children with
careful attention to burn care. In one study, half of children with burn
injuries up to 90% TBSA survived their injuries, and research is ongoing
into new methods for surgical management and pharmacologic treatment of
burn wounds. Burn size and inhalational injury are two key predictors of
survival in children.
Major systemic pathophysiologic effects are seen in children with burns
of more than 20% of body surface area (BSA). Burn injury causes increased
capillary permeability and the release of osmotically active molecules to the
interstitial space resulting in extravasation of fluid. Protein is lost from the
vascular space to the interstitium during the first 24 hours. In patients with
large burns, vasoactive mediators are released to the circulation and result
in systemic capillary leakage. Edema develops in both burned and

noninjured tissues. Circulating factors that depress myocardial function
decrease cardiac output. Acute hemolysis of up to 15% of red blood cells
may occur both from direct heat damage and from a microangiopathic