Pediatric emergency medicine trisk 3219 3219

colonized with potentially pathogenic organisms, primarily from the skin
and intestinal flora of the patient and not from exogenous sources.
Cleansing and debridement reduce substrate for bacterial proliferation and
topical antimicrobial therapy reduces the number of microorganisms, but
burns are never completely sterilized so the risk of secondary infection is
always present. Burn wounds are not treated immediately with systemic
antibiotics unless infection is clearly present, but must be watched closely
for development of subsequent infection.

MAJOR BURNS
CLINICAL PEARLS AND PITFALLS
The placement of a sterile sheet over burned areas can provide
effective analgesia.
Consider carbon monoxide and cyanide exposure with house fires
and do not delay treatment in suspected cases.

Current Evidence
Risk of morbidity and mortality is associated with the size of the burn. A
large, single-center, prospective study of pediatric burn patients found
mortality rates ranging from 3% (30% to 39% TBSA) to 55% (90% to
100% TBSA). In this study, burn size of 62% TBSA was the marker of a
significantly increased mortality risk.

Goals of Treatment
The initial management of the significantly burned patient includes
protection of the airway, maintenance of breathing, and support of
circulation, all with the goal of preventing mortality and disability. Initial
airway assessment needs to include evaluation and management of potential
direct inhalational injury and resultant airway edema, as well as inhaled
toxins including carbon monoxide and cyanide. Patients should receive
supplemental oxygen, as well as appropriate antidotal therapy for

toxicologic exposure, respiratory support as needed (potentially including
escharotomy for circumferential chest burns), and appropriate intravenous
fluid resuscitation to support their circulatory status. The goal is to optimize