Pediatric emergency medicine trisk 3220 3220

wound care and pain management to minimize disability and improve
cosmetic and functional outcomes.

Clinical Considerations
In the appropriate clinical circumstances (fire, usually in an enclosed space)
it is important to consider carbon monoxide and cyanide poisoning. For
carbon monoxide, one should administer 100% O2 and send a
carboxyhemoglobin level. Indications for potential hyperbaric treatment
include loss of consciousness at the scene, persistent neurologic symptoms
including seizure, evidence of cardiac injury, or significant elevation of
carboxyhemoglobin levels (>25% to 40%). The decision to pursue
hyperbaric treatment should be made in conjunction with a toxicologist,
poison control center, or hyperbaric physician. Cyanide poisoning must be
treated before the quantitative level is available. Indications to consider
hydroxycobalamin treatment for cyanide toxicity include history of
cardiopulmonary resuscitation (CPR), abnormal vital signs, intubation,
evidence of hypoxic injury, and severe metabolic acidosis.
Clinical Recognition
Recognition of the severely injured burn patient is based on a combination
of the severity of burn and TBSA involved. Burn shock occurs in adults
with burns over 30% of BSA but may occur in children with burns over
only 20% of BSA. Circumferential burns and full-thickness burns are of the
highest concern.
Triage Considerations
Please see triage guidelines in Table 104.1 . Major burns should be triaged
to rapid physician assessment and care.
Clinical Assessment
As part of the primary trauma survey, the clinician must be vigilant in
carefully evaluating all patients for evidence of inhalational injury. Patients
with a history of fire exposure in an enclosed space, soot in the nose or
mouth, or facial or airway burns may require intubation for airway

protection. These patients may also require treatment for carbon monoxide
and cyanide exposure. In the secondary survey, it is of the greatest