Pediatric emergency medicine trisk 3221 3221

importance not to neglect the possibility of other injuries from the burn
mechanism, or associated injuries, which may also require emergent
treatment and stabilization. Finally, patients with ocular area burns will
need specialized ophthalmology consultation for evaluation of corneal
involvement.
Management
Airway. The inhalation of hot gases can burn the upper airway, leading to
progressive edema and airway obstruction. Children with burns of the face,
singed facial hairs, or hoarseness are at high risk, but airway burns can also
occur in the absence of these signs. Edema of the burned airway will
worsen over the first 24 to 48 hours. Knowledge of the time course of
airway swelling justifies endotracheal intubation for subtle signs of airway
compromise that occur shortly after the injury. Early intubation may
circumvent a difficult intubation later in the course of a child with severe
pharyngeal and airway edema. Endotracheal tubes of smaller diameter than
expected for age should be available in anticipation of a narrowed airway.
Cuffed tubes are preferred to accommodate the potential for changing
airway edema over the course of the recovery.
Children who have jumped or fallen in house fires, been burned in motor
vehicle accidents, or been burned by explosions are at risk for other
traumatic injuries, and cervical spine precautions should be maintained
during management of their airways. Furthermore, children with severe
burns may have depressed levels of consciousness for many reasons and
airway obstruction from the loss of pharyngeal tone is not uncommon.
Breathing. A rapid assessment of ventilation includes respiratory effort,
chest expansion, breath sounds, and color. Pulse oximetry is useful, but
patients with significant levels of carboxyhemoglobin will look pink and
have “normal” oxygen saturation as measured by a pulse oximeter. Children
with severe burn injury should receive 100% supplemental oxygen. Blood
gases with co-oximetry should be obtained promptly. Venous or arterial
gases can be used, although arterial samples are preferred for

hemodynamically unstable patients and to best assess degree of acidosis.