Pediatric emergency medicine trisk 3222 3222

Inhalational injury can also cause damage to the lower airway. Chest
radiographs may be normal initially, even if pulmonary injury has occurred.
Mild inhalational injury can be treated with supplemental oxygen, and
consideration of albuterol or racemic epinephrine nebulizer treatment when
wheezing or stridor are present, respectively. Steroids are generally not
recommended for treatment of burn patients with airway injury, although a
single-center study showed no increased risk with a single dose. Patients
should continue to be monitored closely for any deterioration in their
clinical status. Significant inhalational injury will require endotracheal
intubation and ventilatory support.
Extensive full-thickness burns of the thorax may restrict expansion of the
chest and impair ventilation. Respiratory insufficiency in this setting is an
indication for escharotomy of the chest. Incision through the depth of the
eschar should be performed along the anterior axillary lines to allow
adequate chest expansion. If the deep burns extend to the abdomen, the
escharotomies should be extended downward and connected by incision
along the costal margin.
Circulation. The rapid assessment of circulation includes skin color,
capillary refill time, temperature of the peripheral extremities, heart rate,
and mental status. Blood pressure is often maintained until late in the course
of shock, making it an unreliable early measure. Hypertension from
increased systemic vascular resistance has been reported immediately after
severe burns, particularly in pediatric patients, and should not be taken as
an indication to discontinue proper fluid therapy.
Vascular access should be obtained soon after the arrival of the child with
severe burn injury. Peripheral, large-bore intravenous catheters are favored
because they have the lowest resistance. Catheters placed in the upper
extremity through intact skin are preferred because they are easier to secure,
but access through burned areas may be necessary. Anticipating the need for
hyperalimentation, sites for central catheter placement should be saved, if
possible. Attention to aseptic technique when starting intravenous catheters

in the emergency department (ED) can prevent infectious complications
during subsequent care. Circumferential taping is dangerous because the
swelling that occurs during the first 24 hours can cause circulatory
insufficiency distal to the constriction. Urine output is the most important