Pediatric emergency medicine trisk 3227 3227

Intranasal medications can be given during early assessment of patients
in severe pain. Ongoing analgesic medications are commonly administered
intravenously for patients with severe burns because they are effective and
predictable. Intramuscular injections or oral doses should not be given to
patients with significant burns because circulation to muscle and gut is
reduced, and absorption of medication will be delayed and unpredictable. In
children who do not respond well to the initial dose of pain medication, a
careful assessment for other causes of pain or agitation should be sought.
The possibility of compartment syndrome, hypoxemia, early shock, and
occult injuries should be assessed while simultaneously preparing repeated
doses of analgesics. Analgesic administration just before debridement of
any burn wound is recommended.
Disposition (Transfer Criteria). Guidelines for admission must be
individualized when treating children with burns. Hospitals, physicians, and
parents have varying capabilities for managing pediatric patients with
burns. If a physician suspects that the burns cannot be adequately cared for
in the home, admission to the hospital is warranted.
Children with burns <5% TBSA can be considered for outpatient
management with close follow-up. Admission criteria include 5% to 10%
TBSA burn, 2% to 5% TBSA full-thickness burn, high-voltage injury,
concern for inhalational injury, circumferential burn, significant associated
trauma, or medical comorbidity (such as diabetes or sickle cell disease).
Burns in certain locations are at higher risk for disability or poor cosmetic
outcome and should be considered for treatment in the hospital. These
include more than 1% of BSA burns of the face, perineum, hands, and feet;
or burns overlying joints. Children with any of the following should be
considered for transfer to a burn center: >10% TBSA burn, >5% TBSA
full-thickness burn, high-voltage burn, chemical burn, known inhalational
injury, burn to face, hands, feet, perineum, joints, significant comorbidities
that could affect burn treatment, or when social or emotional factors related
to the burn injuries will influence rehabilitation.

MINOR BURNS
CLINICAL PEARLS AND PITFALLS