Burn Injuries

Hey, so we are going to cover burn injuries in this lesson. This is a big topic because a burn can range from a simple sunburn all the way to full thickness burns that cover the majority of the body.

Management of these two are totally different. I’m not going to try and cover everything here. I just want to highlight things about burns that are specific to kids. For a more general review of burns there is a lesson in the Integumentary course that you can check out. Okay, let’s get started!
Burns are a pretty common injury for our pediatric patients. The most common causes of the more simple burns are from hot liquids, (pulling a cup of hot coffee off the coffee table) hot surfaces (reaching up to touch the stove eye) and even sunburns can be really bad. More severe burns are usually caused by flames, house fires and electrical burns. Preventing burns is all about supervision and making the environment safe.

So you already know burns are classified in degrees, 1st degree through 4th degree. Just a quick recap on these: with 1st degree burns the skin is red but intact, 2nd degree burns are blistered, 3rd degree burns are dry and leathery 4th degree burns are all the way through the skin to underlying tissues. A key point to remember about burns is that every burn has varying degrees of injury throughout (draw circle).

The extent of the burn is determined by looking at Body Surface Area. Kids have a larger BSA compared to adults so the Rule of 9’s formula you use in adults doesn’t work here. Age specific charts have to be used to determine the percentage of skin that has been injured. Burns that cover >30% of the body cause a systemic response and have poorer outcomes. We’ll talk more about these severe burns in a sec.

A couple of things that are really important not to miss with burn assessments are inhalation injury and non-accidental burns.

Inhalation injury is important and also kind of scary because there may not be any outward signs the that respiratory tract has been injured. Respiratory distress may not present until 24-48 hours after the burn so kids have to be monitored closely for a couple of days after the burn. This is especially true if there are any signs that the face has been burned. So, things like singed hair on the face or actual burns like the girl in the photo here.

Okay so one thing that’s really important to be aware of is that sometimes burns aren’t accidental. They can be used as a form of punishment and this is abuse. There are some really important red flags to be on the lookout for when it comes to identifying non-accidental burns. These red flags are 1) patterned burns, like cigarettes, irons, curling irons 2) burns that are the same level of thickness throughout and 3) circumferential burns. An scald injury that is truly accidental is likely to be on the front of the body and will have a spill pattern.

Taking care of minor burns is, again, basic first aid, so we are going to focus on how to manage severe burns.

So remember the younger the kid the more skin they have compared to their body size and this is why the first two things listed here are super important.

Once the kid has arrived to the hospital the first 24-48 hours are the most crucial. During this time something called Burn Shock can happen. When a large percentage of the body has been burned fluids and electrolytes start to shift and are lost. The patient becomes severely hypovolemic, cardiac output decreases and organs are at risk for hypoxia due to decreased blood flow. So, the first thing we need to do is give fluids. Formulas used will vary from hospital to hospital.

But it’s all about careful monitoring- vital signs, urine output, level of consciousness, electrolytes and temperature. One important measurement to note for kids is that for urine output we are looking for 1-2 ml/kg/hr.

Pain is a huge problem for any burn patient, but even more so for children who can’t understand why they are experiencing pain. Remember to remind kids that the pain is not a punishment for something they have done. Opioids and Benzodiazepines are commonly used for pain control and sedation. Make sure to perform dressing changes when the medication is at its peak.

Burns take a long time to heal and require a lot of careful wound care. So after the patient is stabilized efforts are put toward closing the wounds, preventing infection and getting and optimal cosmetic outcome. Once initial healing has taken place, scar tissue can cause a lot of problems like contractures. Rehab focuses on minimizing these and getting as much movement from the tissue as possible.

Psychological support becomes really important as kids are ready to go back to their lives and back to school.

Your priority nursing concepts for pediatric patients with burn injuries are tissue/skin integrity, comfort, and infection control.
Alright that was a very quick, peds-focused lesson on burn injuries. Remember your major take away points for this are: Number 1) being able to identify non-accidental burns (looking for patterns or forced scald injuries that go all the way around an extremity). Number 2) pediatric burns have to be measured using child specific charts because of their increased body surface area. Number 3) The first 24-48 hours are crucial because this is when burn shock occurs and when inhalation injury may present. Number 4) Pain control is essential for ensuring kids aren’t traumatized by surgeries and dressing changes.

Okay guys that’s it for this lesson remember to link all of this information with what you learn from the fundamentals lesson burns. Also- remember everything in peds goes through a developmental filter, so make sure all your nursing care fits the developmental age of the child. Check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!