Research on Paediatric Burns - Essay Example

?Burns Paediatric Burns Burns Burns may be defined as the tissue damage that occurs to the body caused by heat, chemicals, electri sunlight or nuclear radiation (NIH, US). The American Burn Association has defined burn as “an injury to the skin or other organic tissue primarily caused by thermal or other acute trauma” (Green, 2010).The common causes are scalds from boiling liquids like water or oil or other preparations being cooked in the kitchen or steam. Building fires or presence of flammable liquids or gases could also produce burns. Treatment differs slightly in the various classes of burns (NIH, US Health Department). Burns has associated complications like infection. The prognosis of burns patients varies according to the extent of damage, whether tissue repair is complete and whether infection has set in. In present times, even 90% burns patients are being saved while 25 years ago, even 50% burns was considered fatal. Research has evolved the best treatment approaches for burns including resuscitation with fluids, cleaning the wounds, replacement of damaged tissue with skin, control of infection and dietary supports. Incidence Among the leading causes, burns in children (below 9 years are identified as the third one among injury-related deaths (Green, 2010). Burns in children are usually caused at home (Anjali et al, 2009). Scald burns have the commonest incidence in children, 80%. They occur mostly over the upper trunk and upper arms (Anjali et al, 2009). Hot bath water caused 50 % of the scalds. In most cases, the burns could have been prevented. A lapse in parental supervision and curiosity of a child are the two reasons quoted for the tragic incidents. Occasionally the child may not be able to get away from the burning substance Child abuse is another sad cause (Green, 2010). Children who are burnt have a tendency to suffer from post-traumatic stress disorder (Anjali et al, 2009). A study has revealed that young boys and children below 6 years are influenced by movies which exhibit flames and explosions in toys (Anjali et al, 2009). It was also noted that children below 6 had thinner skin making them prone to more tissue damage in burns. Pathophysiology The zones of injury are three in every burns wound: zones of coagulation, ischemia or stasis and hyperemia. The coagulation zone lies in the center of the burn and has necrotic tissue. The ischemic zone indicates microvascular injury causing oxygen-deprived tissues and surrounds the coagulation zone. The outermost hyperemic zone shows vasodilatation as an acute inflammatory response to the injury near it (Green, 2010). Primary Survey The first few steps of nursing care help to stabilize the patient for further treatment. Assessment of the airway is especially important in children and the cervical spine is to be protected while doing so. If the child is not responding or if one feels that the airway is compromised, an endotracheal tube is better used as the airway is much smaller in children (Green, 2010). Evaluation of the respiratory status is the next step. The child’s chest must be exposed and the rate, extent, and quality of the respiratory movements assessed. The movements of the chest wall must be watched. The breath sounds must be auscultated bilaterally (Green, 2010). Children with burns on the chest will definitely have a compromised respiration. Oxygen must be given through a non-breathing mask to ensure 100% saturation (Green, 2010). A pulse oximeter would indicate the percentage of oxygen saturation. Inhalation is diagnosed by the singed hair on the eyebrows or nose. The pulse quality, rate and rhythm need to be assessed for a picture of the circulation status. When the patient is stable, the neurologic status may be assessed. Level of consciousness may be examined using the AVPU protocol by noting the response to verbal stimuli or pain. If neurologic status is compromised, hypoxaemia, carbon monoxide poisoning, smoke inhalation, drug abuse or an earlier medical problem must be suspected (Green 2010). The clothes of the child may be removed but the burns area must not be exposed to prevent the patient feeling the cold due to loss of skin, the integrity of which is necessary for regulation of temperature (Green, 2010). Detailed history may now be obtained. Physical assessment for more injuries must be made. Tetanus prophylaxis may be given. Laboratory investigations for blood cell counts, metabolic functions, urine examination, arterial blood gas analysis, status of fluid volume, electrolyte balance, renal functions and oxygenation levels are to be reviewed at intervals. Application of MEBO immediately on the burns that occurred in the kitchen or at home has been advised by some therapists. This is believed to provide relief for pain, cessation .of bleeding and prevention of infection (Xu et al, 2004). These factors influence further management. Classification of burns wounds is the next step. One classification terms the wounds according to the mechanism of injury into” thermal, chemical, electrical and radiation” (Green, 2010). Further classifications are according to “depth of injury and total body surface area” (Green, 2010). . Burns are classified into first degree, second degree, and third degree burns determined by the depth of skin that is involved (NIH, US). Superficial burns are also termed first degree burns. An erythematous area without blisters is the typical feature. Partial-thickness burns are second degree burns which involve the epidermis and dermis (Green, 2010). Blisters are found between the two layers of the skin a few hours after injury in superficial partial-thickness burns. Pain is more intense than the superficial burn. Deep partial-thickness burns extend further into the deeper layers of the dermis and are extremely painful. Full thickness or third degree burns involve the whole dermis and subcutaneous tissue also. The burns are of black or brown color and look dry (Green, 2010). Pain will be significantly less as the nerve endings have been destroyed. A child may present with a combination of classes of wounds. Fluid resuscitation is not required for children with less than 15% burns by surface area involved. Rehydration may be done orally and supplemented by IV fluids. Fluid resuscitation is performed so that the ischemic area is perfused with tissue fluid so that much of the tissue is saved from damage (Green, 2010). The Parkland Burn formula is used for calculating the fluid volume to be given. Ringer Lactate is the best fluid to be given as it prevents acidosis. Half the lost fluid is to be given within eight hours and the rest over sixteen hours. Overloading of fluids should never be done. Children between 6 months and 5 years need to receive dextrose fluids in addition for maintenance following the initial resuscitation fluids. Fluids must be continued from the emergency department till the burn center is reached. Children above 3 years may be evaluated for pain stress using the Wong-Bakers FACES pain-rating scale. For younger children, the FLACC pain scale is used. Opioids are used in the partial thickness and full thickness burns. The patient must be covered with a sheet or blanket for prevention of heat loss. Referral of burns patients should be made for patients with more than 10% TBSA. Burns involving the extremities, perineum, genitals and large joints need to be referred. All third degree burns or inhalation stress are referred. Chemical and electrical burns patients are referred. Superadded medical problems require referral. If the condition of the patient is risky, there should be no second doubts about referral. Paucity of staff is another condition for referral. Children who need social or emotional or long-term rehabilitation are also referred. Caring for a child with burns is a challenging proposition. Ensuring swift classification of burns, adequate fluid resuscitation and timely referral decides the kind of recovery that the child will make. References: Anjali L. D'Souza, Nicolas G. Nelson and Lara B. McKenzie. Pediatrics 2009;124;1424; originally published online October 5, 2009; DOI: 10.1542/peds.2008-2802 Accessed on 1/10/2011. US Department of Health and Human Resources. Green, T.E. (2010). Paediatric Burns, Nursing, August 2010, pg. 43-49 Burns, National Institute of Health, Department of Health and Human Services, www.ncbi.nlm.nih.gov Xu, R.X., Sun,X., , B.S., (2004) Burns regenerative medicine and therapy. Karger Publishers, Medical. Read More