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in this lecture we'll discuss burns in
children when you see a child with a
burn it's important to identify the
severity of that burn you should
identify the thickness or type of burn
how extensive it is across the skin
where it's located on the body how long
they were exposed to whatever it was
that burned them and the timing of the
presentation was there a delay between
when they had the burn and when they
showed up which can be important
especially in child abuse so let also
talk about associated symptoms to burns
just because a patient is presenting
with a burn doesn't mean there isn't
something else going on that you might
need to take care of right away example
would be a patient who has smoke
inhalation injury which you should think
about in any patient who is in a fire
you might think of carboxyhemoglobin
emia also because that can cause
problems with delivery of oxygen to
peripheral tissues and you might want to
check their hemoglobin electrophoresis
also we don't think of this but it's
fairly common in house fires patients
may get cyanide poisoning this can
happen because of the burning of
plastics inside the house can release
cyanide and lastly if a patient has an
electrical burn consider the possibility
of internal electrical injury especially
in lightning strikes for example but it
can be another electrical injuries as
well
so you need to assess for that as well
especially looking at things like the
muscles for a CPK the heart with an EKG
they can also get rhabdomyolysis they
can get an anemia a variety of things
can happen you want to check those
so let's think about burn thickness in
particular we break things down into
superficial partial thickness or full
thickness burns you can think of these
as first second and third degree burns
let's start with first degree burns or
superficial burns these are generally
only involving the epidermis they're
usually very red and they're typically
very painful so this is that red lesion
after you've just touched something that
was a bit too hot so here's an example
of a superficial burn in this case this
person got too much sun exposure you can
see it's very red but there's not really
any blistering happening or anything
like that
next we can break superficial partial
thickness and deep partial thickness as
two different categories of partial
thickness burns these are our
second-degree burns
so in superficial partial thickness this
goes into the dermis but that's about as
far as it goes
these patients will blister because of
disruption of that of that dermal layer
they're often red moist or ended M&S and
they also will be painful so here's an
example of a superficial partial
thickness burn it's painful there's an
area where the blister is actually
ruptured off once the blister ruptures
off there is then an increased risk for
super infection if there's intact skin
we don't want to pop those blisters
these weren't caused by infection
remember blisters from infection we want
to pop blisters from trauma or burns we
don't want to pop so we're gonna leave
them intact if we can if they've
ruptured you might put a topical
antibiotic or something along those
lines onto the burn to prevent any super
infection moving on
to deeper partial thickness burns these
involve most of the dermis they can
become pale or white in their nature
they're not blistering any more and
they're a little bit ironically less
painful as you're starting to injure
some
the nerve endings in that skin so here's
an example of a deep partial thickness
burn this patient has substantial
sloughing of skin this is an infection
risk and this is perhaps less painful
although it looks certainly worse than
the previous one so or it can still be
painful so keeping in mind that we're
going to give pain control and pain
therapy as needed for these patients
last is the full thickness or
third-degree burn this is typically a
leathery burn it's often charred if it
was done by flames it's generally
painless so they've really injured their
nerves as well and these routinely scar
or scar severely after they heal so
here's an example of a deep partial
thickness burn you can see this has gone
well down to the dermis and has caused
substantial damage this has substantial
infection risk and generally is less
painful but much more severe and Oh
probably scar
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