An 18 month old baby was brought to the ER by a caretaker wi

An 18 month old baby was brought to the ER by a caretaker with burns on both of his buttocks and lower back region. The affected areas are moist, have blisters, and are exquisitely painful to the touch. 1) for this child, what is the most likely degree of burns? 2) 2) what is the most likely cause resulting in the burn associated with this baby? 3) Your management for the baby would include? 4) How does one go about assessing the most severe forms of burn, i.e., third degree burn? List the appropriate percentage allocated to the body. 5) What is the primary goal when treating a severely burned patient? 6) How do you assess fluid dynamics in burn patient?

Solution

1) For this child most likely the degree of burns is second degree.

2) Most likely the cause resulting in the burn associated with this baby is that he/she has pulled a pot of boilling water over himself/herself.

3) Management for the burn is silvadene (silver sulphadiazine) cream. Management for the kid may
require reporting to authorities for child abuse.

4) In kids third degree is deep bright red, rather than white leatherly as in the adult.

5) The primary goal when treating a severely burned patient is to stop the burning process, to reduce the blistering, and most importantly to ease the pain. For that quickly place the burned area under cool (but not cold) water for roughly 10 – 45 minutes. Gently dry the burned area and apply Polysporin Triple Action with pain relief or similar to help treat the burn and prevent infection. Wrap the burned area with gauze. Give the child either Tylenol (acetaminophen) or Advil (ibuprofen) or both to deal with the pain.

6) Assessment of fluid dynamic in burnt area-

Fluid losses from the injury must be replaced to maintain homoeostasis. There is no ideal resuscitation regimen, and many are in use. All the fluid formulas are only guidelines, and their success relies on adjusting the amount of resuscitation fluid against monitored physiological parameters. The main aim of resuscitation is to maintain tissue perfusion to the zone of stasis and so prevent the burn deepening. This is not easy, as too little fluid will cause hypoperfusion whereas too much will lead to oedema that will cause tissue hypoxia.

The greatest amount of fluid loss in burn patients is in the first 24 hours after injury. For the first eight to 12 hours, there is a general shift of fluid from the intravascular to interstitial fluid compartments. This means that any fluid given during this time will rapidly leave the intravascular compartment. Colloids have no advantage over crystalloids in maintaining circulatory volume. Fast fluid boluses probably have little benefit, as a rapid rise in intravascular hydrostatic pressure will just drive more fluid out of the circulation. However, much protein is lost through the burn wound, so there is a need to replace this oncotic loss. Some resuscitation regimens introduce colloid after the first eight hours, when the loss of fluid from the intravascular space is decreasing.decreasing.