burns in children
Introduction
Introduction to pediatric burns Burninjuries are heat burns caused by high temperatures such as hot water, steam, and flame. Children are prone to curiosity and lack of cognitive ability to risk factors. They are prone to occur when there are risk factors in daily environment. Accidents of burns, severe cases can cause serious local and systemic injuries, and even cause disability and death. basic knowledge Sickness ratio: 0.05% Susceptible people: children Mode of infection: non-infectious Complications: shock metabolic acidosis sepsis
Cause
Causes of scald in children
Skin contact with hot objects or high temperature liquids (45%):
More common in children under the age of 3, with the ability to walk and other preliminary activities, in contact with such as not cooling meals, boiling water, hot pot, electric cup, etc., the burned parts and normal tissue boundaries are more clear.
Contact open flames (35%):
More common in children over the age of 2, in the absence of protection, contact with fire, matches, flammable materials suddenly burned after burns, the injury boundary is usually not very clear.
Other factors (20%):
Burns during the explosion: less, seen in fireworks and firecrackers, the burned area of the injured area is more uniform. Electric shock: Less, seen in lightning strikes or exposure to high voltage.
Pathogenesis
Characteristics of scald in children:
1. It is easy to cause burns: children's skin is thin, even if it is exposed to hot substances with low temperature, it can cause burns.
2. It is prone to deep burns: the anti-reflection of heat is not fast enough, and the contact with hot objects is longer, and it is more prone to deeper burns than adults.
3. Susceptible to shock: the ratio of total blood to skin area in children is much smaller than that of adults, so the same area of burns and exudation of skin fluids have a much greater impact on children and are more prone to shock.
4. Prone to dehydration, acidosis: scald exudation and eating disorders after burns are also prone to dehydration, acidosis.
5. Prone to infection: poor resistance to infection, so sepsis and toxemia are also more.
6. Prone to wound contamination: Children can't take care of themselves, and there are more opportunities for urine and urine to contaminate wounds.
Prevention
Pediatric burn prevention
1. Strengthen the safety awareness of children, educate children to stay away from danger sources, parents and caregivers should improve their vigilance against burns.
2, the home should strengthen preventive measures, such as hot water bottles and other items that are dangerous to children should be placed in places that children can not touch, to add guardrails, bath first cold water and then heat water to prevent children from burns and so on.
Complication
Pediatric scald complications Complications, shock, metabolic acidosis, sepsis
Severe burns can occur shock, renal failure, oliguria or no urine, and can appear hyponatremia, acidosis, respiratory scald, large area soft tissue injury, fracture. Infection can occur, and septicemia is more common in Pseudomonas aeruginosa sepsis.
1. Shock: It is a systemic and critical pathological process in which all kinds of strong pathogenic factors act on the body, causing a sharp decline in circulatory function, severely insufficient microcirculation perfusion of tissues and organs, and even vital organs and metabolic disorders. The onset of shock can be divided into early shock and shock phase, which can also be called shock compensation period and shock inhibition period.
2. Renal failure: a pathological condition in which part or all of the kidney function is lost. According to the rapid onset of the attack, it is divided into acute and chronic. Acute renal failure is caused by various diseases, causing the two kidneys to lose excretory function in a short time, referred to as acute renal failure; chronic renal failure is caused by various causes. A chronic syndrome of chronic kidney disease that develops to a late stage and consists of a group of clinical symptoms.
3, acidosis: is an endocrine disease, the accumulation of acidic substances in the blood and tissues of the body, the essence of which is the increase of hydrogen ion concentration in the blood, PH value.
4, respiratory scald: If a child has a respiratory tract burn, usually a tracheotomy is performed, because the child's trachea is too thin, it is easy to fail when using a thick needle to puncture the trachea. However, there are certain risks associated with incision surgery.
5, Pseudomonas aeruginosa sepsis: Pseudomonas aeruginosa sepsis is often secondary to extensive burns, leukemia, lymphoma, malignant tumors, tracheotomy, venous catheters, heart valve replacement and various serious chronic diseases In the process. The main symptom is rash. The rash can occur in any part of the body, but it usually occurs in the perineum, buttocks or underarms. Occasionally in the oral mucosa, there may be migratory abscesses in the late stage of the disease.
Symptom
Symptoms of scald in children Common symptoms Burnt blisters broken edema tissue necrosis oliguria blood pressure drop scald sweat gland damaged kidney failure scald blistering anuria shock
Clinical manifestation
The degree of scald in children depends on the way of scald and the area of scald. The pathological changes and clinical manifestations are mainly reflected in local tissue and systemic changes.
(1) Local changes: After the skin is heated up (more than 60 ° C), the protein in the tissue can coagulate, resulting in cell necrosis, local reaction depending on the temperature of the hot object, the time of contact and the thickness of the injured skin, the general skin and 70 °C is blistering when the hot object touches for 1 s, but the newborn is often burned by the hot water bottle at 50 °C. The depth of local tissue necrosis is also divided into 3 degrees. However, because the skin of the child is very thin, the indexing is difficult, and the general clinical experience. It is easy to estimate low.
(2) systemic changes: severe burns can occur in shock, early shock after burns due to pain and mental stimulation, generally temporary, not serious, and secondary shock is due to increased capillary exudation, tissue edema And a large amount of exudate, plasma loss, blood concentration and circulating blood loss, followed by tissue hypoxia, blood pressure, low pulse, low blood sodium and acidosis, oliguria or no urine, within 6 ~ 8h after burn The liquid oozes fastest, and reaches the highest peak at 36 to 48 hours, usually exceeding the ability of lymphatic reflux, and then gradually slows down.
2. Calculation of burned area
When observing burns, you should pay attention to the details of the injured area, depth, and special parts such as facial features, joints, and facial parts. Accurate calculation of burned area and estimated depth can help determine the severity of the injury, estimate the prognosis, and facilitate treatment. The basis of liquid replenishment, the measurement of burned area is as follows:
(1) Palm method: The area of the palm of the wounded when the five fingers are close together is equivalent to 1% of the total body surface area. This method is less accurate and is often used in the emergency room to estimate a small area of burn or to estimate a small range of 3 degree burns. .
(2) Body surface area calculation method: Refer to the area percentage of children's body at different ages. This method is more accurate, but the younger the child, the larger the proportion of the head, the smaller the proportion of lower limbs, with the increase of age. The proportion of the head and lower limbs of children is gradually close to that of adults. It can be corrected by the following formula: the head area of children (%) = 9+ (12-age).
3. Estimation of burn depth
Clinically, the three-four-point method is usually used for evaluation. In the early stage of scald, the depth of scald is not easy to accurately judge, especially the wound boundary between deep second-degree scald and third-degree scald is more confusing, so the correction is re-verified after 48 hours of treatment; The palm of the hand, the skin of the sole is thick, and it is easy to mistake the second degree to three degrees in the early stage, while the skin of the infant is very thin, and it is easy to mistake the third degree to the second degree.
4. Classification of scald degree
(1) Mild burns: The total area is below 10%, and there is no third degree burn.
(2) Moderate burns: the total area is 11% to 20% or the third degree is below 5% or the second degree is burned on the head and face, hands, feet, and perineum.
(3) severe burns: the total area is 21% to 50% or three degrees at 5% to 15% or combined with respiratory scald, large area soft tissue injury, fracture, renal failure.
(4) Extra-heavy burns: the total area is above 50% or the third degree is above 15%. Because the development of children is not mature, the resistance to shock and infection is poor. Especially the infants under 2 years old have lower immunity and are more dangerous. Therefore, there should be sufficient understanding of the severity of scald in children. According to the medical history, the clinical manifestations can be confirmed.
Examine
Pediatric burn inspection
Blood, urine, routine examination, blood electrolytes, pH, liver and kidney function tests should be performed.
Check according to clinical choices:
1. X-ray: X-ray examination is commonly used in medicine as one of the auxiliary examination methods. Clinically used x-ray examination methods are both fluoroscopy and radiography.
2. B-ultrasound: An imaging discipline that uses the physical properties of ultrasound for diagnosis and treatment. It has a wide range of clinical applications and has become an indispensable diagnostic method in modern clinical medicine.
3. Electrocardiogram: Electrocardiography (ECG or EKG) is a technique for checking the electrical activity change pattern generated by each cardiac cycle of the heart from the body surface using an electrocardiograph.
Diagnosis
Diagnosis and diagnosis of scald in children
According to the cause, clinical symptoms and related examinations can be diagnosed:
1. The degree of scald in children depends on the way of scald and the area of scald. The pathological changes and clinical manifestations are mainly reflected in local tissue and systemic changes.
(1) Local changes: After the skin is heated up (more than 60 ° C), the protein in the tissue can coagulate, resulting in cell necrosis, local reaction depending on the temperature of the hot object, the time of contact and the thickness of the injured skin, the general skin and 70 °C is blistering when the hot object touches for 1 s, but the newborn is often burned by the hot water bottle at 50 °C. The depth of local tissue necrosis is also divided into 3 degrees. However, because the skin of the child is very thin, the indexing is difficult, and the general clinical experience. It is easy to estimate low.
(2) systemic changes: severe burns can occur in shock, early shock after burns due to pain and mental stimulation, generally temporary, not serious, and secondary shock is due to increased capillary exudation, tissue edema And a large amount of exudate, plasma loss, blood concentration and circulating blood loss, followed by tissue hypoxia, blood pressure, low pulse, low blood sodium and acidosis, oliguria or no urine, within 6 ~ 8h after burn The liquid oozes fastest, and reaches the highest peak at 36 to 48 hours, usually exceeding the ability of lymphatic reflux, and then gradually slows down.
2. Calculation of burned area
When observing burns, you should pay attention to the details of the injured area, depth, and special parts such as facial features, joints, and facial parts. Accurate calculation of burned area and estimated depth can help determine the severity of the injury, estimate the prognosis, and facilitate treatment. The basis of liquid replenishment, the measurement of burned area is as follows:
(1) Palm method: The area of the palm of the wounded when the five fingers are close together is equivalent to 1% of the total body surface area. This method is less accurate and is often used in the emergency room to estimate a small area of burn or to estimate a small range of 3 degree burns. .
(2) Body surface area calculation method: Refer to the area percentage of children's body at different ages. This method is more accurate, but the younger the child, the larger the proportion of the head, the smaller the proportion of lower limbs, with the increase of age. The proportion of the head and lower limbs of children is gradually close to that of adults. It can be corrected by the following formula: the head area of children (%) = 9+ (12-age).
3. Estimation of burn depth
Clinically, the three-four-point method is usually used for evaluation. In the early stage of scald, the depth of scald is not easy to accurately judge, especially the wound boundary between deep second-degree scald and third-degree scald is more confusing, so the correction is re-verified after 48 hours of treatment; The palm of the hand, the skin of the sole is thick, and it is easy to mistake the second degree to three degrees in the early stage, while the skin of the infant is very thin, and it is easy to mistake the third degree to the second degree.
4. Classification of scald degree
(1) Mild burns: The total area is below 10%, and there is no third degree burn.
(2) Moderate burns: the total area is 11% to 20% or the third degree is below 5% or the second degree is burned on the head and face, hands, feet, and perineum.
(3) severe burns: the total area is 21% to 50% or three degrees at 5% to 15% or combined with respiratory scald, large area soft tissue injury, fracture, renal failure.
(4) Extra-heavy burns: the total area is above 50% or the third degree is above 15%. Because the development of children is not mature, the resistance to shock and infection is poor. Especially the infants under 2 years old have lower immunity and are more dangerous. Therefore, there should be sufficient understanding of the severity of scald in children. According to the medical history, the clinical manifestations can be confirmed.
