How is burn severity assessed using the Rule of Nines. What are the critical percentages for life-threatening burns. How does burn percentage impact treatment and prognosis.

Understanding the Rule of Nines for Burn Assessment

The Rule of Nines is a standardized method used by medical professionals to quickly estimate the total body surface area (TBSA) affected by burns in adult patients. This crucial assessment tool helps determine the severity of burn injuries and guides appropriate treatment decisions.

How does the Rule of Nines work?

The Rule of Nines divides the adult body into sections, each representing approximately 9% (or a multiple of 9%) of the total body surface area:

• Head and neck: 9%
• Each arm: 9%
• Chest: 9%
• Abdomen: 9%
• Upper back: 9%
• Lower back: 9%
• Each leg: 18% (front 9%, back 9%)
• Groin: 1%

By assessing which areas are affected by burns and to what extent, healthcare providers can quickly calculate an estimate of the total burned surface area.

Critical Burn Percentages and Their Implications

The percentage of body surface area affected by burns plays a crucial role in determining the severity of the injury and the potential for life-threatening complications.

At what percentage do burns become life-threatening?

Generally, burns covering more than 20% of the total body surface area in adults are considered potentially life-threatening. However, several factors influence the severity and prognosis:

• 30% TBSA: Burns covering 30% or more of the body are classified as major burns and require immediate, specialized care.
• 40% TBSA: At this level, the risk of shock and organ failure increases significantly.
• 50% TBSA: Burns affecting half or more of the body surface are extremely critical, with a high mortality rate without proper treatment.

It’s important to note that even smaller burns can be life-threatening if they affect critical areas such as the face, hands, feet, or genitals.

Factors Affecting Burn Severity Beyond Percentage

While the percentage of burned body surface area is a critical factor, several other elements contribute to the overall severity and prognosis of burn injuries.

Which factors influence burn severity besides TBSA percentage?

• Depth of the burn: First-degree, second-degree, or third-degree burns have different implications for healing and treatment.
• Age of the patient: Very young children and older adults are at higher risk for complications.
• Location of burns: Burns on joints, face, or hands can have more severe functional impacts.
• Presence of inhalation injury: Damage to the respiratory system can significantly worsen outcomes.
• Pre-existing medical conditions: Certain health issues can complicate recovery and increase risks.

Treatment Approaches Based on Burn Percentage

The percentage of body surface area affected by burns directly influences the treatment approach and the level of care required.

How does burn percentage impact treatment decisions?

Treatment strategies vary based on the extent of burns:

• <10% TBSA: Often manageable with outpatient care and local wound management.
• 10-20% TBSA: May require hospitalization for fluid resuscitation and wound care.
• >20% TBSA: Typically necessitates treatment in a specialized burn center with intensive care support.
• >40% TBSA: Requires aggressive fluid resuscitation, potential skin grafting, and multidisciplinary care.

The higher the percentage of burns, the more complex and prolonged the treatment process becomes, often involving multiple surgical interventions and extended rehabilitation.

Fluid Resuscitation and Burn Percentage

One of the most critical aspects of early burn management is fluid resuscitation, which is directly tied to the percentage of body surface area burned.

Why is fluid resuscitation crucial in major burns?

Extensive burns lead to significant fluid loss and potential shock. The Parkland Formula, a widely used method for calculating fluid requirements, is based on the patient’s weight and the percentage of burned TBSA:

Fluid requirement (in mL) = 4 x patient’s weight (kg) x % TBSA burned

This calculated volume is typically administered over the first 24 hours, with half given in the first 8 hours and the remainder over the next 16 hours. Proper fluid management is essential to prevent complications such as organ failure and improve overall outcomes.

Long-term Prognosis and Rehabilitation

The extent of burns significantly influences the long-term prognosis and rehabilitation needs of patients.

How does burn percentage affect long-term recovery?

Larger burn percentages generally correlate with:

• Longer hospital stays and recovery periods
• Increased risk of complications such as infections and scarring
• Greater likelihood of needing multiple surgeries and skin grafts
• More extensive physical and occupational therapy requirements
• Higher potential for long-term functional impairments
• Increased need for psychological support due to trauma and body image issues

Patients with burns covering larger percentages of their body often face a more challenging and prolonged rehabilitation process, requiring a comprehensive, multidisciplinary approach to care.

Advancements in Burn Care and Treatment

While the Rule of Nines remains a valuable tool for initial assessment, advancements in burn care have improved outcomes for patients with extensive burns.

What recent developments have improved burn treatment?

Several innovations have enhanced the management of severe burns:

• Improved skin substitutes and grafting techniques
• Advanced wound dressings that promote healing and reduce infection risk
• More sophisticated fluid resuscitation protocols
• Enhanced pain management strategies
• Early excision and grafting procedures
• Specialized nutrition support tailored for burn patients
• Advances in scar management and reconstructive surgery

These developments have significantly improved survival rates and quality of life outcomes for patients with extensive burns that were once considered unsurvivable.

Prevention and Education: Reducing Burn Injuries

While understanding burn assessment and treatment is crucial, prevention remains the most effective strategy in reducing the impact of severe burn injuries.

How can severe burn injuries be prevented?

Key prevention strategies include:

• Installing and maintaining smoke detectors in homes and workplaces
• Implementing workplace safety protocols in high-risk industries
• Educating children and adults about fire safety and burn prevention
• Ensuring proper storage and handling of flammable materials
• Using protective equipment in hazardous environments
• Implementing building codes that incorporate fire-resistant materials and design
• Promoting awareness about scalding prevention, especially for young children and the elderly

By focusing on prevention and early intervention, the incidence of severe burns can be significantly reduced, saving lives and preventing long-term disabilities.

Understanding the Rule of Nines and the critical percentages in burn assessment is essential for healthcare providers and can be valuable knowledge for the general public. While severe burns remain a significant medical challenge, advancements in treatment and a focus on prevention continue to improve outcomes for burn victims. As research progresses, we can expect further developments in burn care that will enhance survival rates and quality of life for those affected by these traumatic injuries.

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What Percentage of Burn Injuries Are Life-Threatening?

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Published on Apr 8, 2021 at 3:23 pm in Burn Injury.

When a burn injury occurs, recovering from the injury can take a long time. These painful injuries can require weeks or months of professional treatment. In some cases, these injuries can put the person’s life at risk. If the burn is over a certain surface area, it can significantly increase in putting the burn victim’s life in danger. Let’s look into what percentage of burn injuries are life-threatening.

When Are Burn Injuries Potentially Fatal?

According to the Chemical Hazards Emergency Medical Management or CHEMM, burn severity is decided by the percent of total body surface area affected, also referred to as TBSA. When burns are more than 20-25% TBSA, then the person will need IV fluid resuscitation. Once the burns reach 30-40% TBSA, then the injuries could be fatal if the person doesn’t get treatment.

The Rule of Nines for Burn Injuries

When the total percentage of a burn is being determined for adults, the rule of nines can be used to indicate it. It breaks down the percentage for the part of the body that’s burned. CHEMM provides the following values:

• Head and Neck: The head and neck account for 9% of body surface burned.
• Arms (Including Hands): This value is 9% each for body surface burned.
• Legs (Including Feet): The legs and feet are 18% each.
• Anterior Trunk and Posterior Trunk: Both are 18%.
• Genitalia. This accounts for 1%.

It’s important to note that this changes for children because their proportions are different. Their heads account for up to 20%, while the percentage for their legs can be lower than the 18% for adults.

What Additional Factors Can Make Burn Injuries Life-Threatening?

The percentage of the body surface area covered in burns isn’t the only indicator of potentially fatal injuries. Other factors that can affect this include:

• Delay in Treatment. If there’s a delay in treatment, this could mean someone’s condition could worsen while time passes. When there’s a delay in treatment, the person will likely need more fluids.
• Smoke Inhalation. When someone has inhaled smoke, this can double the mortality relative to burn size.
• Age. The older a person gets, the more their mortality for any burn size increases. CHEMM reports that children and young adults can survive larger burns, while those who are elderly are less likely to survive small burns.
• Other Injuries. If an accident resulted in other injuries additional to the burn injuries, the person will require treatment for those injuries as well. If it’s severe trauma, then it’s more likely for their injuries to be life-threatening.

Have You Sustained Burn Injuries?

If you have sustained burn injuries in an accident, it’s likely that someone’s negligent actions are the reason why. You can hold that person accountable for their actions.

When you’re dealing with burn injuries, the care you require may result in extensive medical bills. You may need to stay in the hospital for a prolonged period of time, in addition to undergoing procedures for your treatment. While you’re getting the care you need, you’ll also be away from work. When these bills start to pile up on you and you’re unable to return to work, it may cause financial stress. This is where a burn injury lawyer from Pittman Roberts & Welsh, PLLC can help you.

We’ll investigate how the burn injury occurred. This could have resulted from a motor vehicle accident where the other party was distracted behind the wheel, or an electrical problem in a building that the landowner wasn’t taking care of in a timely manner. When we find out who was responsible, we can hold them accountable for your injuries.

Our lawyers will calculate the extent of your injuries, which includes the cost of care you’ve already had and what you’ll need in the future. Your time away from work will also be calculated. We’ll total what you’ve lost in damages because of the accident and fight for your compensation to cover these losses. We’re here for you.

Seek Representation from Pittman Roberts & Welsh, PLLC

Burn injuries can cause permanent scarring and disabilities. While this is a lot for someone to come to terms with, it doesn’t mean they have to pay for the total costs of the accident all on their own. That’s where our lawyers can help.

If you or a loved one has been burned in an accident, we can help you move forward. Contact us today for a free case evaluation. Our lawyers will seek full and fair compensation on your behalf so you can recover in peace.

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Burn Sickness ➤ Burn Sickness Stages 2023

Burns are common in combat situations . Flamethrowers, blast waves, and the ignition of combustible materials all present a burn hazard on the battlefield.

The causative agent may be thermal, chemical, electrical or radiation related. Each of these factors has specific implications that may require specific types of care

Prevalence of burn injuries on the battlefield.

According to statistics, burns occupy a significant part (5%) of the damage on the battlefield.

• During the Korean War, burns from napalm used by American aircraft amounted to 25%, in Vietnam – 45%, and according to general statistics during the war in Afghanistan – 5% of the total number of sanitary losses (mainly among mechanized departments).

• In the Anglo-Argentine armed conflict of 1982 in the Falkland Islands, the proportion of sanitary losses for burnt victims was 19%, for victims with mechanical burn injuries – up to 30%.

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Patients with burns covering more than 40-50% of the body surface rarely survive in the field, and the most that can be done for them is to provide them with fluid replacement and high doses of painkillers. Under the conditions of sorting the wounded with mass casualties, such wounded will be assigned to category IV, that is, they will receive only supportive treatment.

Degrees of burns.

Burns is damage (destruction of structures) of the skin and tissues of the body resulting from the local action of high temperature, chemicals, electric current or ionizing radiation.

Usually, according to the depth of the lesion, it is customary to distribute burns into 1,2,3, 3B and 4 degrees.

Classification of burns according to the degree depending on the depth of tissue damage;

1. epidermis,
2. dermis,
3. subcutaneous fat layer,
4. muscle,
5. bone;

I degree burns are characterized by damage to the cells of the surface layers of the epidermis, manifested by hyperemia, swelling and pain in the affected area, which subsides after 1-2 days, and after 3-4 days swelling and redness disappear.

In case of a second degree burn , the entire thickness of the epidermis is damaged into the growth zone. Its signs: redness, sharp pain, swelling, blistering with yellowish exudate. The bottom of the wound with such a burn is a bright pink painful basal layer of the epidermis.

Severe pain and burning persist for some time at the site of the burn.

With a favorable course of the burn, by the end of the second week, the damaged skin areas are completely epithelialized without scarring.

Third degree burns are characterized by necrosis of the entire epidermis and superficial layers of the dermis. First, either a dry, light brown eschar (burns from flames, acids) or a whitish-gray wet eschar (exposure to steam, hot water) forms. Sometimes thick-walled vesicles filled with hemorrhagic exudate are formed. Redness and swelling around the burned area. There is sensitivity.

With IIIb degree burns , the skin is affected to the full thickness, and subcutaneous fat is often also affected. Dead tissue forms a scab. Characterized by a significant loss of sensitivity in the area of ​​the scab. At the bottom of the scab, dilated blood vessels are visible, their blood does not circulate. Outside the lesion, there is a large edema. Epithelialization in such cases is possible only along the edges of the wound, it occurs very slowly. Only a small wound can take on its own.

IV degree burns (charring) accompanied by death of the skin and deep tissues (muscles, tendons, bones). The scab is thick, dense, sometimes with signs of charring. At the site of such burns, deep wounds are formed that do not tend to self-heal, epithelialize or scar.

Combined degrees of burns are more common

The depth of the burn is determined by local clinical signs: hyperemia, blistering, scab formation

In addition to the extent of the burn, the determination of the extent of the spread – the total area of ​​the burn – is of great importance.

Determining the area of ​​burns.

Two basic methods can be used to determine the area of ​​burns:

– When burns are small or located in different parts of the body and in a chaotic pattern, the “rule of the palm” can be used. It is known that the palm together with the fingers makes up about 1% of the body surface. How many palms of the wounded fit over the burn surface, such is the area of ​​​​burns.

For extensive burns, the rule of nines is usually used.

Burn disease.

With superficial burns of more than 20-30% and deep burns of more than 10% of the body surface (5% in children), pronounced general disorders of the whole organism develop – burn disease.

The development of this condition is affected by the depth and area of ​​the burn. Unfavorable factors include concomitant diseases, childhood and old age of the affected person, concomitant burns of the VDS, eyes, genitals, etc.

The depth of the burn determines the duration of its healing, therefore, the duration of the burn disease, the likelihood of secondary infection, the possibility of self-healing. The area of ​​the burn is the main criterion for determining the prognosis of the burn disease.

Prognosis and outcome of burn disease.

The prognosis and outcome of burn disease, depending on the prognostic index, can be determined by the “hundred rule” and the Franco index.

Hundred rule.

This prognostic index is determined by the sum of the indicators of age and area of ​​the burn.

Forecast on the Franco index.

When calculating which it is assumed that 1% burn is equivalent to: for burns I, II st. = 1 unit, burns IIIa = 2 units and burns IIIB, IV degree = 3 units. In case of a burn of the upper respiratory tract, another 20 units should be added to the resulting Franco index.

Upper respiratory tract burn.

The course of burn disease makes it difficult to burn the upper respiratory tract.

Flame, hot air and combustion products during fires in confined spaces (dugouts), military equipment and in the centers of the use of combat fire mixtures often affect the respiratory organs. When inhaling hot air, after a few hours, there may be a pronounced swelling of the oral mucosa and subglottic space with the development of stenotic asphyxia.

Upper respiratory tract burn may be indicated by:

• hoarseness,

• shortness of breath,

• cough,

• complaints of sore throat,

• burns of the mucous membrane of the lips, tongue, throat , nose,

• burnt hair in the area of ​​the nasolabial triangle.

It is also important to remember that often burns in combination with other injuries (mine-explosive injury) are not the main factor determining the critical condition of a fighter and paying all attention to burns; you can skip critical bleeding.

Periods of burn disease.

There are four periods of burn disease :

– burn shock;

– acute burn toxemia;

– septic period;

– recovery period (convalescence)

Burn shock – a clinical form of acute disorders of vital functions at the tissue, organ and system levels, life-threatening and requiring urgent measures. The pathophysiological basis of shock is hypovolemia due to massive exudative plasma loss due to burn surfaces.

The consciousness of those affected with burns (without combined injuries.) Is preserved. They can move independently even with fairly large burn surfaces.

Mental status is characterized by different options: from pronounced psychomotor agitation to complete apathy. Complaints of pain, thirst and chills, sometimes nausea are typical.

In severe lesions, vomiting may occur. The skin is pale, the body temperature is subnormal. Characteristic signs of burn shock are: tachycardia, decreased blood pressure and the amount of hourly diuresis (from oliguria to anuria).

The manifestation of these disorders depends on the severity of the lesion. Plasma loss is up to 20-30% of the bcc.

When skin burns are combined with burns of the respiratory tract , poisoning with toxic combustion products and general overheating of the body (multifactorial lesions), impaired consciousness is observed. This is usually due to carbon monoxide poisoning, and sometimes such people die without regaining consciousness.

Multifactorial lesions are accompanied by arterial hypotension and severe respiratory failure. Lack of consciousness can also be observed in those affected with combined explosive injuries as a result of severe hydrodynamic impact.

Acute burn toxemia – the second period of burn disease. Burn toxemia is the toxic phase of the course of the disease. The decay products of tissues enter the blood, leading to endogenous intoxication. In addition, the waste products of a rapidly developing infection on burn wounds are involved in poisoning. Acute burn toxemia lasts about 2 weeks.

Septic period – the third period of burn disease. During it, not only toxins, but also pathogenic microorganisms enter the bloodstream. Burn sepsis develops. Microorganisms circulating in the blood can settle in any organ, causing purulent metastases in the form of phlegmon, abscesses, pleurisy, meningitis. This period of the disease is often aggravated by hepatitis, pericarditis, nephritis, which significantly worsens the prognosis for recovery.

Recovery – the fourth period of burn disease. Recovery begins from the moment of complete independent or operative renewal of the skin. This period continues indefinitely, anemia persists for a long time. The end of the burn disease occurs 1.5-2.0 months after the restoration of the skin.

General principles of care for burns or when a person is on fire.

1. Stop combustion.

2. Remove all jewelry (metal, etc.) from the body and hands of the victim. After all, when the swelling increases, they give the risk of injury.

3. Assess the victim’s airway and secure the airway.

4. When assessing the airway, look for signs of inhalation injury, which often causes respiratory distress, which should be suspected if present:

Premedical measures for thermal burns .

• Cover the entire burn area as soon as possible with clean, dry (!) sterile wipes. This will help prevent or at least reduce the pollution of the affected skin and eliminate the influence of air currents, and then reduce pain.

• Do not break blisters (!) and apply antiseptics (!) to affected skin.

• Do not apply cold compresses or pour cold water on the victim.

• The skin should be cooled for 10-15 minutes, but with solutions at room temperature (!).

• Great care must be taken when dousing with water, it may be too cold for the victim and lead to general hypothermia.

• Do not apply tight bandages to wounds. Excessive pressure from tight bandages exacerbates soft tissue swelling and may be a factor in the development of muscle compression syndrome/syndrome.

• If the victim has a burn area < 20%, take care to control the body temperature. (!). The person should be covered with dry, clean napkins and tightly covered.

First aid for thermal burns on the battlefield.

The higher the temperature of the traumatic agent and the longer the contact with it, the wider and deeper the thermal damage. Based on this provision, the first and most important thing in helping a burn victim is is the elimination of the traumatic factor.

It should be remembered that even in victims with burns, the following algorithm should be used.

• Extinguish flame or remove injurious agent.

• Move the casualty to the safe area.

• Stop critical bleeding and ensure airway patency;

• Cool affected area . To do this, you need to use a large amount of running water, or cooling service anti-burn dressings.

• Remove clothing, ammunition , and any pulling objects. As a result of the increase in edema, the ring or bracelet can compress the tissues and guard the fingers or limbs.

• Cover the patient with a clean dry sheet or special blanket to prevent contamination during transport and loss of temperature.

• Provide intravenous or intraosseous access . If possible, do this through unburned skin, if necessary through burned skin, and securely fasten (sew) the IV catheters.

• Start fluid therapy according to protocol .

• Provide adequate pain relief.

The best way to calculate the amount of infusion required during the evacuation phase is “rule of ten” .

Initial hourly infusion rate = TIR (total burn area) burn x 10 ml/hour. (when weighing more than 80 kg + 100 ml for every 10 kg for over 80 kg additionally)

For example: for a 100 kg fighter -30% OPT burn. Initial hourly rate of infusion of lactated Ringer’s solution = 30×10+100+100=500ml/h

Infusion therapy should be controlled by diuresis, so the installation of a urinary catheter is mandatory. It is necessary to achieve 30-50 ml / hour by raising or lowering the volume of infusion by 25%.

With regard to burn injury, golden hour rule is important. In the case of the start of antishock therapy 2 hours after the injury, the lethality increases by 2 times.

Restoration of BCC (volume of circulating blood) mainly consists in the elimination of hypovolemia. The calculation of intravenous infusions during the period of burn shock is calculated according to the formula for a certain rational intensive care scheme for burn patients:

• V = M x S x 2 where:

• V — amount (volume) of fluid injected during 1 day of burn shock in “ml”;

• S – the total area of ​​burns in “%”, but not more than 50%;

• M is the patient’s body weight in “kg”.

In this case, 2/3 of the volume must be transfused already in the first 8 hours after the injury.

This means that if fluid therapy is started 2 hours after the injury, then half of the calculated amount of fluid should be given in 6 hours.

Crystalloids should be 2/3 – 1/2 of the indicated volume, and colloid preparations, respectively, 1/3 – 1/2, depending on the severity of shock. In addition, it is necessary to introduce about 2 liters of 5% glucose solution.

On the 2nd day of shock , the volume of intravenous infusions is reduced by 2 times, on the 3rd day – to 1/3 of the initially established volume.

Glucosuria is common after severe burns and may lead to hypovolemia due to osmotic diuresis. Monitor urinary glucose levels and treat hyperglycemia with IV insulin as needed.

In case of damage to the respiratory tract, 150-200 mg of hydrocortisone or 60-90 mg of prednisolone, aminophylline, antihistamines are administered intramuscularly to eliminate spasm of the bronchi and reduce swelling of the mucous membrane of the larynx.

10-12 drops of vaseline oil are instilled into the nasal passages. Increasing asphyxia due to edema of the subglottic space of the larynx is an indication for intubation or, if it is impossible, for tracheotomy (conicotomy).

Indications for early intubation in burn victims

1. Signs of upper airway obstruction:

• hoarseness,

• stridor – noisy, harsh , coarse breathing,

• use of additional respiratory muscles in the process of breathing;

2. Significant 2-3 degree burn area – total burn area > 40%;

3. Large deep burns of the face;

4. Burn of the oral mucosa;

5. Signs of respiratory failure:

• impaired sputum production;

• respiratory fatigue;

• Decreased level of consciousness.

In case of poisoning with toxic combustion products 40 ml of 40% glucose solution is injected intravenously together with 5-10 ml of 5% ascorbic acid solution, oxygen is inhaled.

With pulmonary edema, the affected person is given a half-sitting position. Oxygen passed through alcohol is supplied. Cardiac agents, calcium chloride solution, prednisolone are administered intravenously.

Battlefield pain relief for burns.

Usually strong painkillers of the opioid series (nalbuphine, butarphanol, morphine, fentanyl) will be used on the battlefield.

But for more correct management of the burn wounded, it is necessary to clearly divide the wounded into categories of pain syndrome.

For minor pain and (small area and depth of injury):

Moderate pain when the wounded is conscious

Severe pain.

• the wounded is in a state of burn shock, has respiratory disorders or is at risk of their occurrence.

• ketamine 50 mg IM or 20 mg slow IV. Repeat the dose after 30 minutes for intramuscular administration and after 20 minutes for intravenous administration.

References.

1. Edited by Doctor of Medical Sciences, Professor B. V. Gaidar. Combat burn injuries. “Publishing house” SpetsLit “”, 2019.– 247 p.

2. Vikhriev, B.S. Burns: a guide for physicians. – 2nd ed., revised. and additional / B.S. Vikhriev, V.M. Burmistrov. – L .: Medicine, 1986. – 272 p.

3. Burns. Information on the WHO website. https://www.who.int/ru/news-room/fact-sheets/detail/burns

4. Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. Military Medicine , Volume 180, Issue 6, June 2015, Pages 601–603. https://doi.org/10.7205/MILMED-D-15-00039

5. Training standard І-ST-3 (grade 2) Military service training in tactical medicine. Ministry of Defense of Ukraine. Kiev, 2015.-148 pages.

6. Losses of the Armed Forces of the USSR in wars, hostilities and military conflicts: stat. study. – M., 1993. – P. 125

Author:
Andrey Alexandrovich Zhernov
Plastic surgeon

Examples of operations performed

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Burns in children . What are burns in children?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Burns in children are a type of injury that occurs when tissues are damaged by physical and chemical factors (thermal energy, electricity, ionizing radiation, chemicals, etc.). The clinic of burns in children depends on the influencing factor, localization, depth, extent of tissue damage and includes local (pain, hyperemia, swelling, blistering) and general manifestations (shock). The main tasks of diagnosing burns in children is to determine the nature of the burn injury, the depth and area of ​​damage, for which infrared thermography and measuring techniques are used. The treatment of burns in children requires anti-shock therapy, the toilet of the burn surface, and the application of bandages.

• Causes and classification of burns in children
• Symptoms of thermal burns in children
• Burn disease in children
• Diagnosis of burns in children
• Treatment of burns in children
• Prognosis and prevention
• Prices for treatment

General

Burns in children – thermal, chemical, electrical, radiation damage to the skin, mucous membranes and underlying tissues. Among the total number of people with burn injuries, children make up 20-30%; while almost half of them are children under 3 years old. The mortality rate due to burns among children reaches 2-4%, in addition, about 35% of children annually remain disabled. The high prevalence of burns in the pediatric population, the tendency to develop burn disease and severe post-burn disorders make the prevention and treatment of burn injuries in children a priority in pediatric surgery and traumatology.

Features of children’s anatomy and physiology are such that the skin of children is thinner and more delicate than that of adults, has a developed circulatory and lymphatic network and, therefore, has a greater thermal conductivity. This feature contributes to the fact that exposure to a chemical or physical agent, which in an adult causes only superficial skin damage, leads to a deep burn in a child. The helplessness of children during trauma causes a longer exposure of the damaging factor, which also contributes to the depth of tissue damage.

In addition, the imperfection of compensatory and regulatory mechanisms in children can lead to the development of a burn disease even with a lesion of 5-10%, and in infancy or with a deep burn – only 3-5% of the body surface. Thus, any burns in children are more severe than in adults, since in childhood disorders of blood circulation, metabolism, and functioning of vital organs and systems occur faster.

Burns in children

Causes and classification of burns in children

Depending on the damaging agent, burns in children are divided into thermal, chemical, electrical and radiation.

The occurrence of thermal burns in children in most cases is due to skin contact with boiling water, steam, open fire, molten fat, hot metal objects. Young children are most often scalded with hot liquids (water, milk, tea, soup). Often, burns in children occur due to the negligence of parents when they immerse the child in an overly hot bath or leave heating pads to warm for a long time.

At school age, various pyrotechnic amusements, kindling fires, “experiments” with combustible mixtures, etc., are especially dangerous for children. Such pranks with fire, as a rule, end in failure, as they often lead to extensive thermal burns. Thermal burns in children usually affect the integumentary tissues, but burns to the eyes, respiratory tract, and digestive tract can also occur.

Chemical burns are less common and usually occur when household chemicals are not stored properly and out of reach of children. Young children may inadvertently spill acid or alkali on themselves, spill a powdery substance, spray an aerosol with a dangerous chemical, or mistakenly drink a caustic liquid. When aggressive chemicals are taken orally, a burn of the esophagus in children is combined with a burn of the oral cavity and respiratory tract.

The causes of electrical burns in young children are the malfunction of electrical appliances, their improper storage and operation, the presence in the house of electrical outlets accessible to the child, sticking out bare wires. Older children usually get electrical burns playing near high-voltage lines, riding on the roofs of electric trains, hiding in transformer boxes.

Radiation burns in children are most often associated with direct sunlight on the skin for a long period of time. In general, thermal burns in children account for about 65-80% of cases, electrical burns – 11%, and other types – 10-15%.

Within the framework of this topic, the features of thermal burns in children will be considered.

Symptoms of thermal burns in children

Depending on the depth of tissue damage, thermal burns in children can be of four degrees.

• A first-degree burn (epidermal burn) is characterized by superficial damage to the skin due to short-term or low-intensity exposure. Children have local pain, hyperemia, swelling and burning sensation. At the site of the burn, slight peeling of the epidermis may be observed; superficial burns in children heal in 3-5 days on their own completely without a trace or with the formation of a small pigmentation.
• A second-degree burn (superficial dermal burn) proceeds with complete necrosis of the epidermis, under which a clear liquid accumulates, forming blisters. Swelling, pain and redness of the skin are more pronounced. After 2-3 days, the contents of the blisters become thick and jelly-like. Healing and restoration of the skin lasts about 2 weeks. With second-degree burns in children, the risk of infection of the burn wound increases.
• A III degree burn (deep dermal burn) can be of two types: IIIa degree – with preservation of the basal layer of the skin and IIIb degree – with necrosis of the entire thickness of the skin and partially the subcutaneous layer. III degree burns in children occur with the formation of dry or wet necrosis. Dry necrosis is a dense brown or black eschar, insensitive to touch. Wet necrosis has the appearance of a yellowish-gray scab with a sharp swelling of the tissue in the burn area. After 7-14 days, the scab rejection begins, and the full healing process is delayed for 1-2 months. Epithelialization of the skin occurs due to the preserved germ layer. IIIb degree burns in children heal with the formation of rough, inelastic scars.
• A IV degree burn (subfascial burn) is characterized by damage and exposure of tissues that lie deeper than the aponeurosis (muscles, tendons, blood vessels, nerves, bones and cartilage). Visually, with IV degree burns, a dark brown or black scab is visible, through the cracks of which the affected deep tissues look through. With such lesions, the burn process in children (cleansing the wound, the formation of granulations) proceeds slowly, often local, primarily purulent, complications develop – abscesses, phlegmon, arthritis. IV degree burns are accompanied by a rapid increase in secondary changes in tissues, progressive thrombosis, damage to internal organs and may result in the death of a child.

Burns of I, II and IIIa degrees in children are regarded as superficial, burns of IIIb and IV degrees – as deep. In pediatrics, as a rule, there is a combination of burns of various degrees.

Burn disease in children

In addition to local phenomena, burns in children often develop severe systemic reactions, which are characterized as a burn disease. During the burn disease, 4 periods are distinguished – burn shock, acute burn toxemia, burn septicopyemia and recovery.

Burn shock lasts 1-3 days. In the first hours after receiving a burn, children are excited, react sharply to pain, scream (erectile phase of shock). Chills, increased blood pressure, increased respiration, tachycardia are noted. In severe shock, body temperature may drop. 2–6 hours after the burn, children begin the torpid phase of shock: the child is adynamic, lethargic, does not complain and practically does not react to the environment. The torpid phase is characterized by arterial hypotension, frequent thready pulse, pronounced pallor of the skin, intense thirst, oliguria or anuria, in severe cases, vomiting of “coffee grounds” due to gastrointestinal bleeding. Burn shock I degree develops in children with a superficial lesion of 15-20% of the body area; II degree – with burns of 20-60% of the body surface; III degree – more than 60% of the body area. Rapidly progressing burn shock leads to the death of the child on the first day.

With further development, the period of burn shock is replaced by a phase of burn toxemia, the manifestations of which are due to the entry of decay products from damaged tissues into the general bloodstream. At this time, children who have received burns may have fever, delirium, convulsions, tachycardia, arrhythmia; in some cases, a coma. Against the background of toxemia, toxic myocarditis, hepatitis, acute erosive-ulcerative gastritis, secondary anemia, nephritis, and sometimes acute renal failure may develop. The duration of the period of burn toxemia is up to 10 days, after which, with deep or extensive burns in children, the phase of septicotoxemia begins.

Burn septicotoxemia is characterized by the addition of a secondary infection and suppuration of the burn wound. The general condition of children with burns remains severe; possible complications in the form of otitis, ulcerative stomatitis, lymphadenitis, pneumonia, bacteremia, burn sepsis and burn exhaustion. In the recovery phase, the processes of restoring all vital functions and scarring of the burn surface predominate.

Diagnosis of burns in children

Diagnosis of burns in children is made on the basis of anamnesis and visual examination. To determine the area of ​​the burn in young children, the Lund-Browder tables are used, which take into account the change in the area of ​​\u200b\u200bdifferent parts of the body with age. In children over 15 years old, the “nine” rule is used, and with limited burns, the palm rule.

Children with burns need to examine hemoglobin and hematocrit of the blood, a general urine test, a biochemical blood test (electrolytes, total protein, albumin, urea, creatinine, etc.). In case of suppuration of a burn wound, a sampling and bacteriological seeding of the wound discharge for microflora is performed.

Mandatory (especially with electrical trauma in children) is performed and repeated in the dynamics of the ECG. In the case of a chemical burn of the esophagus in children, esophagoscopy (EGD) is necessary. In case of damage to the respiratory tract, bronchoscopy, X-ray of the lungs is required.

Treatment of burns in children

First aid for a burn in children involves stopping the action of the thermal agent, releasing the affected area of ​​the skin from clothing and cooling it (by washing with water, an ice pack). To prevent a state of shock at the prehospital stage, the child can be given analgesics.

In a medical institution, the primary treatment of the burn surface, the removal of foreign bodies and fragments of the epidermis is carried out. Anti-shock measures for burns in children include adequate anesthesia and sedation, infusion therapy, antibiotic therapy, and oxygen therapy. Children who have not received appropriate preventive vaccinations are given emergency immunization against tetanus.

Local treatment of burns in children is carried out in a closed, open, mixed or surgical way. With the closed method, the burn wound is closed with an aseptic bandage. For dressings, antiseptics (chlorhexidine, furatsilin), film-forming aerosols, ointments (ofloxacin + lidocaine, chloramphenicol + methyluracil, etc.), enzyme preparations (chymotrypsin, streptokinase) are used. An open method for the treatment of burns in children involves the rejection of dressings and the management of the patient under strict aseptic conditions. It is possible to switch from a closed method to an open one to speed up the recovery process, or from an open to a closed one – with the development of an infection.

In the rehabilitation period, children with burns are prescribed exercise therapy, physiotherapy (UVR, laser therapy, magneto-laser therapy, ultrasound), hyperbaric oxygenation.

With deep, but small burns in children, excision of necrotic tissues is performed, followed by autodermoplasty. In the case of scarring, the scar is excised with a cosmetic suture. The method of treating burns in children is determined by the combustiologist or pediatric traumatologist.

Prognosis and prevention

With burns of I-II degree, the outcome is almost always favorable. With extensive and deep burns in children, the prognosis is always serious. For young children, burns of more than 30% of the body surface are critical; for older children – 40% of the body area or more. The cause of death of children in most cases is a secondary infection.

Prevention of burns in children, first of all, requires increased responsibility on the part of adults. A child should not be allowed to come into contact with fire, hot liquids, chemicals, electricity, etc. To do this, in a house where there are small children, safety measures must be provided (storage of household chemicals in an inaccessible place, special plugs in sockets, hidden electrical wiring, etc.