THERMAL INJURY

Course Outline

 INTRODUCTION
 FROSTBITE
 BURNS
 DEPTH OF BURN Therapeutic Management
 EMERGENCY MANAGEMENT OF BURNS
 THERAPY FOR BURNS  Always warm frostbitten areas gradually
 TOPICAL THERAPY  Administration of a vasodilator and use of hyperbaric
 ESCHAROTOMY oxygen may help reduce the effect on body cells
 DEBRIDEMENT
 GRAFTING BURNS
 Injuries to body tissue caused by excessive heat
INTRODUCTION (40°C)
 Commonly occur in children of all ages after infancy
Thermal injury include either cold (frost-bite) or by excessive (1 to 5 years old)
heat (burns)  Tend to be more serious in children than in adults,
because the same size burn covers a larger surface
FROSTBITE of a child’s body
 ∙ Tissue injury caused by freezing cold Assessment
 ∙ Cold exposure leads to peripheral vasoconstriction
cutting off the oxygen supply to surrounding cells  Questions upon arriving at the hospital:
 ∙ In children nose, fingers and toes are commonly a) Where is the burn?
affected b) What is its extent and depth?
 ∙ Cell at the site can be so injured that they die  Face and throat burns are particularly hazardous
because there may be accompanying but unseen
Assessment burns in the respiratory tract. (can cause edema)
 Hand burns- if fingers and thumb are not positioned
 Appears white or erythematous
properly during healing, adhesions will inhibit full
 Edema is present
range of motion in the future
 Feels numb
 Feet and genitalia- carry high risk for secondary
 Occurs in children who have been skiing,
infection, edema in the genital may prevent a child
snowmobiling, snowboarding for long periods
from voiding.
 Can also occur from sucking on popsicles and from
inhalant abuse Classification of Burn
Degrees of Frostbite

Determination of Extent of Burns in Children

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DEPTH OF BURN  Child usually is asked to return in 24 hours to assess
that pain control is adequate and there are no signs
and symptoms of infection
 Broken blisters may be debrided (cut away) to
remove possible necrotic tissue as the burn heals

Severe Burns

 Critically injured and needs swift, sure care

 IV fluid therapy
 Systemic antibiotic therapy
 Pain management
 Physical therapy

Electrical Burns of the Mouth

 If the child puts the prongs of a plugged-in extension

cord into the mouth or chews on an electric cord
the mouth will be burned severely
 If blood vessels were burned, active bleeding will be
present
 Immediate treatment for electrical burns of the
mouth is to unplug the electric cord and control
bleeding
 Pressure applied to the site with gauze is usually
effective
 Children are admitted to a hospital for at least 24
hours in an observation unit because edema in the
mouth can lead to airway obstruction
 Supply pain relief as long as necessary
 Clean wound about four times a day with an
antiseptic solution, such as half strength hydrogen
peroxide, or as otherwise ordered to reduce the
possibility of infection
 May be able to drink fluid from a cup best
 Bland fluids, such as artificial fruit drinks
 Electrical burns of the mouth turn black as local
tissue necrosis begins
 Heal with white, fibrous scar tissue, possibly causing
a deformity of the lip and cheeks with healing
 Need to have a follow up care by a plastic surgeon to
restore their lip contour
 Let the parents be knowledgeable about the
importance of not leaving “live” electrical cords
where young children can reach them

THERAPY FOR BURNS

Second and third degree burns may receive open treatment,
leaving the burned area exposed to the air, or closed
EMERGENCY MANAGEMENT OF BURNS treatment, in which the burned area is covered with an
Minor Burns antibacterial cream and many layers of gauze.

 First degree and partial thickness burns

 Simplest type of burns
 Involves pain and death of skin cells
 Immediately apply ice to cool the skin and prevent
further burning ∙ Application of an analgesic,
antibiotic ointment and a gauze bandage to prevent
infection
 Follow up visit in 2 days to have the area inspected Note:
for a secondary infection and to have the dressing
changed a) As a rule, burn dressing are applied loosely for the first 24
 Caution parents to keep the dressing dry (no hours to prevent interference with circulation as edema
swimming or getting the area wet while bathing for forms
1 week)
b) Be certain not to allow two burned body surfaces, such as
Moderate Burns the sides of fingers or the back of the ears and the scalp, to
touch (as healing takes place, a webbing will form between
 Second degree burns these surfaces)
 May have blisters- do not rupture, it may cause
infection c) Do not use adhesive tapes to anchor dressings to the skin;
 Cover with a topical antibiotic such as silver it is painful to remove and can leave excoriated areas (it will
sulfadiazine and a bulky dressing to prevent damage provide additional entry for infection)
to the denuded skin

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TOPICAL THERAPY

SILVER SULFADIAZINE
 drug of choice for burn therapy to limit infection at
the burn sit for children
 applied as a paste to the burn, and the area is then
covered with a few layers of mesh gauze
 effective agent against both gram-negative and
gram-positive organisms and even against
secondary infectious agents
 it is soothing when applied and tends to keep the
burn eschar soft, making debridement easier

POVIDONE IODINE
 May also be used to inhibit bacterial and fungal
growth
 Iodine stings as it is applied and stains skin and
clothing brown
 Dressing must be kept continually wet to keep them
from clinging to and disrupting the healing tissue
NITROFURAZONE CREAM
 If Pseudomonas is detected in culture
Note: If a topical cream is not effective against invading
organisms in the deeper tissue under the eschar, daily
injections of specific antibiotics into the deeper layer of
the burned area may be necessary.
Note:
 The advantage of grafting is that it reduces fluid and
electrolyte loss, pain and the chance of infection.
 The graft is covered by a bulky dressing so that the
growth of the newly adhering cells will not be
disrupted; this should not be removed or changed.
 The donor site on the child’s body is also covered by
a gauze dressing (often the anterior thigh or
buttocks)
 Observe for fluid drainage and odor
 Observe the child to determine whether there is pain
at either site, which might indicate infection
 Monitor the child’s temperature every 4 hours

ESCHAROTOMY
Cut into the eschar (some bleeding will occur after, pack the
wound and apply pressure usually relieves bleeding)

DEBRIDEMENT
 Removal of necrotic tissue from a burned area
 Reduces the possibility of infection, it reduces the
amount of dead tissue present on which
microorganisms could thrive
 Children usually have 20 minutes of hydrotherapy
before debridement to soften and loosen eschar,
which then can be gently removed with forceps and
scissors.
 It is painful and some bleeding occur, premedication
is given to the child as prescribed and help the child
use a distraction technique during the procedure to
reduce the level of pain
 Praise any degree of cooperation
 Plan an enjoyable activity afterward to aid in pain
relief and also help re-establish some sense of
control over the situation
 If eschar tissue is debrided, granulation tissue forms
underneath (when full bed of granulation tissue is
present, the area is ready for skin grafting)

GRAFTING
a) Homografting (allografting) - placement of skin (sterilized
and frozen) from cadavers or a donor on the cleaned burn
site. (Graft does not grow but provide a protective covering
for the area)

b) Heterografts (xenografts) - from other sources, such as

porcine (pig) skin

c) Autografting - process in which a layer of skin of both

epidermis and a part of the dermis is removed from a distal,
unburned portion of the child’s body and placed at the
prepared burn site

d) Mesh Grafts - a strip of partial-thickness skin that is slit at

intervals so that it can be stretched to cover a larger area

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