SOUTHERN LUZON STATE UNIVERSITY

College of Allied Medicine

Lucban, Quezon

Pediatric Burn
Scenario
(Final Term)

Jenivelle C. Velasco
BSN 2C

Submitted to:
Mrs. Rosalinda A. Abuy

June, 2023

1|P e diatric Worksheet: Final

 SOUTHERN LUZON STATE UNIVERSITY
College of Allied Medicine
Lucban, Quezon

PEDIATRIC BURN SCENARIO

A 9-year-old boy weighing 48 kgs. Sustained a burn today while playing with matches in the garage. Unknown
accelerants and his pants caught on fire, which he attempted to put out using his hands. He sustained burns on both
lower extremities. The burns are circumferential on the right lower extremity extending from the ankle to the mid-
thigh and anteriorly on the left thigh, both have partial thickness burns He also has partial thickness burns to both
hands and palmar surfaces.

1. Describe components of the initial assessment for this patient.

> The initial assessment for this patient should start with airway patency. Assess breathing, central and peripheral
circulation, and cardiac status; stabilize any disability, deficit, or gross deformity; and remove clothing to assess the
extent of burns and concurrent injuries.

Airway

Airway assessment includes visualizing the upper airway to look for obstructions, edema, or evidence of burn (soot;
singed nasal hairs, eyebrows, facial hairs; raspy voice; cough). Evaluate for signs of inhalation injury; pre-emptive
intubation may be required if suspected or high-risk. Remember to protect the cervical spine until clinically cleared.
Auscultate breath sounds and inspect and palpate the patient’s chest wall.

Vital signs

Monitoring vital signs and the color of unburned skin can help assess the patient’s circulatory and cardiac status.
Carefully check pulses in any extremity with circumferential burns. These burns can act as tourniquets as burn-
associated edema begins, leading to compartment syndrome. Heart rate (HR) in most burn patients will be elevated to
100 to 120 beats per minute (bpm) because of increased circulating catecholamines and hypermetabolism; HR higher
than that may indicate hypovolemia from trauma, inadequate oxygenation, or uncontrolled pain and anxiety. Blood
pressure and other vital signs in the early stages of burn resuscitation should be the same as the patient’s baseline.
Arrhythmias may be seen in electrical burn injuries, electrolyte imbalances, or underlying cardiac abnormalities.
Begin interventions as ordered to avoid complications.

Neurologic assessment

Determine if the patient is alert, responsive to verbal and pain stimuli, or unconscious and use the Glasgow Coma
Scale to trend the patient’s neurologic status.

Skin exposure

To prevent increased depth of injury, remove any causative burn agent from the skin and immediately flush the
affected area with tepid water. However, use caution to pre-vent a rapid drop in body temperature and subsequent
ventricular fibrillation or asystole. Don’t use ice to cool the area; it can further damage the skin or cause hypothermia.
Remove all of the patient’s clothing, jewelry, shoes, diapers, and contact lenses to stop the burning process and
prevent the items from becoming tourniquets when edema develops. To preserve core body temperature, cover the
patient and the burn wounds with clean sheets or blankets, use warmed fluids, and maintain a warm environment.

2. Calculate % body surface area burned using the diagram (lecture page).

2|P e diatric Worksheet: Final

 SOUTHERN LUZON STATE UNIVERSITY
College of Allied Medicine
Lucban, Quezon

> Using the Lund & Browder Method, the percentage of palmar surface
(partial thickness burn) is 1 ½, since both palms were affected, then it is 3%.
Calculating the patient’s remaining burns on his right lower extremity
extending from the ankle to the mid-thigh and anteriorly on the left thigh, the
lower extremities from the thigh to the ankle are counted as 7.5% since the
affected area is only the right lower extremity and the anterior left thigh that
will be 7.5%. Both the palmar and anterior thigh burns account for 18%.

3. Calculate the needed fluid replacement for 24 hrs using the Parkland
Fig 1: 2nd Degree Burn from Hand & Wrist Institute
formula.
Formula: 3-4ml x Weight (kg) x TBSA
Fluid replacement: 4 x 48 x 18 = 3,456 ml
= 1,728mL (3,456 x 50%) fluid requirement for 1st 8hrs from the time of burn
= 864mL (1,728 x 50%) fluid requirement for 2nd 8 hours from the time of burn
= 864mL (1,728 x 50%) fluid requirement for 2nd 8 hours from the time of burn

4. When do you expect maximal swelling to appear for this case?

> The maximum swelling occurs shortly after the injury. It usually fades after 8-12 hours for minor burns and 12-24
hours for severe burns. In this case, the patient has about 18% of burn wounds with partial thickness burns on both his
palmar surface and lower extremities, he is very edematous, and the wound usually heals in 14-21 days.

5. What critical piece of information about the patient’s burn will likely be affected with maximal swelling and
will need close observation/evaluation?
> How the patient sustained this burn would be the most important information; In this case, it was said that the
patient got it while playing matches in their garage. When an unknown accelerant caught on his pants and started a
fire, he tried to put it out with his hands, but he burned his palms, thighs, and legs as well. At the point when he
arrived at the hospital, it was determined that px had partial thickness burns on his palms and lower extremities,
which we all know will cause the most swelling because this type of burn is very edematous. As the px suffered
partial thickness burns to his palm and lower extremities, he needs to be closely watched because aside from the
blister formation and extreme swelling, it is extremely painful because nerve endings for pain are exposed.

6. What should his hourly urine output be?

> The recommended urine output for a pediatric patient weighing 20 kg or higher with IV fluid resuscitation is
1ml/kg/hr. In his case, his hourly urine output should be 1ml/kg/hr.

7. Six hours post burn his urine output is 3cc/kg/hr for 2 hours. What is the next step in fluid management of
this child and why?
> His urine output was greater than the desired urine output 6 hours after the burn. The next step in management
would be to contact the provider and request that the fluids be reduced. Although it is well understood that fluid is
lost from the circulation into burned tissue due to a moderate increase in capillary permeability to fluid and
macromolecules and a modest increase in hydrostatic pressure inside the perfusing micro-vessels. Because the
patient's urine output is higher, reducing fluids will prevent fluid overload, which could lead to pulmonary edema.

3|P e diatric Worksheet: Final

 SOUTHERN LUZON STATE UNIVERSITY
College of Allied Medicine
Lucban, Quezon

4|P e diatric Worksheet: Final