Burns in children

Burns in children are most likely to arise from exposure to hot liquids, flames, hot items. Clinical manifestations depend on the area of the burn, its extent, the age of the child and shall be derived from the General and local symptoms. In children there are the same degree burns, as adults, but at the same temperature influences the skin of children damaged stronger. During the first visit, it is often difficult to determine precisely the extent of the burn; in children is more common combination burns of varying degrees. Burns with extensive lesions develop shock, and in children, it may occur already at a burn 5-8% of the body surface, and in infancy even 3%. It is therefore important to determine the area of the burn by the scheme (Fig. 3) and table.


Table to calculate the area of the burn (percentage of total body surface) Fig. 3. A scheme for determining the size of the burn in children under 1 year (in percentage of total body surface).

Forecast with extensive burns always serious and especially unfavorable in the defeat of 50% of the body surface and more. The principles of first aid for burns in children are the same as in adults; for pain children entering promedol the rate of 0.1 ml of 1% solution for 1 year. Outpatient valid treatment of burns of I - II degree, on the area not exceeding 2% in infants and 4% in older children. To reduce pain uses cool gadgets, then burned surface irrigated with 70% alcohol and place dry sterile dressing; bubbles are not removed. Infected burns are treated bands with Vishnevsky ointment. When the more common or more deep burns children need to be hospitalized. Both common and local treatment of burns among children has some peculiarities in comparison with adults. Treatment starts with measures to combat shock. Blood transfusions - from 50 to 250 ml, depending on age (per 50 ml of blood administered 1 ml of 10% solution of chloride calcium). Blood transfusion appropriate and prevention of shock.
Of great importance in the treatment of shock has infusion therapy. Intravenously administered: poliglyukin, 10% glucose with insulin, the solution Ringera, isotonic solution of sodium chloride, glucose-procaine mixture. The number of input per day of liquid should be 10% of body weight of the child. Infusion therapy is carried out within 24-48 hours. depending on the severity of the shock. In addition, the child receives through the mouth liquid respectively physiological needs. Infusion therapy is carried out with simultaneous control of urination; it is important to measure hourly urine output, which in the bladder catheter, and leave it to complete removal of the child from the shock. Only after removal of shock start processing burn surface under anesthesia: remove foreign body, polluted the epidermis, carefully cut off revealed bubbles. After processing impose bandages, often with Vishnevsky ointment, as in the treatment of dry bandages bandages too painful for the child. Ligation do not usually 2 times a week. Emergency immunization against tetanus (see Immunization, table, tetanus) is carried out for children who did not receive immunization, and the evident pollution burnt surface. When processing burns of II degree in the face and perineum, given the difficulties of care and a greater chance of infection in children can be used the way of St. Nicholas - Bettona: under General anesthesia clean the surface of burns from debonded epidermis and bubbles using a napkin moistened with alcohol, and grease it 5% aqueous solution of tannin, and then a 10% solution of nitrate of silver (silver nitrate). There is a healing of the burn under the crust, which rejected on 8 - 14th day. Surgical treatment involves excision of the non-viable tissues and closing of defects using autoplasty, applied with deep burns III and IV degree. In the process of child care you need to pay attention to the prevention of bedsores. To prevent scar contractures and deformities, stiffness of the joints bandages put to burn surface is not in contact, limbs fix Longuet, bus sredneaziatskom position, use the methods of exercise therapy. With deep burns prevention of contractures and deformities provided timely surgical intervention. Prevention of burns is ensured by strengthening the supervision of children.

Burns up to 8.5% of the total number of all surgical diseases in children; children and preschool children from the total number of injuries are Acting 63,2%. The most commonly in children occur O. hot liquids (liquid food, water), rarely - fire and even more rarely - chemicals. O. there are more children predostavlennogo age, when the child is very mobile. Localization O. the most various, in most cases, the lower half of the torso and legs.
The clinical picture and over. Unlike an adult patient, the nature and severity of Acting in children above all depend on their age: the younger the age, the harder flows Acting in the same area of defeat. O., covering an area of more than 1/3 of the body surface, are life-threatening for the child. The mortality rate among children with Acting body for the last time decreased to 1,86%; relatively high she remained in children under 3 years of 6.8 %.
Shock kids have already burns a small area, especially when Acting electrocutions. These children has been severe torpid shock in small local changes. B. the period of the shock may have convulsions, vomiting, fever.
In the first hours of burn disease in the area of lesion appears edema; due to hypoxia come morphological changes in the myocardium, liver, kidneys, adrenal glands, pancreas and thyroid glands. Young children often occurs brain swelling. In the first two days of illness destroyed up to 20% of the total number of red blood cells, white blood cell count increased to 16 - 39 thousand, there is a significant deviation from the norm of biochemical parameters, indicating the change of carbohydrate, protein and fat metabolism in the body of the child: increases the amount of residual nitrogen, globulin, sugar, reduces the amount of albumin and so on


Complications. During the first days of the disease with extensive Acting very often toxemia. To fight it is a constant need of parenteral introduction protein drugs, salts and glucose. On 14-21 day often develop sepsis. "Scarlatina" rash is a rare complication that occurs in the first days of burn disease.
Treatment. For the treatment of burn shock in children using different types of anesthesia (omnopon, pipolfen; chloral hydrate, nitrous oxide, and so on) with simultaneous restoration of the volume and composition of circulating blood. In severe cases it is recommended to apply a policy mix consisting of largactil, phenergan and dolantine. The child should be warm. The majority of children's surgeons insists on limitation of parenteral introduction of liquids. During the first days of the disease impose blood or blood substitutes at the rate of 1.5 ml per 1 kg of weight of a patient and 1 % burnt surface and 1 ml of physiological solution of salt per 1 kg of weight and 1% of the surface of the burn. In the absence of vomiting appoint excessive drinking.
Upon removal from the state of shock produce processing burn surface. The most common is a private method of treatment. Burn the surface is washed with saline and 1/2% solution novokaina, and then alcohol. Scraps of epidermis are removed. Debonded swollen epidermis not removed. After treatment with dressings with various drugs: fish oil, carotene, vaseline, triplewin, Kanin, furatsilina, ointment Shnyreva with various combinations of antibiotics, etc. On the face, buttocks burn surface is treated by the method of Nikol'skii-Battman (5% solution of tannin, then 10% solution of silver nitrate) and openly. At the end of processing the evidence produced immobilization burnt limbs in a functionally advantageous position.
Recently has become widely used necrectomie that the most appropriate use of children by the end of 2 - 3 weeks after burn.
Prevention of burns associated primarily with the provision of supervision of children, first of all, toddlers, and preschool age.