Tag Archives: trauma

February 29th 2020

Burns this month – with much discussion amongst the editorial group prior to publication.  There are lots of different children’s burns protocols it transpires.  RCEM’s is not aligned with the London and South East Burns Network’s.  The message is “use your own burns referral unit’s guideline”.  The other important message about burns is watch out for NAI but, even if the burn is accidental, refer all children to their health visitor as HVs in the UK are responsible for talking to families about safety in the home.

Also, complications of Kawasaki Disease, ADHD and the updated MAP guideline (managing cows milk allergy in primary care) which emphasises that 98% of crying babies do not have CMPA.  Do leave comments below.

Do you know your ABCDDE of burns management?

With thanks to Dr Cate Luce:

Here is a systematic approach to burns using an ABCDE approach.

A: Is their airway compromised?

Consider in:

  • Facial burns
  • Smoke Inhalation
  • Dyspnoea
  • Hoarseness
  • Drooling
  • Stridor, wheeze, crepitations
  • Increase work of breathing

For more information: https://dontforgetthebubbles.com/picu-qa-airway-injuries-due-burns/ 1

B: Basic first aid 

Adequate pain relief is essential in burns. You should use something fast-acting such as intranasal diamorphine or follow your local policy. This will allow for a better assessment of the extent of the burns and delivery of basic first aid. Don’t forget running cold water on the affected area for at least 20 minutes, which may be effective up to 3 hours after the burn.  First aid steps at https://cks.nice.org.uk/burns-and-scalds.

C: Calculate the percentage of total body surface area (TBSA)

There are several methods to calculate the percentage of TBSA. The palmar aspect of a child’s hand is 1% of a child’s surface area. You can use the Lund and Browder charts.

https://em3.org.uk/foamed/25/10/2015/remember-remember-burns-and-blasts 2

People often overestimate the percentage of TBSA affected; remember to only include partial and full thickness burns as defined at www.cks.nhs.uk/burns_and_scalds3.

Why not make it easy for yourself and download the Mersey Burns App4, which calculates the percentage of burns for you?

Children with more than 10% of TBSA will need intravenous fluids. The app also calculates the fluid required using the Parkland Formula (3-4ml x (%TBSA) x (weight kg)). You should give half in the first 8 hours followed by the rest within the next 16hours.

D: Discussion with burns centre

  • >1% TBSA in children, >3% in adults (London and South East Burns Network)
  • Chemical/electrical/high pressure steam
  • Face/hands/feet/perineum/flexures/circumferential
  • Inhalation
  • Serious co-morbidity
  • Non accidental

D: Disabilities– what are the complications?

E: External factors 

Burns can be a result of neglect or physical abuse therefore safeguarding should always be considered. All children should be referred to their Health Visitor who is responsible for talking to the family about safety in the home – even if you feel it was an accident.  Use the Child Protection Companion as a guide.  https://www.rcpch.ac.uk/sites/default/files/2019-09/child_protection_evidence_-_burns.pdf 6

Always check the child’s immunisation status, especially tetanus, as burns can act as a tetanus-prone wound.

References

  1. Davis, T. PICU Q+A: airway injuries due to burns, Don’t Forget the Bubbles, 2013.https://dontforgetthebubbles.com/picu-qa-airway-injuries-due-burns/
  2. Sillett, Remember, Remember Burns and Scalds, https://em3.org.uk/foamed/25/10/2015/remember-remember-burns-and-blasts
  3. NICE, Burns and Scalds 2019, cks.nhs.uk/burns_and_scalds.
  4. https://app.merseyburns.com/
  5. Toxic Shock Syndrome 2019, https://www.nhs.uk/conditions/toxic-shock-syndrome/
  6. Child Protection Evidence, Systemic review of burns, July 2019, https://www.rcpch.ac.uk/sites/default/files/2019-09/child_protection_evidence_-_burns.pdf

 

April and May!

I seem to have forgotten to put a blog post up when I published April’s newsletter which contains information on: tonsillectomy for parents, erythema infectiosum (which I think my son had this week), a safety alert about bath seats, tranexamic acid in paediatric trauma and how to make a nasal douche for rhinitis sufferers.

May is now also published and features dangerous dogs, knee pain, dental caries and continuations of both the dermatology and ENT features.  Do leave comments below.

February 2014 uploaded

Scabies this month with a beautiful picture of plantar lesions in a child.  Updated NICE head injuries, antipyretics (or not) for febrile convulsions, child trafficking and the last in the sleep series.  Do leave comments below.

July 2013 PDF

Neglect and emotional abuse is the safeguarding topic this month.  ED advice on the management of minor head injuries, a report from BPSU in hypocalcaemic fits secondary to vitamin D deficiency, the new UK immunisation poster and a bit on crying babies.  Hope you find it all helpful.  Comments welcome below

June 2013 ready to go!

Lots of things to talk about this month.  Reminder of what Koplik spots look like, good e-learning on human trafficking, a link to the new primary care guidelines page, night terrors v. nightmares, some good allergy websites and Jess Spedding again on scaphoid injuries.  Do leave comments below.