Burns, fluid, pain in children

Pain

Assessment

Observational and behavioural measures rather than by direct questioning (2 years old)

e.g. FLACC (Face, Legs, Activity, Cry, Consolability each scored on a 3 point scale, total score out of 10)

Management

Most burns are extremely painful

Need to titrate IV opiates in a potentially shocked child (Morph 0.1mg/kg every 5 mins - max 0.3mg/kg, then infusion 0-40 mcg/kg/hr, with simple analgesics)

Fluid Requirements

Assessment

TBSA burned: 'Rule of nines' not appropriate (larger head, smaller legs). Use Lund-Browderchart.

Burn depth

Epidermal/superficial: red, painful, no blisters

Superficial dermal: red, painful, blisters, CRT normal

Deep dermal: lobster/cherry red, no blisters, no CRT, not painful, usually requires grafting

Full thickness: white and charred, not painful, requires excision and grafting

Management

Start IV fluids if > 10% TBSA burns

Resuscitation: Parkland formulae - 3-4ml/kg/% burn/24hrs

Half is given in first 8 hours post burn (not initial resus), and half in the next 16 hours.

Is only a guide: the goal is UO > 1ml/kg/hr in children < 30kg

Maintenance is given in addition e.g. Hartmann's (4:2:1 rule)

Blood transfusion guided by Hb levels