Introduction

Introduction to pediatric burns

Burns are accidents that children often encounter. Because of their age and range of activities, they are more common in adults. Hot water burns are more common in daily life. A few are caused by fire burns or other high-temperature substances and chemicals. Infancy and preschool, especially children aged 1 to 4. The degree of burns in children is closely related to the temperature of the heat source and the time of contact. It is also related to the characteristics of children's delicate skin and the inability to eliminate the cause of injury. Therefore, under the same conditions, the degree of injury in children is more serious than that in adults. In the same area of burns, children are more prone to dehydration, acidosis and shock than adults. The body's anti-infective ability is weak, and the wounds are more likely to be contaminated. Therefore, the chances of local and systemic infections are more than adults, and sepsis is prone to occur.

basic knowledge

Sickness ratio: 0.0001%

Susceptible people: young children

Mode of infection: non-infectious

Complications: bacteremia, high fever in children, shock

Pathogen

Pediatric burn cause

Thermal factors (50%):

Most children's burns are thermal burns, that is, damage caused by high temperature substances, including hydrothermal fluids, flames, hot metal materials, etc., which are often burned by hot water bottles, hot water in bath tubs or containers that contain hot liquid. In the northern part of China, there is a habit of connecting the pots to the pots. The children may accidentally fall from the sputum to a large area of burns in the hot water pot.

Physical and chemical factors (20%):

Preschool and school-age children have a wider range of activities, curiosity, but lack of self-protection and related knowledge, easy to accidentally touch some dangerous facilities and substances, causing burns, such as acid, alkaline chemicals, electrical contact injuries, radioactivity Damage, etc.

Due to the above reasons, the burns in children are mostly in the head and face, the perineum, the buttocks and the palms. The burn wounds in these areas are susceptible to contamination during the process of transport therapy, and the prevention of infection should be paid more attention.

Pathogenesis

In children with burns, the compensatory ability of shock and the disease resistance of infection are lower. The same area burns in children with shock, and the incidence of bacteremia is high. The reason is that children's skin is thin, and the temperature is short. It can cause more serious damage, and the immune mechanism is not mature. Once the wound is infected, it is often accompanied by obvious poisoning reaction. The incidence of serious complications such as bacteremia and multiple organ failure is also high. Children calculate the surface area according to the unit body. The blood volume is less than that of adults. After the burn, the body fluid suddenly oozes a lot, and it is easy to have shock. Therefore, the classification standard of the severity of pediatric burns is special.

Prevention

Pediatric burn prevention

1, prevent burns

(1) Heat the water after putting cold water in the winter bath, and prevent hot water leakage in the hot water bottle or the heat preservation pot when heating.

(2) Place the liquid with a higher temperature and its container in a safe place where the child cannot climb or knock.

2, to prevent fire burns

(1) Do not leave the child alone in the kitchen or near the stove.

(2) Educate children not to play with fire, try not to set off fireworks and firecrackers.

3, education children do not play with household appliances, do not play and close to the power switch, plugs, wires and so on.

4. Do not store chemicals in your home.

Complication

Pediatric burn complications Complications bacteremia children with high heat shock

May be complicated by indigestion, scarlet fever-like Staphylococcus aureus infection, high fever, convulsive pyoderma and bacteremia.

Symptom

Pediatric burn symptoms Common symptoms Heat pain dehydration high heat no urine burn wounds fecal smell secretions irritability corneal burns chills burn wounds sweet suffocation...

First, children with burn shock

1. Because the development of various organs in children is not mature, especially the development of the nervous system is more incomplete, and the calculation of body surface area unit, the total blood volume is relatively small, so the regulation function of children and the tolerance to body fluid loss are higher than adults. Poor, due to pain, dehydration, loss of plasma components, imbalance of water and electrolytes, etc., is far more serious than adults, and the incidence of burn shock is higher than that of adults. Under normal circumstances, children with burns greater than 10% will occur. The possibility of shock.

2, children with head and face burns are prone to shock: This is because the head area of children is relatively large, the tissue is loose, blood supply is rich, more exudation than other parts, and swelling of the head and face is easy to cause respiratory dysfunction and lack of oxygen.

3. The incidence of shock is related to age: generally, with the increase of age, the body's regulating function and tolerance to body fluid loss are gradually enhanced. For children with burns exceeding 40%, the incidence of shock is high. However, the incidence of shock was significantly correlated with the age of children with burns below 40%. The incidence of shock in children aged 4 years and older and under 4 years old was significantly different. The younger the age, the higher the incidence of shock. .

4, the clinical characteristics and diagnosis of pediatric burn shock: due to the anatomical and physiological characteristics of children, primary shock in children is more common, especially in the head, perineum and other pain-stimulated sensitive parts of the burn, and later converted to secondary shock, often Shows: thirst, irritability, even convulsions or convulsions, little or no urine, cold limbs, pale, bun, capillary filling slow, severe skin sallow, and patterns appear, pulse fast and weak It can be increased to 180 to 200 times per minute. The blood pressure becomes weak and finally cannot be detected. The heart sound becomes dull, the heart slows down, and finally there is respiratory failure. The diagnosis of pediatric burn shock is mainly based on the easy use of clinical diseases, such as changes in urine volume, mental state and skin color, followed by reference blood pressure, pulse, etc. When observing mental state, it should be noted that different ages behave differently, within 1 year of age. More performance of drowsiness, more than 1 to 4 years old, excited, restless or anti-study quiet, and gradually turned into drowsiness, people over 4 years old are extremely excited, more nervous and more words.

5, children with hypertension: about 20% of children with burns have obvious blood pressure rise, the cause is unknown, often appear 7 to 10 days after injury, sometimes only gradually after the skin graft, most children have no symptoms, sometimes There can be headaches or even confusion.

Second, pediatric burn infection and pediatric burn sepsis

Insufficient immune function in children, thin skin, agitation, high incidence of shock, so the incidence of wound sepsis is high, sepsis is the main cause of burn death in children, accounting for 740.6%, 71.4% of sepsis occurred within 15 days after injury .

(1) Pediatric burn wound sepsis:

(1) Local changes of wound surface: 1 fresh wound color darkens, partial ulceration, sometimes bleeding point, or ulcer surface; 2 fresh granulation wound surface hardens, color becomes black or purple, base purulent or wound edge suddenly cuts Depression; 3 normal skin around the wound has redness, heat and other inflammatory infiltration; 4 sometimes spotted or small pieces of necrotic spots can be seen on the wound surface, 5 tissue edema does not subside, or relapse after relapse edema.

(2) systemic symptoms: systemic symptoms are basically the same as adults, generally showing high fever, chills, leukopenia or increased, toxic shock in the late stage.

(B) Pediatric burn sepsis:

(1) Body temperature: Children's body temperature is susceptible to dressing change, environment, etc. It is difficult to explain the problem with simple fever, but the high fever is above 40 °C, especially if it rises or falls suddenly to normal or below. It has diagnostic value and the body temperature does not rise. Often it is a manifestation of severe sepsis, older children, chills may occur before or during fever, sometimes several times a day, infants and young children may have convulsions.

(2) Heart rate: Children's heart rate is unstable, any external stimulus can increase their speed, but when the heart rate exceeds 160 beats/min, it should be noticed. If it exceeds 200 beats/min, especially with irregular rhythm, heart sound is strong, running horse Law, pre-contraction or sudden increase in unexplained causes, etc., have more diagnostic reference value.

(3) Respiratory: Burn sepsis, infant breathing increased earlier, there are changes in fashion and respiratory state, such as breathing tightness or pause, often complicated by pulmonary infection or pulmonary edema.

(4) Psychiatric symptoms: infants within 6 months, showing unresponsiveness, not crying, not eating, heavy coma or shallow coma, within 2 years old, manifested as listlessness, apathy, lethargy, easy to wake up or dream scream , crying, sometimes expressed as excitement, irritability, empty, shaking his head, limbs turbulence or even horror, 3 years old or older expressed as hallucinations, delusions or bulimia and other adult-like sepsis.

(5) Digestive system symptoms: diarrhea is the earliest symptom, several times or dozens of times a day, also manifested as anorexia, vomiting, bowel sounds, intestinal paralysis, severe dehydration and acidosis.

(6) rash: rash, ecchymosis, bleeding points, rash and other rash, S. aureus sepsis can cause scarlet fever-like rash, and more common in babies.

(7) Wound surface: the surface is stagnant with epithelial growth, deepening, steep edge, granulation tissue contamination, dull or necrotic spots, and focal necrosis and normal skin necrotic spots caused by Pseudomonas aeruginosa sepsis are more common.

(8) Laboratory test; the more prominent is the increase in the number of white blood cells in the blood, generally above 20 × 109 / L, sometimes up to 30 ~ 40 × 109 / L, and poisoning particles and vacuoles.

Third, the characteristics of inhalation injury in children

Inhalation injury in children, if there is airway obstruction or lower airway injury, endotracheal intubation or tracheotomy should be performed immediately. When intubation is performed in children, the catheter should be placed in the pharyngeal and tracheal edema area to prevent airway. Obstruction, airway tube to the pharynx and trachea damage is less, because the child's neck is short, the child tracheotomy should be lower than the adult, in order to better between the fourth and fifth ring tracheal cartilage.

Examine

Pediatric burn examination

Laboratory project

1. Urea: Observe whether it is higher than 8.2 mmol/L to determine the possibility of kidney damage.

2. Aspartate aminotransferase (AST/SGOT): Observe whether it is higher than 55 U/L and judge the degree of burn (whether it reaches deep burn).

3. Chloride (Chloride): Observe whether it is lower than 96mmol/L, and it can be judged whether the burn causes internal environment disorder.

4. Sodium: Observe whether it is lower than 136mmol/L, and the degree of water loss can be judged.

Diagnosis

Diagnosis of pediatric burn diagnosis

1. Estimation of burn area in children: (1) Head and neck is 9+ (12-age). The lower limbs are 46-(12-age). The method of estimating the area of the trunk and upper limbs is the same as that of adults. (2) Palm method: The five fingers of the sick child are close together, and the size of one palm is 1%.

2. Classification of pediatric burn degree: (1) mild burn: II° burn with a total area below 5%. (2) Moderate burns: II° burns with a total area of 5%-15%. Or a 3% or less III° burn.

(3) Severe burns: II% of the total area of 15%-25%. Or III° burns in 5%-10% burns.

(4) Extra-severe burns: II° with a total area of 25% or more. Or III° burns in more than 10%.

3. Characteristics of pediatric burn shock: (1) Burns of the same area, the incidence of pediatric shock is higher than that of adults, and it is more serious. (2) The clinical manifestations of children are thirst, restlessness, even convulsions or convulsions, oliguria or anuria, pale, cold limbs, purpura, skin color yellow or bruising, rapid pulse, low blood pressure or can not be measured.