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Pediatric Terrorism and Disaster Preparedness

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

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Table 7.4. Principles of Advanced Burn Life Support®

Principle Description
Primary Survey
Airway Rapid upper airway closure may occur following inhalation injury and require early intubation
Breathing Circumferential full thickness burns of the trunk may impair ventilation and require escharotomy
Circulation Circulation in a limb with full thickness burns may be impaired and require escharotomy
Disability Consider carbon monoxide poisoning if the patient is not initially alert and oriented
Exposure and environment Remove all jewelry to avoid constriction of digits
Adjuncts
Foley catheter Needed to titrate fluid replacement against urine output
Gastric tube Needed to decompress stomach due to burn ileus
Resuscitation
Stop the burning process
 
Fluid resuscitation Parkland formula: 3-4 mL Ringer's lactate × body weight in kg × total body surface area (BSA) burned; administer half the amount during the first 8 hr after injury, half over the next 16 hr.

Modification for pediatric patients: Add maintenance fluid to Parkland formula for children and infants; 100 mL/kg for first 10 kg + 50 mL/kg for next 10 kg + 20 mL/kg for each additional kg
Secondary Survey
History and physical
Obtain as much information as possible regarding the circumstances of injury

Flame

How did the burn occur?
Did the burn occur outside or inside?
Did the clothes catch on fire?
How long did it take to extinguish the flames?
How were the flames extinguished?
Was gasoline or another fuel involved?
Was there an explosion?
Was there a house fire?
Was the patient found in a smoke-filled room?
How did the patient escape?
If the patient jumped out a window, from what floor?
Were others killed at the scene?
Was there a motor vehicle crash?
How badly was the car damaged?
Was there a car fire?
Are there other injuries?
Are the purported circumstances of the injury consistent with the burn characteristics?

Scald

How did the burn occur?
What was the temperature of the liquid?
What was the liquid?
How much liquid was involved?
What was the temperature setting of the water heater?
Was the patient wearing clothes?
How quickly were the patient's clothes removed?
Was the burned area cooled?
Who was with the patient when the burn took place?
How quickly was care sought?
Where did the burn occur?
Are the purported circumstances of the injury consistent with the burn characteristics?

Chemical

What was the agent?
How did the exposure occur?
What was the duration of contact?
What decontamination occurred?
Was there an explosion?

Electrical

What kind of electricity was involved?
What was the duration of contact?
Did the patient fall?
What was the estimated voltage?
Was there loss of consciousness?
Was cardiopulmonary resuscitation administered at the scene?

Determine the severity of the burn

Extent of burn

Rule of nines for adolescents
Lund-Browder chart for children and infants (Table 6.5)

Depth of burn

Adjuncts
Imaging and laboratory studies Carboxyhemoglobin
Reevaluation
Continued assessment of ventilatory effort
Continued assessment of extremity perfusion
Pain management
Psychosocial assessment
Burn Wound Care
Thermal burns Cover the area with a clean, dry sheet
Ice applications are appropriate only in small burns
Chemical burns Flush the chemical agent from the body surface with copious amounts of water
Powdered chemicals should be brushed from the skin prior to flushing the involved area
Remove all contaminated clothing
Chemical eye injuries require continuous irrigation until otherwise instructed by an expert
Electrical burns Continuous cardiac monitoring may be necessary during the first 24 hr after injury
Maintain urine output at twice normal target volumes if myoglobinuria
Burn Center Referral
Partial thickness burns >10% total BSA
Burns that involve face, hands, feet, genitalia, perineum, or major joints
Full-thickness burns
Chemical burns
Electrical burns, including lightning injury
Inhalation injury
Burn injury in patients with significant comorbidities; concomitant trauma; or who require special social, emotional, or rehabilitative intervention
Burned children in hospitals without qualified personnel or equipment for care of children

Note: The principles of Advanced Burn Life Support are identical to the principles of Advanced Trauma Life Support® (Table 7.3), with additional caveats pertinent to Advanced Burn Life Support.

Source: Courtesy American Burn Association. Used with permission.

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