As before, but consider indicators of inhalational injury and consider intubation EARLY:
Early shock due to trauma, not burns! Establish intravenous access ideally in unburnt aras, but eschar can be perforated if necessary, else the intraosseous route can be used.
Apart from burns, children may suffer effects of blast, falling objects or injuries sustained trying to escape from fire. A thorough head-to-toe secondary survey should be carried out.
Use paediatric chart, else Palm + adducted fingers = 1% surface. Rule of 9s only for over 14 yrs. Special areas include the face (as above), hand (can cause severe functional loss if scarring occurs) and perineum (prone to infection and difficult to manage).
Partial = pink, mottled, blistered. Full thickness= white or charred, painless and leathery.
Use Entonox, else IV morphine 0.1 mg/kg.
For burns over 10:
Leave blisters intact. Max 10 minutes cold irrigation (NOT for partial thickness burns >10%).
Nerves, blood vessels, skin and muscle sustain most injury. The airway may be compromised by facial burns and early management of such problems is essential. If unconscious, assume cervical spine injury until excluded. Virtually any injury can occur, especially arising from being thrown from the source. Burns are common (exit burns are often more severe than entry) and the powerful tetanic contraction caused by the shock can cause fractures and dislocations.
Late complications include fluid loss, oedema, myoglobinuria and acute renal failure. A diuresis of at least 2ml/kg/hr must be maintinaed. Metabolic acidosis must be corrected because myoglobin is more soluble in alkaline urine.
Discuss children suffering from significant electrical burns with the local burns unit.
Children who survive not only require therapy for near drowning but also assessment and treament of concomitant hypothermia, elecrolyte imbalance, and injury (esp spinal).
Immobilise the cervical spine until injury is excluded. The stomach is usually full of swallowed water, and intubation and gastric decompression must be performed early to protect the airway.
A rectal or oesophageal temperature reading must be obtained as soon as possible. Hypothermia is common and adversely affects resuscitation attempts unless treated. Arrhythmias are more common and some eg VF may be refractory. Resuscitation should bot be discontinued until core temperature is at least 32degC or cannot be raised despite active measures.
External warming is usually sufficient if core temperature is above 32degC:
Core rewarming should be added if <32 degC:
Beware Rewarming shock from peripheral vasodilatation.
Once blood cultures have been taken, IV antibiotics can be started with cefotaxime. Fever is common in the first few hours, but systemic infection should be suspected if a pyrexia develops after 24 hrs.
Survival is 70% if basic life support at waterside, otherwise only 40%. Of the survivors, 70% will make a complete recovery, 25% will have mild neurological deficit, and 5% will be severely disabled.