Assessment and management of pediatric burns and electrical injuries
Aim: To develop a comprehensive understanding of the assessment, management and outcome of
pediatric burn injuries.
Objectives:
Knowledge objectives:
The trainee should have acquired the following knowledge:
 Epidemiology and etiology of burns in children
 An understanding of commonly associated injuries in the pediatric burn patient and the
impact of these injuries on assessment and management
 Understanding of the presentation and patterns of injury in the child abuse victim presenting
with burn injuries
 Clinical assessment of a pediatric patient with a burn injury including examination principles
during the primary and secondary survey
 Understanding of the association of shock in the pediatric burn patient, including etiologies,
assessment and management of the shock state
 Classification of pediatric burn injuries according to depth (First Degree to Fourth Degree or
superficial / partial thickness / full thickness)
 Estimation of burn size in pediatric patients according to Body Surface Area and age
o Rule of 9’s for older patients
o Familiarity with standardized burn charts (like the Lund Browder)
o Modification for pediatric patients
o Use of palm size as a crude estimate
 Understanding of the principles of treatment of the burn injury during the first 24 hours
including
o Parkland Formula for fluid resuscitation
o Formula based on BSA
 Understand the principles, limitations and complications of monitoring techniques and
parameters used during the assessment and management of pediatric burn patients (O2
saturation, end-tidal CO2, central venous pressure, arterial line, urinary output, acid-base
balance, serum lactate, vital signs, etc)
 Understanding of blood product therapy in the management of burn injuries in children,
including indications, limitations, timing and potential complications
 Understanding of alternative volume expanders (for example albumin, Pentaspan) in the
management of burn injuries in children, including indications, timing, limitations and
complications
 Understanding of the clinical implications of inhalation injury in pediatric patients, including
o Physical signs suggestive of airway injury (carbonaceous sputum, singed facial hair,
hoarseness, stridor, burned oral mucosa)
o The need for early intubation and the best approaches to achieve this
o The need to recognize and manage possible burn-associated diseases, such as carbon
monoxide or cyanide toxicity
o The indications for hyperbaric oxygen treatment
 Indications for airway management/intubation in pediatric burn injuries including
o suspected inhalation injuries and
o criteria for intubation based on burn size and depth
o Transportation injuries
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Assessment and management of circumferential extremity burns and compartment syndromes
in pediatric burn patients
Indications and procedure principles of burn wound escharotomy and/or fasciotomy in
pediatric burn patients
Indications for gastric tube insertion in pediatric burn patients
Principles of pain management with the use of narcotic and sedative administration in
pediatric burn patients
Principles of wound care and dressings in pediatric burn patients
Indications for consultation to Plastic Surgery
Principles of burn wound grafting in pediatric burn injuries
Know the need for tetanus prophylaxis in pediatric burn injuries
Indications for antibiotic administration in pediatric burn injuries, and knowing that it is not
routinely recommended
Special Burn Injuries- assessment, management, monitoring, potential complications and
outcome:
o Chemical burns
o Electrical burns including high voltage injuries
o Pediatric oral electrical injuries
Knowledge of potential serious complications of burns (rhabdomyolysis, ARDS, etc.)
Criteria for transfer to a Pediatric Burn Centre
Skill objectives:
 Perform an appropriate clinical exam to assess the pediatric burn patient
 Demonstrate assessment and diagnostic skills in determining the size and depth of the burn
injury
 Identify and apply burn wound dressings
 Recognition of patterns of child abuse in pediatric patients presenting with burn injuries and
knowledge of how to make appropriate referrals
 Ability to adequately fluid resuscitate an acutely burned child based on burn size, time from
injury, and hemodynamic status
o Use of mental status, vital status, and urine output to guide adequacy of fluid
resuscitation
 Emergency airway management in burn patients with airway compromise or inhalation
injuries.