Upload
yolondanic
View
8
Download
0
Tags:
Embed Size (px)
DESCRIPTION
!
Citation preview
Pediatric Burn: Changing lives foreverLillian F. Liao, MD, MPHDivision of Trauma and Emergency Surgery Department of SurgeryUTHSCSA
Pediatric epidemiologyAnnual incidence of pediatric diagnosisCancer : 10,500Burn : >133,000South Texas > 200 cases annually [under estimated]
Annual pediatric mortalityHeart disease 674Birth defects 1,117Cancer 1,930Burn 2,500Trauma 12,388
EpidemiologyMOST COMMON out-patient burnsNon-intentional scalding burn
Most are preventable [woman and children]
Between 1985-2009: mortality decreases over timeBurn size and age are most important determinants
EpidemiologySocioeconomicsBurn admissions increase with decreasing socioeconomic statusHighest risk are:children in households without a separate kitchen kitchen without doors kerosene lamp usage in winter months
EpidemiologyEstimated 140,000 burns per year11,000 Children require hospitalizationSouth Texas average annual admission = 200+South Texas average annual clinic visits = 800+
Average hospital LOS = 3 daysSouth Texas average LOS = 2.4 days
Average $211 million in hospital charges annuallyLifetime cost associated with pediatric burn >$2 billion
EpidemiologyMost common types of burnScalding< 5 years 70% (Food > Water)> 5 years 30%
EpidemiologyMost common types of burnScalding< 5 years 70% (Food > Water)> 5 years 30%Flame
EpidemiologyMost common types of burnScalding< 5 years 70% (Food > Water)> 5 years 30%FlameContact
EpidemiologyMost common types of burnScalding< 5 years 70% (Food > Water)> 5 years 30%FlameContactElectrical
EpidemiologyMost common types of burnScalding< 5 years 70% (Food > Water)> 5 years 30%FlameContactElectricalNon-accidental burns - 20%
Acute burn resuscitation Four periods of treatmentEmergentAcuteChronicRehabilitation
Acute burn wound careAccess the depth of the burnSuperficialPartial thicknessFull thickness
Accurate assessment of % TBSA
Acute burn resuscitationNeed active resuscitation if >15% TBSA partial thickness burnParkland formula: [4ml] * [Kg] * [%TBSA]Brookes: [2ml] * [Kg] * [%TBSA]
Replace over first 8 hoursStarts from the time of injuryNext over the next 16 hours
Acute burn resuscitationFluid resuscitationResuscitation goals:HR [normal range for age]UOP 0.5 to 1 ml/kg/hrTemp > 37F
Acute burn resuscitationCriteria for transport to Burn centerPartial thickness burn >10% TBSA
Face, hands, feet, genitalia, major joints
Full thickness burn of any age
Electrical burns
Chemical burns
Inhalation injury
Acute burn resuscitationCriteria for transport to Burn centerPatient with multiple pre-existing medical problems + burn of any size
Burn + TraumaBurn + ChildBurn + Elderly Burn in patients with special needs
Sub-acute burn wound carePigment management
Risk of hypertrophic scarringHealing time 14-21 days: ~30% risk>21 days: ~70%
Pain management
Chronic burn wound careOccupational therapy
Physical therapy
Hypertrophic scar management
Psychosocial trauma
UT Medicine and UHS BURN TEAM
BURN Hotline:210-358-BURN
Thank you very much for inviting me to speak with you about the management of burn wounds.
**** ****