Clinical Formula for Management of Pediatric Scald Burn

Introduction

Introduction • Thermal injuries affecting more than 10% of the total body

surface area in children can result in burn shock as a result of inflammatory response and evaporative losses.

• This sequence of events leads to intravascular hypovolaemia and haemoconcentration that are maximal 12 hours after injury.

• Under resuscitation had become uncommon since the adoption of weight and injury based formulas.

• Instead, administration of excessive fluid volume has been reported causing respiratory complications, water intoxication and multiple organ dysfunctions.

Introduction

• The clinical formula was elaborated in our mind to overcome the hypervolemia that may be associated

with modified parkland formula during shock stage.

Introduction

Goal

• Establish a safe procedure to adequately resuscitate children with scald burn without overloading the circulation.

Three important aspects are present in the management of scald burn in

children.

Children are not small adults

The intensity of the scalding versus direct flame.

Complications raised with fluid resuscitation formulas.

The intravascular volume in this age can`t compensate any overload, as well as the kidney function can`t eliminate this excess volume.

• 300 cases of scald burn, most of them were due to boiled water, tea, or soup.

• Age : 2 m - 12 y with an average of 3.5 years.• Male to female ratio = 1:1. • 179 cases > 10%-20% TBSA. 121 cases > 20% TBSA.

Methods

Methods

• Children with major and moderate scald burn were infused by the equivalent amount to their normal urine output in the form of Ringer solution over 24 hours, aided by normal oral fluid intake.

• The fluid balance chart included the amount of IV fluidtherapy , the total oral fluid intake and UOP per hour.

• Balance was modified by decreasing or increasing the fluid infused.

Proper monitoring• Sensorium • Heart rate• UOP • Lab investigations mainly haematocrit &electrolytes

Additional• CVP • Chest X ray

Methods

Results

• No signs of volume overload, pulmonary oedema or brain water intoxication were recorded with the application of this process.

• The intravenous fluid as well as the immediate oral feeding were sufficient to keep the urine out put and the the heart rate at their normal values.

• This formula is only a guide. Each child needs to be treated as an individual and clinical observations need to be assessed regularly to evaluate the effectiveness of the fluid replacement.

We called this process The Clinical Formula for management of scald

burn in children.Egy. J. Plast. Reconstr. Surg., Vol. 36, No. 1, January: 97-98, 2012

Conclusion

• We concluded that The Clinical Formula for management of scald burn in children is safe, easy and competent procedure.

Thank you