Category Archives: Child Protection

Do you know your ABCDDE of burns management?

With thanks to Dr Cate Luce:

Here is a systematic approach to burns using an ABCDE approach.

A: Is their airway compromised?

Consider in:

  • Facial burns
  • Smoke Inhalation
  • Dyspnoea
  • Hoarseness
  • Drooling
  • Stridor, wheeze, crepitations
  • Increase work of breathing

For more information: https://dontforgetthebubbles.com/picu-qa-airway-injuries-due-burns/ 1

B: Basic first aid 

Adequate pain relief is essential in burns. You should use something fast-acting such as intranasal diamorphine or follow your local policy. This will allow for a better assessment of the extent of the burns and delivery of basic first aid. Don’t forget running cold water on the affected area for at least 20 minutes, which may be effective up to 3 hours after the burn.  First aid steps at https://cks.nice.org.uk/burns-and-scalds.

C: Calculate the percentage of total body surface area (TBSA)

There are several methods to calculate the percentage of TBSA. The palmar aspect of a child’s hand is 1% of a child’s surface area. You can use the Lund and Browder charts.

https://em3.org.uk/foamed/25/10/2015/remember-remember-burns-and-blasts 2

People often overestimate the percentage of TBSA affected; remember to only include partial and full thickness burns as defined at www.cks.nhs.uk/burns_and_scalds3.

Why not make it easy for yourself and download the Mersey Burns App4, which calculates the percentage of burns for you?

Children with more than 10% of TBSA will need intravenous fluids. The app also calculates the fluid required using the Parkland Formula (3-4ml x (%TBSA) x (weight kg)). You should give half in the first 8 hours followed by the rest within the next 16hours.

D: Discussion with burns centre

  • >1% TBSA in children, >3% in adults (London and South East Burns Network)
  • Chemical/electrical/high pressure steam
  • Face/hands/feet/perineum/flexures/circumferential
  • Inhalation
  • Serious co-morbidity
  • Non accidental

D: Disabilities– what are the complications?

E: External factors 

Burns can be a result of neglect or physical abuse therefore safeguarding should always be considered. All children should be referred to their Health Visitor who is responsible for talking to the family about safety in the home – even if you feel it was an accident.  Use the Child Protection Companion as a guide.  https://www.rcpch.ac.uk/sites/default/files/2019-09/child_protection_evidence_-_burns.pdf 6

Always check the child’s immunisation status, especially tetanus, as burns can act as a tetanus-prone wound.

References

  1. Davis, T. PICU Q+A: airway injuries due to burns, Don’t Forget the Bubbles, 2013.https://dontforgetthebubbles.com/picu-qa-airway-injuries-due-burns/
  2. Sillett, Remember, Remember Burns and Scalds, https://em3.org.uk/foamed/25/10/2015/remember-remember-burns-and-blasts
  3. NICE, Burns and Scalds 2019, cks.nhs.uk/burns_and_scalds.
  4. https://app.merseyburns.com/
  5. Toxic Shock Syndrome 2019, https://www.nhs.uk/conditions/toxic-shock-syndrome/
  6. Child Protection Evidence, Systemic review of burns, July 2019, https://www.rcpch.ac.uk/sites/default/files/2019-09/child_protection_evidence_-_burns.pdf

 

October 2018 newsletter

This month brings a handout entitled “Towards a healthy lifestyle…” which is a collaboration between dietitians, physiotherapists, psychiatrists and paediatricians at Homerton Hospital.  We have found many families are keen to do something about their child’s weight but don’t know where to start.  Hopefully this friendly article aiming for families to be “healthy enough” is a good place to start.

Also a bit on faltering growth, on-line safety, BRUE and the investigations that do not need to be done.  Tachycardia is (of course) mentioned again.  Do leave comments below.

September 2018 PDF content

September’s newsletter reminds us of the CPD requirements for child safeguarding for all of us, warns us of the dangers of missing Kawasaki Disease, talks about PHE’s #askaboutasthma campaign and describes the differences between fever and sepsis.  Do leave comments below:

August 2018 uploaded

August brings more returning travellers, this time with dengue fever.  Also adolescent sleep problems, adverse childhood experiences (ACEs), an update on rhinitis and the neurological effects of rotavirus.  Do leave comments below.

April 2018 newsletter uploaded

NICE on Lyme disease this month – just in time for the weather to pick up and the tics to start biting.  Also a reminder on the risk factors for SIDS, what to do in a terrorist attack, how to manage a child with a non-blanching rash and a discussion on the use of the antistreptolysin O titre.  Do leave comments below:

March 2018 PDF in time for Easter

NICE on faltering growth this month, paediatric stroke, a reminder of the new epilepsy classification and a contribution from the safeguarding team on what constitutes a “legal high”?  Do leave comments below:

February’s newsletter 2018

What constitutes sexualised behaviour in a 4 year old?  This and the childhood asthma control test, this month, toddler fractures and the PCV vaccine.  Do leave comments below.

Happy New Year 2018! January newsletter uploaded.

Raised intracranial pressure this month, nappy rash, complex febrile seizures, tingling side effects of recreational nitrous oxide use and Vitamin D – again….

Please do leave comments below.

 

May newsletter – uploaded a little after the bank holiday…

May 2017 brings Tourette’s syndrome, child sexual exploitation, a paper on predicting serious bacterial infection and links to resources on recognising it.  Do leave comments below:

April 2017 PDF published

April 2017 brings children who were not brought, lucozade, hypertension, leucocytes in urine and macrocytosis.  I am not sure of the linking theme…  Do leave comments below.