**8. Consequences of burns**

full-thickness burns 3–10% total body surface area, and superficial partial-thickness burns of the head, hands, feet, or perineum [1]. Each case of suspected child abuse is classified as moderate burn [1]. Moreover, in this group, all patients have burn injury and concomitant trauma, significant preexisting disease, and extreme age (neonate and infants). Major burns cover more than 25% total body surface area in adults and more than 15% total body surface area in children [1]. In this group are full-thickness burns of more than 10% total body surface area, deep burns of the head, hands, feet, and perineum, inhalation injuries, chemical burns,

Initial treatment follows the ABCDEs of resuscitation. The aim is to stabilize the airway,

Airway management should also include assessment for the presence of airway or inhalation injury [4]. In the cases of suspected airway burns, early intubation can be considered [9]. Children with stridor due to upper airway compromise also require urgent intubation [9]. Potential indications for ventilation are excessive burns that cover over 60–70% of total body surface area, full-thickness circumferential chest burns, and severe inhalation lung injury

All children with burns over 20% of total body surface area should have intravenous access (peripheral access through non-burnt skin is preferred) [9]. Fluid resuscitation rates should be calculated using the time of burn, patient's body mass, and the surface of burn with the use, for example, of Parkland formula [9]. To determine the adequacy of fluid replacement, monitoring of urinary output is useful [9]. Some patients require nasogastric tube. Important

The treatment of burns can be conservative and operative. Fortunately, most of children do not require surgical treatment, which is reserved for patients with deep (third degree) burns. Conservative treatment is indicated in children with superficial, partial-thickness burns.

Among the most often realized surgical procedures are escharotomy (rare), excision of the dead tissue, and skin grafting [1]. Escharotomy is indicated in patients with circumferential burns on the chest or limbs. The aim of escharotomy is to release the constrictive eschar. The burned skin should be released by incisions with electrocautery within the lines of escharotomy. Early excision of necrotic tissues and grafting is indicated in patients with full-thickness burns. In Poland burn wounds are covered with autografts (donor site is usually tight, less often scalp or back). Skin grafts can be split-skin grafts and full-thickness skin grafts. Most pediatric patients require split-skin grafts. Full-thickness skin grafts can be necessary in specific areas, such as the face (lips, eyelids, nose), hand/fingers, toes, and genitalia. In cases of

Burn wound dressings play crucial role in the care for patient with burns. Burn dressing should protect the burn wound from further harm, such as desiccation, mechanical trauma, and infection. Moreover, they can facilitate the process of healing and relief pain [10]. The current literature is still inconclusive with regard to the gold standard burn dressing for the pediatric population [15]. In Poland burn wound is usually treated with silver sulfadiazine. However, it is commonly known that the ideal dressing for children should alleviate pain,

decrease length of hospital stay, and minimize the risk of complications [15].

and electrical burns [1].

breathing, and circulation [9].

284 Essentials of Accident and Emergency Medicine

causing pulmonary edema and hypoxemia [9].

issue in care of burned patient is analgesia.

extensive burns, it is possible to use meshed skin grafts.

The consequences of burns are mostly related with the loss of skin functions. The skin is the largest organ in the body and plays a crucial role in regulating body's temperature by preventing heat loss to the environment. It also prevents water loss from the body and acts as a barrier to infective organisms [9].

It is important to underline the fact that children have a greater ratio of surface area to volume of the body, increased metabolic rate, increased heat loss (less fat and shivering), and increased evaporative water loss [10].

Possible complications of burns include variety of problems, for example, sepsis, hypovolemia, hypothermia, carbon monoxide poisoning, cyanide poisoning, gastric ulcers, cardiac dysfunction, hypermetabolic state, renal failure, transient antidiuresis, and anemia [4]. Another possible complication is laryngeal edema that can be treated with endotracheal intubation and tracheostomy [4]. Moreover, due to edema, compartment syndrome can develop, which means that the patient requires escharotomy [4]. Escharotomy technique involves making longitudinal incisions in segments with inelastic circumferential burns, usually of full thickness [1]. Possible contractures should be treated with physical therapy. Due to the risk of psychological trauma, it is important to provide to burn patients psychological rehabilitation [4]. The possible complications from respiratory system include pulmonary infiltrates, pulmonary edema, pneumonia, and bronchospasm [4]. Inhalation injuries may result in bronchospasm, airway inflammation, and impaired pulmonary function [4]. Moreover, they can result in difficulties in eating and drinking [4].

Among long-term consequences of burns in children are physical scarring and emotional impact of disfiguring burns [4].
