Despite the decreased incidence of drowning since the 1990s, few prevention strategies have been shown to be effective. Exceptions include implementation of mandatory four-sided fencing around pools (decreasing the number of children <5 years of age who drown) and immediate provision of CPR to children who drown. The use of safety flotation devices in older children during water sport activities may be beneficial. Enhanced supervision is required to reduce the incidence of infants drowning in bathtubs.
The pathophysiology of burn injury is caused by disruption of the three key functions of the skin: regulation of heat loss, preservation of body fluids, and barrier to infection. Burn injury releases inflammatory and vasoactive mediators resulting in increased capillary permeability, decreased plasma volume, and decreased cardiac output. The body then becomes hypermetabolic with increased resting energy expenditure and protein catabolism. This hypermetabolic state may continue for up to a year after injury.
Burns usually are classified on the basis of four criteria: 1.
Depth of injury 2.
Percent of body surface area involved 3.
Location of the burn 4.
Association with other injuries
More than 100,000 children sustain a burn injury each year. Burns are the third leading cause of injury-related death for children ages 1 to 9 and are a major cause of morbidity. Boys are more likely to sustain a burn injury, as are children age 6 and under. Scald burns are more common in younger children as compared to older children. Overall, thermal burns secondary to scald or flame are much more common than electrical or chemical burns. Most fire-related childhood deaths and injuries occur in homes.
The depth of injury should be assessed by the clinicalappearance. Categories of first-degree, second-degree, andthird-degree are commonly used; however, classification bydepth (superficial, superficial partial-thickness, deep partial-thickness, and full-thickness) conveys more information aboutthe structures injured and the likely need for surgical treatmentand may be more clinically useful.
Superficial (first-degree) burns are red, painful, anddry. Commonly seen with sun exposure or mild scald injuries, these burns involve injury to the epidermis only. Theyheal in 2 to 5 days without scarring and are not included inburn surface area calculations. Superficial partial-thickness (second-degree) burns involve the entire epidermis andsuperficial dermis. These burns have fluid-containing blisters.
2 of head 91 2 of one thigh 23 2 of one lower leg 21
Figure 44-1 This chart of body areas, together with the table inserted in the figure showing the percentage of surface area of head and legs at various ages, can be used to estimate the surface area burned in a child. From Solomon JR: Pediatric burns, Crit Care Clin 1:159–174, 1985.