Consider early intubation in patients with suspected pharyngeal or airway swelling Inquire about the circumstances of the burn and determine the potential for associated injuries Remember to remove sources contributing to ongoing thermal damage Current Evidence Globally, burns are the 11th leading cause of death in children aged to and the fifth most common cause of nonlethal injury A recent study examining data on pediatric burns from the Nationwide Emergency Department Sample (NEDS) found that the majority were burns to the wrists/hands, followed by the lower limbs, with the most common causes being electric appliances and hot liquids/vapors Data from the National Burn Repository suggest that burn injuries are more prevalent in minority children than would be expected based on demographics alone Scald and contact burns are more common in the younger ages, with fire/flame more common in adolescent and adult patients Recent data suggest significantly improved survival for children with careful attention to burn care In one study, half of children with burn injuries up to 90% TBSA survived their injuries, and research is ongoing into new methods for surgical management and pharmacologic treatment of burn wounds Burn size and inhalational injury are two key predictors of survival in children Major systemic pathophysiologic effects are seen in children with burns of more than 20% of body surface area (BSA) Burn injury causes increased capillary permeability and the release of osmotically active molecules to the interstitial space resulting in extravasation of fluid Protein is lost from the vascular space to the interstitium during the first 24 hours In patients with large burns, vasoactive mediators are released to the circulation and result in systemic capillary leakage Edema develops in both burned and noninjured tissues Circulating factors that depress myocardial function decrease cardiac output Acute hemolysis of up to 15% of red blood cells may occur both from direct heat damage and from a microangiopathic hemolytic process The profound circulatory effects of severe burns can result in life-threatening shock early after injury Goals of Treatment High-quality care is key for functional outcome and survival from burn injuries Emergency management begins with prehospital care, assessment, resuscitation, treatment of potential inhalational injury, wound care, infection control, and appropriate admission The continuum of care extends through hospitalization, potential surgical management, and rehabilitation The unifying goals of these treatment modalities are to compensate for the physiologic effects of the burn and promote healing Clinical Considerations Clinical Recognition Immediately after arrival, the physician must determine if a patient with burn injury requires aggressive therapy for major burns In children with severe injuries, the evaluation and initial management take place simultaneously Smoldering clothing or other sources of continued burning must be removed Information about the circumstances of the burn and the potential for associated injuries should be sought from prehospital care providers, police, or family members, but this should not delay the initial treatment It is crucial to recognize inhalational injury as a cause of impending airway obstruction and respiratory failure A history of smoke exposure is a risk factor Clinical signs of potential inhalational injury include burns on the face, singed nasal hairs, soot in the sputum or soot visible in the upper airway Triage Considerations All children with nontrivial burns should be rapidly transported to a hospital setting Once in the hospital, the triage process should take into account the child’s age and medical history, the injury mechanism, and the surface area and depth of the burn Children 25% TBSA Electrical burns with history of either altered mental status or seizure Any full-thickness burn Partial thickness >15% TBSA Burns to face, genitalia Caustic chemicals to eyes Circumferential burns Significant burns of hands, feet Any burn with significant pain Caustic skin burns Electrical burns with any of the following: Loss of consciousness Thrown from source or frozen to source Entrance and exit wounds Concern for abuse Partial thickness >5% TBSA Infected burn Burns requiring debridement