Burns at children – a kind of the trauma arising at defeat of fabrics physical and chemical factors (thermal energy, electricity, ionizing radiation, chemicals, etc.). The clinic of burns at children depends on the influencing factor, localization, depth, extensiveness of damage of fabrics and includes local (pain, hyperaemia, hypostasis, formation of bubbles) and the general manifestations (shock). The main tasks of diagnosis of burns at children is definition of nature of a burn trauma, depth and area of damage for what the infrared termografiya, measuring techniques are used. Treatment of burns demands performing antishock therapy, a toilet of a burn surface, imposing of bandages from children.
Burns at children
Burns at children – thermal, chemical, electric, beam damage of integuments, mucous membranes and subjects of fabrics. Among total number of persons with a burn trauma children make 20–30%; at the same time nearly a half of them are children up to 3 years. Lethality level in connection with burns among children reaches 2-4%, besides about 35% of children annually remain disabled people. High prevalence of burns in children's population, tendency to development of a burn disease and heavy postburn frustration raise questions of the prevention and treatment of a burn trauma at children in number priority in children's surgery and traumatology.
Features of children's anatomy and physiology are that that skin at children is thinner and more gentle, than at adults, has the developed blood and lymphatic network and, therefore, has bigger heat conductivity. This feature promotes that influence of the chemical or physical agent who at the adult causes only superficial damage of skin at the child leads to a deep burn. Helplessness of children during a trauma causes longer exposition of the striking factor that also promotes depth of damage of fabrics. Besides, imperfection of compensatory and regulatory mechanisms at children can lead to development of a burn disease even at defeat 5-10%, and at chest age or at a deep burn – only 3-5% of a surface of a body. Thus, any burns at children proceed heavier, than at adults as at children's age there come disorders of blood circulation, exchange, functioning of vitals and systems quicker.
The reasons and classification of burns at children
Depending on the damaging agent burns at children share on thermal, chemical, electric and beam. Developing of thermal burns at children is in most cases caused by contact of skin with the boiled water, steam, naked flame melted by fat, the heated metal objects. Children of early age most often scald hot liquids (water, milk, tea, soup). Quite often burns at children arise owing to negligence of parents when they immerse the child in too hot bathtub or for a long time leave to be warmed by hot-water bottles. At school age special danger to children is constituted by various pyrotechnic entertainments, kindling of fires, "experiments" with gas mixtures etc. Similar pranks with fire, as a rule, come to an end is deplorable as quite often lead to extensive thermal burns. At thermal burns at children integumentary fabrics usually are surprised, however can be also noted, burns of eyes, airways and a digestive tract.
Chemical burns meet less often and usually happen at the wrong storage of household chemical means in the place, available to children. Small children can unintentionally spill on themselves acid or alkali, to spill out powdery substance, to spray an aerosol with dangerous chemical, by mistake to drink caustic liquid. At reception of aggressive chemicals inside the gullet burn at children is combined with a burn of an oral cavity and airways.
Small children have the reasons of electric burns a malfunction of electric devices, their wrong storage and operation, existence in the house of electrosockets, available to the child, the sticking-out bared wires. More senior children usually get electric burns, playing near high-voltage lines, riding roofs of electric trains, hiding in transformer boxes.
Beam burns at children are most often connected with hit on skin of direct sunshine during the long period of time. In general of thermal burns at children about 65-80% of cases, on electric – 11%, are the share of other types – 10-15%.
Within this subject features of thermal burns at children will be considered.
Symptoms of thermal burns at children
Depending on depth of defeat of fabrics children can have thermal burns of four degrees.
The burn of the I degree (epidermalny burn) is characterized by superficial injury of skin owing to influence, short-term or weak on intensity. At children local morbidity, hyperaemia, hypostasis and burning sensation is noted. In the place of a burn the small peeling of epidermis can be observed; superficial burns at children heal in 3-5 days independently absolutely completely or with formation of small pigmentation.
The burn of the II degree (superficial thermal burn) proceeds with full necrosis of epidermis under which the prozrachyony liquid forming bubbles accumulates. The swelling, pain and reddening of skin are expressed stronger. 2–3 days later contents of bubbles become dense and jellylike. Healing and restoration of an integument lasts about 2 weeks. At burns of the II degree at children the risk of infection of a burn wound increases.
The burn of the III degree (deep thermal burn) can be two types: IIIA of degree – with preservation of a basal layer of skin and IIIB of degree – with a necrosis of all thickness of skin and partially a hypodermic. Burns of the III degree at children proceed with formation of a dry or damp necrosis. The dry necrosis represents the dense scab of brown or black color tolerant to touches. The damp necrosis has an appearance a gray scab with sharp hypostasis of cellulose in a burn zone. In 7-14 days rejection of a scab begins, and full process of healing is dragged out for 1-2 months. Epitelization of skin occurs at the expense of the remained rostkovy layer. Degree IIIB burns at children heal with formation of rough, inelastic hems.
The burn of the IV degree (subfastsialny burn) is characterized by defeat and an exposure of the fabrics lying more deeply than an aponeurosis (muscles, sinews, vessels, nerves, bones and cartilages). Visually at burns of the IV degree darkly brown or black scab through which cracks look through the struck deep fabrics is visible. At such defeats burn process at children (clarification of a wound, formation of granulations) proceeds slowly, local, first of all purulent, complications – abscesses, phlegmons, arthritises often develop. Burns of the IV degree are followed by bystry increase of secondary changes in fabrics, the progressing thrombosis, and can end with an internal injury with death of the child.
Burns of I, II and IIIA of degree at children are regarded as superficial, burns of IIIB and the IV degree – as deep. In pediatrics the combination of burns of various degrees, as a rule, meets.
Burn disease at children
Except the local phenomena, at burns at children heavy system reactions which are characterized as a burn disease quite often develop. During a burn disease allocate 4 periods - burn shock, a sharp burn toksemiya, a burn septikopiyemiya and recovery.
Burn shock lasts 1-3 days. During the first hours after receiving a burn children are excited, sharply react to pain, shout (an erectile phase of shock). The fever, increase HELL, breath increase, tachycardia is noted. At heavy shock body temperature can go down. In 2–6 hours after a burn at children there comes the torpedo phase of shock: the child is adynamic, slowed down, does not show complaints and practically does not react to a surrounding situation. Arterial hypotonia, frequent threadlike pulse, the expressed pallor of integuments, strong thirst, an oliguriya or an anury, in hard cases – vomiting "a coffee thick" because of gastrointestinal bleeding is characteristic of a torpedo phase. Burn shock of the I degree develops at children at superficial defeat of 15-20% of the area of a body; The II degrees – at burns of 20-60% of a surface of a body; The III degrees - more than 60% of the area of a body. Quickly progressing burn shock leads to death of the child in the first days.
At further development the period of burn shock is replaced by a phase a burn toksemiya which manifestations are caused by receipt of products of disintegration from the damaged fabrics in the general blood-groove. At this time at the children who got burns fever, nonsense, spasms, tachycardia, arrhythmia is possible; in some cases coma. Against the background of a toksemiya toxic myocarditis, hepatitis, sharp erosive and ulcer gastritis, secondary anemia, nephrite, sometimes - a sharp renal failure can develop. Duration of the period of a burn toksemiya makes up to 10 days then at deep or extensive burns at children there comes the septikotoksemiya phase.
The burn septikotoksemiya is characterized by accession of a secondary infection and suppuration of a burn wound. The general condition of children with burns remains heavy; complications in the form of otitis, ulcer stomatitis, lymphadenitis, pneumonia, bacteremia, burn sepsis and burn exhaustion are possible
In a phase of recovery processes of restoration of all vital signs and scarring of a burn surface prevail.
Diagnosis of burns at children
Diagnosis of burns at children is made on the basis of the anamnesis and visual survey. For determination of the area of a burn at children of younger age the tables of Lund Browder considering change of the area of various parts of a body with age are used. At children 15 years are more senior use the rule "nine", and at limited burns - the rule of a palm.
Children with burns need to investigate hemoglobin and gematokrit blood, the general analysis of urine, biochemical blood test (electrolytes, the general protein, albumine, urea, creatinine, etc.). In case of suppuration of a burn wound the fence and bacteriological crops wound separated on microflora is made.
Surely (in particular at an electric trauma at children) is carried out and repeats in the ECG loudspeaker. In case of a chemical burn of a gullet at children carrying out an ezofagoskopiya (FGDS) is necessary. At damage of airways performance of a bronkhoskopiya, X-ray analysis of lungs is required.
Treatment of burns at children
First aid at a burn at children assumes cancellation of the thermal agent, release of an affected area of skin from clothes and its cooling (by means of washing by water, a bubble with ice). For prevention of a state of shock at a pre-hospital stage the child can enter analgetics.
In medical institution preprocessing of a burn surface, removal of foreign matters and scraps of epidermis is carried out. Antishock actions at burns at children include adequate anesthesia and a sedation, performing infusional therapy, antibiotic treatment, oxygenotherapy. To the children who were not receiving the corresponding preventive inoculations the emergency immunization against tetanus is carried out.
Local treatment of burns at children is performed in the closed, opened, mixed or surgical way. At the closed way the burn wound is closed by an aseptic bandage. For bandagings use antiseptics (, Furacilin), film-forming aerosols, ointments ( + lidocaine, chloramphenicol + methyluracil, etc.), fermental medicines (chymotrypsin, streptokinase). The open way of treatment of burns at children assumes refusal of imposing of bandages and maintaining the patient in the conditions of a strict asepsis. Transition from the closed method to open for acceleration of recovery process or from opened to closed – is possible at development of an infection.
At burns, deep, but small on the area, at children excision of nekrotizirovanny fabrics from the subsequent autodermoplastiky is carried out. In case of formation of scars excision of a hem with imposing of a cosmetic seam is made. The way of treatment of burns at children is defined kombustiology or the children's traumatologist.
The forecast and prevention of burns at children
At burns of the I-II degree practically always the outcome happens favorable. At extensive and deep burns at children the forecast is always serious. For children of early age burns more than 30% of a surface of a body are critical; for more senior children - 40% of the area of a body and more. The secondary infection becomes a cause of death of children in most cases.
Prevention of burns, first of all, demands the increased responsibility from adults from children. It is impossible to allow contact of the child with fire, hot liquids, chemicals, electricity and so forth. For this purpose in the house where there are small children, security measures have to be provided (storage of household chemicals in the inaccessible place, special caps in sockets, the hidden electrical wiring etc.). Continuous baby sitting, imposing of the strict ban on a touch to dangerous objects is necessary.