pediatric burn Ahmed Atef Plastic & Reconstructive Surgeon Mataria Teaching Hospital

1. Clinical Formula for Management of
Pediatric Scald Burn

2. Introduction

3. Introduction
• Thermal injuries affecting more than 10% of the total body
surface area in children can result in burn shock as a result
of inflammatory response and evaporative losses.
• This sequence of events leads to intravascular hypovolaemia
and haemoconcentration that are maximal 12 hours after
injury.

5. • Under resuscitation had become uncommon since the
adoption of weight and injury based formulas.
• Instead, administration of excessive fluid volume has
been reported causing respiratory complications, water
intoxication and multiple organ dysfunctions.
Introduction

6. • The clinical formula was elaborated in our mind to
overcome the hypervolemia that may be associated
with modified parkland formula during shock stage.
Introduction

7. Goal
• Establish a safe procedure to adequately resuscitate
children with scald burn without overloading the
circulation.

8. Three important aspects are present in
the management of scald burn in
children.

9. Children are not small adults

10. The intensity of the scalding versus direct
flame.

11. Complications raised with fluid resuscitation
formulas.
The intravascular volume in this age can`t compensate any
overload, as well as the kidney function can`t eliminate
this excess volume.

12. • 300 cases of scald burn, most of them were due to boiled
water, tea, or soup.
• Age : 2 m - 12 y with an average of 3.5 years.
• Male to female ratio = 1:1.
• 179 cases > 10%-20% TBSA.
121 cases > 20% TBSA.
Methods

13. Methods
• Children with major and moderate scald burn were
infused by the equivalent amount to their normal urine
output in the form of Ringer solution over 24 hours, aided
by normal oral fluid intake.
• The fluid balance chart included the amount of IV fluid
therapy , the total oral fluid intake and UOP per hour.
• Balance was modified by decreasing or increasing the fluid
infused.

14. Proper monitoring
• Sensorium
• Heart rate
• UOP
• Lab investigations mainly haematocrit &electrolytes
Additional
• CVP
• Chest X ray
Methods

15. Results
• No signs of volume overload, pulmonary oedema or
brain water intoxication were recorded with the
application of this process.
• The intravenous fluid as well as the immediate oral
feeding were sufficient to keep the urine out put and the
the heart rate at their normal values.

16. • This formula is only a guide. Each child needs to be
treated as an individual and clinical observations need to
be assessed regularly to evaluate the effectiveness of the
fluid replacement.

17. We called this process
The Clinical Formula for management of scald
burn in children.
Egy. J. Plast. Reconstr. Surg., Vol. 36, No. 1, January: 97-98, 2012

18. Conclusion
• We concluded that The Clinical Formula for management
of scald burn in children is safe, easy and competent
procedure.

19. Thank you