Bukenya Ali - K-G Burns Case presentation 2025.pptx

Burns management

1. Case Presentation Presenter: Dr. Bukenya Ali Moderator: Mr. Basimbe Francis 27 TH /Feb/2025

2. OUTLINE CASE PRESENTATION DISCUSSION TAKE HOME MESSAGE

3. Demographics NAME; K.G AGE; 01Yr SEX; MALE RESIDENCE; KIREKA-D, KASOKOSO – KIGANDA ZONE RELIGION; BORN AGAIN OCCUPATION; N/A N.O.K; N.R (PARENTS) DOA; 26 TH /AUG/2025 04:00HRS

4. PC - C/O severe thermal burns at ~ 24% x 2 / 7 HPC - A 01Yr/M, a third born (first twin), has been relatively well, until he got burned with hot water 2 / 7 ago, after pulling a charcoal stove. Burns over the anterior aspect of the trunk, the genitalia, bilateral lower limbs, and the left forearm. On arrival at the A&E department, the primary survey indicated that the airway was patent, and the child was crying with no voice change. Had a spontaneous SPO2 of 95%, normal Bronchial breath sounds, chest expansion was equal with no sign of respiratory distress. Circulation: Was normal with warm extremities, with no signs of catastrophic bleeding. Disability: No signs of neurological focal deficit. Upon exposure, he was noted to have extensive blisters on the anterior chest, left forearm, bilateral lower limbs (anterior aspect), and genitalia. The child is reported to have been with the maid at the time of the incident (parents were still at work).

5. Had his meals (on & off) with breastfeeding since the burns. PMHx: Had been on cough linctus and vit C for Rx of a common cold. Secondary survey: The child has no known h/o allergies for both food & drugs. PSHx: No known h/o of transfusion or surgical procedures. FSHx: A third born (first twin), delivered by an eventful C/section. The child has normal milestones (at the moment, attempting to walk with support) Both parents are working with the father employed with NWSC, and the mother is self-employed.

6. O/E: Child is sleeping with a good nutritional status with no pallor, no edema, but with some degree of dehydration. Weight recorded: 13Kg Noted extensive dressing, intact, clean and dry, covering the trunk, lower limbs (bilateral), and left upper limb. Genitalia exposed with severe blisters and burn wounds on the penile region. Burns estimation: 24.5% Using the rule of 9: Anterior trunk (09%) Forearm (3.5%) Genitalia (01%) Anterior aspect of Lower limbs (11%) Dx: 01 Yr /male twin child with no known chronic illness, having second-degree scald burns (superficial thickness).

7. Plan; Do CBC. Serum electrolytes Blood grouping Mgt: Following the modified Parkland formula (4ml RL/Kg per % burns). Given the child’s weight (13Kg) Requires: 1274ml. For the first 08Hrs, the child will get 637 ml Maintenance Fluid: Remaining 637 ml of RL in 16 Hrs. 05% Dextrose (02mL/Kg per Hr ) Prophylactic antibiotic Baby must be kept warm: dressing the wounds and covering the child with dry sheets to manage hypothermia. Pain mgt with analgesics Plastic surgeon’s review to avoid complications.

8. Parameter Reference Range Result Chloride 96.0 - 104.6 98.3 Potassium 3.4 - 4.8 6.55 Sodium 136 - 148 129 Serum Electrolytes CBC Parameter Result Reference Range Hb 15 g/dl 13 - 18 Hct 43. 40 - 54 WBC 10.0 4 - 11 #ANC 5 2 - 7.5 PLT 300         150 - 400

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12. Article References Author Year of Publication Study Topic Findings Conclusion Bazzi et al. June 2022 Systematic Review on adherence to referral criteria for burn patients. - Scalds were the most common burn mechanism (62.76%). - The most frequently burned areas were hands and face. - 51.88% of burn patients met ≥1 referral criterion. The patient's scald mechanism is the most common type. The extensive burns involving the trunk, genitalia, and limbs likely meet multiple referral criteria. Van Yperen et al. Feb 2023 Comparison of burn characteristics, treatment, and outcomes in patients admitted to hospitals with vs. without a Burn Centre. - Patients at non-burn centers were older, had higher injury severity scores (from other trauma), but smaller burns. This study highlights the importance of correct triage. The patient's young age, burn extent, and involvement of the genitalia are clear EMSB/ABA referral criteria. Boissin et al. Mar 2019 Analysis of factors associated with in-hospital mortality in a resource-constrained adult burn center. - Overall in-hospital mortality was 20.4%. - For flame burns, female gender, larger burn size (%TBSA), were associated with higher mortality. While this study focused on adults and flame burns, the core principle is that adherence to referral criteria and accurate severity assessment are critical for outcomes, even in pediatrics.